THU0519 DISEASE COURSE AND OUTCOMES OF PREGNANCY IN JUVENIL IDIOPHATIC ARTHRITIS: ANY DIFFERENCE AMONG DISEASE SUBSETS?
Authors: Antía García Fernández, Laura Andreoli, Maria Chiara Gerardi, Francesca Crisafulli, Cecilia Nalli, Matteo Filippini, Roberto Gorla, Marco Taglietti, Micaela Fredi, Maria Grazia Lazzaroni, Andrea Lojacono, Sonia Zatti, Franco Franceschini, Angela Tincani
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Data on the disease activity and pregnancy outcomes taking into account the different types of Juvenile idiopathic arthritis (JIA) patients are limited. <h3>Objectives:</h3> To analyze the course of disease during pregnancy and pregnancy outcomes in patients with JIA according to disease subtype, with focus on the medication use. <h3>Methods:</h3> A retrospective observational study was conducted on pregnant JIA patients followed in our pregnancy clinic between 2010 and 2018. Disease activity (DAS28-PCR3) was analyzed before conception, at each trimester and postpartum. Flare was defined as an increase in clinical activity leading to intensified therapy with at least one of: new prednisone, increase in dosage ≥5 mg/day, treatment with intraarticular glucocorticoids, (re-)treatment with DMARDS/TNFi. Pregnancy outcome were also recorded. <h3>Results:</h3> Sixteen patients and 22 pregnancies were included. Two pregnancies were voluntary interrupted (1 for Methotrexate exposure and 1 for fetal encephalocele). Table 1 summarizes disease features and pregnancy outcomes according to disease subsets. 10/22 (45,5%) were pregnancies observed in Oligoarticular Extended (OLA-E), 6 (27,3%) Polyarticular (PLA), 4 (18,2%) Systemic (SYS), 1 (4,5%) Oligoarticular (OLA) and 1 (4,5%) Enthesitis related Arthritis (ERA) JIA patients. At conception 19(95%) pregnancies were on remission, 1(5%) OLA-E patient in low disease activity. Among the 20 pregnancies ended with a live birth, 1 OLA, 4 SYS and 1 ERA patients mantained sustained remission, without cDMARDs or bDMARDs, throughout pregnancy. There were 7 flares in 6 (31,8%) pregnancies, 5 (71,4%) of them among PLA patients and 2 (28,6%) among OLA-E patients. No extrarticular flare was recorded. There was no flare among SYS, OLA and ERA patients. One pregnancy in a patient with PLA JIA (4,5%) was characterized by more that one flare, but none had more than two flares. Most of flares (2/29% 1^trimester, 4/57% 2^trimester, 1/14% 3^trimester) occurred during 2^trimester. Eigth flares occurred in postpartum, also in 2 pregnancies after voluntary pregnancy interruption. Regarding treatment at conception; 8 (40%) pregnancies were on bDMARDs, treatment was stopped at positive pregnancy test in 6 pregnancies, 2 (33,3%) required restart of treatment due to a flare in 1^Trimester (1 CTZ) and 3^Trimester (1 ETA), and 3 flared in puerperium with restart of bDMARDs. Two (25%) pregnancies continued bDMARDs at positive pregnancy test throughout the pregnancy to prevent a flare, that had been already experienced in previous pregnancies (not followed in our centre). Regarding pregnancy complications and outcomes, no cases of Preeclampsia, eclampsia, small for gestational age babies, intrauterine death, were observed. One pregnancy was complicated with pre-term premature rupture of membranes at 35 gestational week, in a patient not taking prednisone. There were 5 (25%) pre-term deliveries. <h3>Conclusion:</h3> Nearly one third of pregnant patients with JIA had a disease flare during pregnancy. Flares were observed only in 2 disease subsets (PLA; OLA-E) and associated with discontinuation of bDMARDs at positive pregnancy index. The preconception counseling of patients with JIA should include the disease subset in the risk stratification and consequently the continuation of bDMARDs during pregnancy. Maternal disease control is necessary to minimize the risk of adverse pregnancy outcomes (especially pre-term birth). <h3>Disclosure of Interests:</h3> Antía García Fernández: None declared, Laura Andreoli: None declared, Maria Chiara Gerardi: None declared, Francesca Crisafulli: None declared, Cecilia Nalli: None declared, Matteo Filippini: None declared, Roberto Gorla: None declared, Marco Taglietti: None declared, Micaela Fredi: None declared, Maria Grazia Lazzaroni: None declared, Andrea Lojacono: None declared, Sonia Zatti: None declared, Franco Franceschini: None declared, Angela Tincani Consultant for: UCB, Pfizer, Abbvie, BMS, Sanofi, Roche, GSK, AlphaSigma, Lillly, Jannsen, Cellgene, Novartis