Low disease activity and remission are feasible goals for women with rheumatoid arthritis (RA) cared for with a modern treatment approach during pregnancy, according to a study published online Feb. 10 in the Annals of the Rheumatic Diseases.
Hieronymus T. W. Smeele, from the Erasmus Medical Center in Rotterdam, Netherlands, and colleagues assessed the feasibility of a modern treatment approach, including treat-to-target and the prescription of tumor necrosis factor (TNF) inhibitors, in patients with RA with a wish to conceive or who are pregnant. Disease activity was compared between the Preconception Counseling in Active RA (PreCARA; 309 patients; 2011 to present) cohort and the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA; 253 patients; 2002 to 2010) cohort.
The researchers report that in the PreCARA study, 188 children were born and 47.3 percent of the women used a TNF inhibitor at any time during pregnancy. In the PreCARA cohort, mean disease activity was lower than in the reference PARA cohort. In the PreCARA cohort, 75.4 percent of women were in low disease activity or remission before pregnancy, which increased to 90.4 percent in the third trimester, compared with 33.2 and 47.3 percent, respectively, in the PARA cohort.
“In patients with RA with a wish to conceive or who are pregnant, clinicians should strive for remission or low disease activity,” the authors write.