AB0473 TREATMENT OF ANKYLOSING SPONDYLITIS (AS) DURING PREGNANCY
Authors: O. Krichevskaya, T. Dubinina, E. Ilinykh, S. Glukhova, A. Demina
Journal: Annals of the Rheumatic Diseases (2021)

Background: The use of medications during pregnancy remains a challenge for both rheumatologists and patients. The lack of compelling evidence of the safety of a line of different drugs, as well as the traditional idea of the incompatibility of therapy and gestation that is common view in Russia, lead to unjustified withdrawal of drugs by both pregnant women and rheumatologists. Objectives: to describe the frequency of drug usage in pregnant women with AS, to determine the relationship of AS activity and pregnancy complications. Methods: 49 pregnant women with confirmed AS (modified New York criteria, 1984) were included for prospective observation. 50 pregnancies in total were traced. The average age of the patients was 31.6±4.9 years, the duration of the disease was 134.4±85.8 months. The visits were conducted at 10-11, 20-21, and 31-32 weeks of pregnancy. The BASDAI in the month of conception and in the trimesters of pregnancy was: 1,4[0,6; 3,3]; 2,3[1,2; 4,4]; 2,8[1,4; 4,2] and 2,2[1,6; 4,0], respectively. 48 pregnancies ended with the birth of alive children at an average of 39±1.1 weeks, the height of newborns-51.6±2.1 cm, weight-3397.3±433.1 g. 8 (16.3%) newborns had malformations, 7 of them - minor heart development anomalies, 1 - hydronephrosis. Pregnancy complications: early toxicosis - 18% of pregnant women, threatening of early abortion - 10%, threatening of late abortion-4.1%, threatening of early preterm birth - 6.3%; premature birth – 3 (6.3%) at 36.8±0.1 weeks. Results: NSAIDs. After inclusion in the study, the drug of choice was ibuprofen, which was canceled for all women no later than the 32-nd week of pregnancy. At the time of conception and in the first, second and third trimesters of pregnancy, NSAIDs were taken by 23 (46%), 20 (40%), 30 (60%) and 21 (43.8%) women, respectively. No effect of NSAIDs on the activity of AS was revealed. Sulfasalazine (SS) was taken for 3 months before pregnancy by 11(22%) women, during pregnancy – 6 (12%) at a dose of 1.25±0.25 g because of arthritis. The withdrawal of SS was not associated with the recurrence of arthritis. Glucocorticoids (GC) at a dose of 7.5±2.5 mg 3 months before pregnancy and in the trimesters of pregnancy were taken: 1 (2%), 4 (8%), 8 (16%) and 10 (20.8%) women, of whom 1 patient had arthritis and 1 had inflammatory bowel disease. The remaining patients received GC due to the high activity of AS due to axial manifestations and the unavailability of bDMARDs) intake. Against the background of taking GC, the AS activity did not decrease: BASDAI in the 2nd and 3rd trimesters was 5.5±0.6 and 5.8±1.3 (p&gt;0.05). bDMARDs. TNF inhibitors for 3 months before pregnancy and on trimesters were received by 11 (22%), 7 (14%), 6 (12%) and 2 (4.2%) patients, of which 1 woman in the second trimester obtained firstly initiated therapy with certolizumab pegol due to the recurrence of uveitis. In those who canceled bDMARDs therapy (both independently and due to the recommendation of a rheumatologist), an increase in AS activity was noted on the eve of pregnancy; BASDAI in the month of conception and in the I, II, and III trimesters was: 2,7 [0,8; 3,5]; 5,1[3,1; 5,9]; 5,5 [5;6] and 6,7 [5,3; 7;3], p&lt;0,05 compared to the month of conception. Undoing the bDMARDs in the month of conception is a risk factor for high activity as (BASDAI&gt;4) in the second trimester (OR OF 30.4; 95% CI 1,5-612,3; p=0.03) and in the third trimester (OR A 32.7; 95% CI 1,6-662,2; p=0.02). The relationship between pregnancy complications, malformations of the newborns and the used medications was not revealed. Conclusion: NSAIDs and GC in low doses do not reduce the activity of AS. Withdrawal of TNF inhibitors on the eve of pregnancy is a predictor of high AS activity. It is necessary to increase the knowledge of rheumatologists and patients about the therapeutic possibilities during pregnancy to avoid unjustified drug withdrawal. Disclosure of Interests: None declared.