The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) demonstrate that pregnancies in women with rheumatoid arthritis are associated with premature delivery and low birth weight.1
Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects a person's joints, causing pain and disability. It can also affect internal organs. RA is more common in older people, but there is also a high prevalence in young adults, adolescents and even children, and it affects women more frequently than men.
It is well documented that during pregnancy many women with RA experience improvement in their symptoms.2 This is thought to be due to alterations in the body which suppress the immune system to stop the mother rejecting the foetus. However, the effect of RA in pregnant women on foetuses is less known.
"Our results add to a growing body of evidence from different populations suggesting small but significant increases in prematurity and a decrease in birth weight in pregnancies in mothers with rheumatoid arthritis," said Dr Yun-Chen Tsai, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan (study author). "While these findings are important, they should not discourage women with RA from trying to conceive."
Results of this study showed that babies born to women with RA were associated with an increased chance of low birthweighti (OR 1.65, 95% CI 1.37-1.98), prematurityii (OR 1.41, 95% CI 1.13-1.68), and being small for their gestational age (OR 1.62, 95% CI 1.36-1.92). Investigators also looked for potential risks to the mother but, apart from preterm labour, no associations were found. Investigated outcomes included birth-related death, cardiovascular complications, surgical complications and other systemic organ dysfunction.1
"Pregnancy in patients with rheumatoid arthritis is very complex as there are many factors clinicians and patients need to consider and limited data available," said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. "More information is needed to understand implications of the disease and treatments on both mother and foetus."
Investigators identified 845 women with single pregnancies who also had RA from over two million pregnancies within the Taiwan National Health Insurance database and birth registry between 2001 and 2012. Statistical analysis was conducted using an adjusted generalised estimating equation model to estimate the association between RA and pregnancy outcomes.1
Abstract number: OP0135
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i Low birthweight defined as less than 2.5kg.
ii Premature birth defined as less than 37 weeks.
NOTES TO EDITORS
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About Rheumatic and Musculoskeletal Diseases
Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints but can affect any organ of the body. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscle and bones. Many of these diseases are long term and worsen over time. They are typically painful and Iimit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.3
About 'Don't Delay, Connect Today!'
'Don't Delay, Connect Today!' is a EULAR initiative that unites the voices of its three pillars, patient (PARE) organisations, scientific member societies and health professional associations - as well as its international network - with the goal of highlighting the importance of early diagnosis and access to treatment. In the European Union alone, over 120 million people are currently living with a rheumatic disease (RMD), with many cases undetected.4 The 'Don't Delay, Connect Today!' campaign aims to highlight that early diagnosis of RMDs and access to treatment can prevent further damage, and also reduce the burden on individual life and society as a whole.
About EULAR
The European League against Rheumatism (EULAR) is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with RMDs. EULAR aims to reduce the burden of RMDs on individuals and society and to improve the treatment, prevention and rehabilitation of RMDs. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with RMDs by the EU institutions through advocacy action.
To find out more about the activities of EULAR, visit: http://www.eular.org.
References
1 Tsai YC, Luo SF, Chiou MJ, et al. Foetal-neonatal and maternal outcomes in women with rheumatoid arthritis. EULAR 2018; Amsterdam: Abstract OP0135.
2 Chakravarty EF. Rheumatoid arthritis and pregnancy: where do we go from here? J Intern Med. 2010;268(4):309-11.
3 van der Heijde D, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Annals of the Rheumatic Diseases. 2018;doi:10.1136/annrheumdis-2017-212565. [Epub ahead of print].
4 EULAR. 10 things you should know about rheumatic diseases fact sheet. Available at: https://www.eular.org/myUploadData/files/10%20things%20on%20RD.pdf [Last accessed April 2018].
Journal
Annals of the Rheumatic Diseases