https://doi.org/10.55788/3a2ed898
Untreated inflammatory disease is associated with a delay in pregnancy. In a cohort of patients with rheumatoid arthritis, high disease activity was associated with not achieving pregnancy in 67% of participants and 30% of participants with inactive disease did not achieve pregnancy within the first 12 months [3]. Furthermore, untreated disease is associated with poor obstetric outcomes [4].
Thus, there is an increased need for improving care for women of childbearing age, suffering from inflammatory conditions. “Firstly, we should consider all women as pre-pregnant, and not just the ones who indicate they missed their period or have a positive pregnancy test,” said Dr Etomi. “Additionally, we need to be able to talk about sex, address comorbidities, and offer long-acting reversible contraception and pre-pregnancy counselling.”
Stopping medication at the time of conception can lead to disease flares. In patients with rheumatoid arthritis and axial spondyloarthritis, discontinuation of TNF inhibitors at the time of a positive pregnancy test led to a 3.0–3.3 relative increase in flares during the first trimester (P=0.001), while reintroduction of therapy could lead to improved disease control [5]. Good disease control is important. In a Toronto database of patients with psoriatic arthritis, 32% suffered from worsening or ongoing disease during pregnancy, whereas 58% experienced a favourable disease course. The skin activity following pregnancy worsened in 43% of patients but improved or was mostly stable in most patients during pregnancy [6].
Several anti-rheumatic medications can be used during pregnancy. Current guidelines from the British Society for Rheumatology consider corticosteroids (prednisolone), azathioprine, cyclosporin, and anti-TNF medications to be safe to use in all stages of pregnancy, whereas methotrexate should be stopped at least 1 month prior to conception [7]. A meta-analysis of patients with inflammatory bowel disease showed that adverse pregnancy outcomes following ustekinumab were similar to adverse outcomes in the general population [8]. Furthermore, long-term data from the PIANO registry enrolling patients with inflammatory bowel disease did not show increased rates of congenital malformations, spontaneous abortions, preterm birth, or low birth weight following biologics [9].
“To conclude, I think it’s clear that psoriasis and psoriatic arthritis affect a high proportion of women of childbearing age,” said Dr Etomi. “Despite this, many pregnancies remain unplanned. Severe disease increases the adverse outcomes of the mom and baby, making it important to learn from what our colleagues are investigating and share the knowledge to improve the care for these patients.”
- Chakravarty E, et al. BMJ Open. 2014;4(2):e004081.
- Etomi O. Pregnancy in psoriasis disease. IFPA Conference 2024, 27–29 June, Stockholm, Sweden.
- Brouwer J, et al. Ann Rheum Dis. 2015;74(10):1836-41.
- Bharti B, et al. J Rheumatol. 2015;42(8):1376-82.
- van den Brandt S, et al. Arthritis Res Ther. 2017;19(1):64.
- Polachek A, et al. Semin Arthritis Rheum. 2019;48(4):764.
- Russel MD, et al. Rheumatology (Oxford). 2023;62(4):e48-e88.
- Nielsen OH, et al. Clin Gastroenterol Hepatol. 2022;20(1):74-87.e3.
- Mahadevan U, et al. Gastroenterology. 2021;160(4):1131-1139.
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Table of Contents: IFPA 2024
Featured articles
Multiple novel oral agents show promise in psoriasis
Advances in psoriasis treatment: topical therapies show promising results
Personalised Medicine and Genetics in Psoriatic Disease
How close are we to personalised medicine in psoriatic arthritis?
Genetic and immunological advances in risk assessment and treatment of psoriatic diseases
Using advances in the genetics of psoriatic disease to better predict treatment response
Comorbidities and Complications in Psoriatic Disease
Depression complicates the management of psoriatic disease
The unfavourable role of obesity in psoriatic disease
Managing obesity and fibromyalgia in psoriatic disease
Advances in Psoriasis Treatment
Multiple novel oral agents show promise in psoriasis
Biologics for psoriasis: towards oral therapies and less frequent dosing
Advances in psoriasis treatment: topical therapies show promising results
Special Populations and Psoriatic Disease
Improving outcomes in pregnancy and psoriatic disease
Towards prevention of psoriatic arthritis in patients with psoriasis
Diagnostic Challenges and Disease Management
Itch and pain are major components of psoriatic disease and require management
Can diet help with the management of psoriasis?
Biologics in psoriatic arthritis: where we are and where we are headed
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