妊娠期间和妊娠后幼年特发性关节炎的疾病活动度：一项前瞻性多中心研究。
Disease Activity of Juvenile Idiopathic Arthritis during and after Pregnancy: A Prospective Multicenter Study.
机构信息
From the National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology (NTNU); Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU, Trondheim, Norway.
K. Ursin, MD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU; S. Lydersen, PhD, Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU; J.F. Skomsvoll, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; M. Wallenius, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU.
出版信息
J Rheumatol. 2018 Feb;45(2):257-265. doi: 10.3899/jrheum.161410. Epub 2017 Dec 1.
OBJECTIVE
To study disease activity in women with juvenile idiopathic arthritis (JIA) during and after pregnancy. There is little previous knowledge about this topic.
METHODS
Our study included 135 pregnancies in 114 women with JIA. Disease activity was assessed at 7 timepoints before, throughout, and after pregnancy with the Disease Activity Score-28-C-reactive protein 3 (DAS28-CRP3). Scores assessed at each visit were analyzed in a linear mixed model. The same statistical method was used to study self-reported physical function, pain, and mental health.
RESULTS
Almost 80% of the women were in remission or had low disease activity during and after pregnancy. Although disease activity was stable throughout the study period, we found that DAS28 6 weeks postpartum increased significantly compared to the first trimester (2.78 vs 2.51, p = 0.005) and third trimester (2.78 vs 2.56, p = 0.011), respectively. DAS28 decreased significantly between 6 weeks and 12 months postpartum (2.78 vs 2.54, p = 0.014). Self-reported mental health was significantly better 6 weeks postpartum than before pregnancy (Medical Outcomes Study Short Form-36 Mental Health subscale 80.7 vs 76.5, p = 0.039). Self-reported pain was stable. Physical function was significantly worse in the third trimester of pregnancy than postpartum (Modified Health Assessment Questionnaire 0.57 vs 0.39, p < 0.001).
CONCLUSION
In women with JIA, disease activity was highest 6 weeks postpartum, but altogether low and stable in the period from planning pregnancy to 1 year after delivery.
目的
研究妊娠期间及产后女性幼年特发性关节炎（JIA）的疾病活动情况。针对这一主题，目前仅有少量既往研究。
方法
我们的研究纳入了 114 名 JIA 女性的 135 次妊娠。使用疾病活动评分-28-红细胞沉降率 3（DAS28-ESR3）在妊娠前、妊娠期间及产后共 7 个时间点评估疾病活动。分析每个就诊时的评分，使用线性混合模型。采用相同的统计方法研究自我报告的身体功能、疼痛和心理健康。
结果
将近 80%的女性在妊娠期间及产后处于缓解或低疾病活动状态。尽管整个研究期间疾病活动稳定，但我们发现产后 6 周 DAS28 与妊娠早期（2.78 比 2.51，p=0.005）和妊娠晚期（2.78 比 2.56，p=0.011）相比显著增加。产后 6 周至 12 个月 DAS28 显著降低（2.78 比 2.54，p=0.014）。产后 6 周自我报告心理健康显著优于妊娠前（医疗结局研究 36 项简明健康调查量表心理健康子量表 80.7 比 76.5，p=0.039）。自我报告疼痛稳定。与产后相比，妊娠晚期身体功能显著恶化（健康评估问卷修订版 0.57 比 0.39，p<0.001）。
结论
在 JIA 女性中，产后 6 周疾病活动度最高，但从计划妊娠到分娩后 1 年期间疾病活动度总体较低且稳定。
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