Duke University Medical Center, Durham, North Carolina.
Arthritis Care Res (Hoboken). 2019 Mar;71(3):390-397. doi: 10.1002/acr.23621.
While increased rheumatic disease activity during pregnancy has been associated with adverse pregnancy outcomes, this disease activity is typically assessed by physicians. Little is known, however, about the association between patient-reported measures of disease activity and pregnancy outcomes. The aim of our study was to evaluate this association.
Univariate and multivariable regression models were used to assess the relationship between patient- and physician-reported measures of disease activity and adverse pregnancy outcomes in 225 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). The patients were enrolled from 2008-2016 in a prospective registry at a single academic center.
In women with RA, patient-reported disease activity was associated with preterm birth (odds ratio [OR] 5.9 [95% confidence interval (95% CI) 1.5, 23.9]) and gestational age in weeks (β = -1.5 [95% CI -2.6, -0.4]). The physician assessment of disease activity also predicted preterm (OR 2.1 [95% CI 1.2, 3.5]), small for gestational age births (OR 1.8 [95% CI 1.03, 3.1]), and gestational age in weeks (β = -0.6 [95% CI -0.9, -0.02]). Alternatively, in women with SLE, patient-reported disease activity measures, including the Health Assessment Questionnaire, pain, or global health measures, were not associated with adverse pregnancy outcomes. However, physician measures of SLE disease activity are associated with preterm birth (OR 2.9 [95% CI 1.3, 6.3]), cesarean delivery (OR 2.3 [95% CI 1.0, 5.3]), and preeclampsia (OR 2.8 [95% CI 1.3, 6.3]). The results did not appear to be driven by lupus nephritis or antiphospholipid syndrome.
For women with RA, patient-reported measures of disease activity were associated with adverse pregnancy outcomes, and thus may be useful adjuncts to physician-reported measures in identifying pregnancies at greater risk. In contrast, in SLE, while physician measures of disease activity helped predict several adverse pregnancy outcomes, no patient-reported measures were associated with adverse outcomes.
虽然怀孕期间风湿性疾病活动增加与不良妊娠结局有关，但这种疾病活动通常由医生评估。然而，关于患者报告的疾病活动测量值与妊娠结局之间的关联知之甚少。我们的研究目的是评估这种关联。
在 2008 年至 2016 年期间，使用单变量和多变量回归模型评估了来自单一学术中心前瞻性登记处的 225 例系统性红斑狼疮（SLE）或类风湿关节炎（RA）患者的患者和医生报告的疾病活动测量值与不良妊娠结局之间的关系。
在 RA 女性中，患者报告的疾病活动与早产（比值比 [OR] 5.9 [95%置信区间 95%CI] 1.5, 23.9）和孕周（β = -1.5 [95%CI -2.6, -0.4]）有关。疾病活动的医生评估也预测了早产（OR 2.1 [95%CI 1.2, 3.5]）、小于胎龄儿出生（OR 1.8 [95%CI 1.03, 3.1]）和孕周（β = -0.6 [95%CI -0.9, -0.02]）。相反，在 SLE 女性中，患者报告的疾病活动测量值，包括健康评估问卷、疼痛或整体健康测量值，与不良妊娠结局无关。然而，SLE 疾病活动的医生测量值与早产（OR 2.9 [95%CI 1.3, 6.3]）、剖宫产（OR 2.3 [95%CI 1.0, 5.3]）和子痫前期（OR 2.8 [95%CI 1.3, 6.3]）有关。结果似乎不是由狼疮肾炎或抗磷脂综合征引起的。
对于 RA 女性，患者报告的疾病活动测量值与不良妊娠结局有关，因此可能有助于识别风险较高的妊娠，作为医生报告测量值的补充。相比之下，在 SLE 中，尽管医生评估的疾病活动有助于预测多种不良妊娠结局，但没有患者报告的测量值与不良结局相关。
