Copenhagen Center for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
RMD Open. 2022 Nov;8(2). doi: 10.1136/rmdopen-2022-002445.
To explore the risk of pre-eclampsia in rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA), focusing on the impact of treatment and disease activity.
We identified RA, AxSpA and PsA singleton pregnancies (2006-2018) by linking medical birth registers to Swedish (SRQ) and Danish (DANBIO) rheumatology registers. Control pregnancies from the medical birth registers were matched 1:10 on maternal age, parity and birth year.We obtained information on antirheumatic treatment before and during pregnancy and disease activity during pregnancy. Risks of pre-eclampsia in RA, AxSpA and PsA pregnancies, compared with control pregnancies, were estimated overall and by antirheumatic treatment (conventional synthetic disease-modifying antirheumatic drug (DMARD)/biological DMARD/corticosteroids, as monotherapy or combination therapy) and disease load (Health Assessment Questionnaire≥1/C-reactive protein≥10/Disease Activity Score in 28 joints≥3.2) through logistic regression (adjusted ORs (aORs) with 95% CI).
We observed 69, 34, and 26 pre-eclampsia events among RA (n=1739), AxSpA (n=819) and PsA (n=489), resulting in a risk of pre-eclampsia of, respectively, aOR 1.27 (95% CI 0.96 to 1.67), 1.17 (0.76 to 1.78) and 1.85 (1.10 to 3.12), compared with controls.For RA, maternal combination therapy before and during pregnancy was associated with increased risk (1.59; 1.07 to 2.37 and 1.53; 0.97 to 2.39, respectively). For PsA, maternal monotherapy before pregnancy was associated with pre-eclampsia (2.72; 1.4 to 5.13). In RA pregnancies with available information (43%), high disease load was associated with doubled risk of pre-eclampsia (aOR 1.96; 1.26 to 3.04).
PsA pregnancies, but not AxSpA pregnancies, were at increased risk of pre-eclampsia. For RA, combination therapy (potentially a surrogate for high disease activity both before and during pregnancy) and high disease load during pregnancy might be a risk factor for pre-eclampsia.
探讨类风湿关节炎（RA）、轴性脊柱关节炎（AxSpA）和银屑病关节炎（PsA）患者发生子痫前期的风险，重点关注治疗和疾病活动度的影响。
通过将瑞典（SRQ）和丹麦（DANBIO）风湿病登记处与医学出生登记处相链接，我们确定了 2006 年至 2018 年间的 RA、AxSpA 和 PsA 单胎妊娠（RA、AxSpA 和 PsA）。医学出生登记处的对照妊娠按母亲年龄、产次和出生年份 1:10 匹配。我们获得了妊娠前和妊娠期间抗风湿治疗以及妊娠期间疾病活动度的信息。通过逻辑回归（调整后的比值比[aOR]，95%CI），总体上以及根据抗风湿治疗（传统合成疾病修饰抗风湿药物[DMARD]/生物 DMARD/皮质类固醇，单药或联合治疗）和疾病负荷（健康评估问卷[HAQ]≥1/C 反应蛋白[CRP]≥10/28 关节疾病活动度评分[DAS28]≥3.2）比较 RA、AxSpA 和 PsA 妊娠与对照妊娠子痫前期的风险。
我们观察到 1739 例 RA 中出现 69 例、819 例 AxSpA 中出现 34 例和 489 例 PsA 中出现 26 例子痫前期事件，导致 RA 的子痫前期风险分别为 aOR 1.27（95%CI 0.96 至 1.67）、1.17（0.76 至 1.78）和 1.85（1.10 至 3.12），与对照组相比。对于 RA，妊娠前和妊娠期间的母亲联合治疗与风险增加相关（1.59；1.07 至 2.37 和 1.53；0.97 至 239）。对于 PsA，妊娠前的母亲单药治疗与子痫前期相关（2.72；1.4 至 5.13）。在 RA 妊娠中有可用信息（43%）的情况下，高疾病负荷与子痫前期风险增加两倍相关（aOR 1.96；1.26 至 3.04）。
PsA 妊娠，但不是 AxSpA 妊娠，子痫前期的风险增加。对于 RA，联合治疗（可能是妊娠前和妊娠期间疾病活动度高的替代指标）和妊娠期间高疾病负荷可能是子痫前期的一个危险因素。
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