类风湿关节炎或脊柱关节炎患者孕期的疾病活动度：多中心前瞻性GR2研究结果
Disease activity during pregnancy in patients with rheumatoid arthritis or spondyloarthritis: results from the multicentre prospective GR2 study.
作者信息
Couderc Marion, Lambert Céline, Hamroun Sabrina, Gallot Denis, Costedoat-Chalumeau Nathalie, Gossec Laure, Guettrot-Imbert Gaëlle, Le Guern Veronique, Richez Christophe, Soubrier Martin, Molto Anna
机构信息
Rheumatology Department, Université Clermont-Auvergne, CHU Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand, 63000, France.
INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France.
出版信息
BMC Rheumatol. 2025 Mar 11;9(1):30. doi: 10.1186/s41927-025-00479-x.
BACKGROUND
Pregnancy may have a beneficial effect on disease activity in rheumatoid arthritis (RA) but the evidence is more conflicting in spondyloarthritis (SpA). The aim of this study was to analyse disease activity and relapse during pregnancy in women with RA and SpA.
METHODS
Consecutive pregnant women with RA or SpA were enrolled in this French multicentre observational cohort from 2014 to 2022. Women who had at least two prenatal visits (including one in the first trimester) were included in the analysis. Disease relapse was defined as treatment intensification (initiation or switch of a DMARD) or increase in disease activity scores (DAS28-CRP for RA patients; ASDAS-CRP and/or BASDAI for SpA patients).
RESULTS
Of the 124 pregnant women included, 53 had RA and 71 had SpA. A total of 18 (35%) RA and 44 (62%) SPA received a TNF inhibitor during pregnancy. At the group level, disease activity indexes remained stable in the 1st, 2nd and 3rd trimesters. Disease relapse during pregnancy occurred in 17 (32%) RA patients and 28 (39%) SpA patients, among whom 30 (24%) requiring a treatment intensification. In multivariable analysis, factors associated with disease relapse were nulliparity (odds ratio, OR: 6.5, 95%CI: 1.1 to 37.9) and a disease flare in the 12 months prior to conception (OR: 8.2, 95%CI: 1.6 to 42.7) for RA patients, and a history of bDMARD use (OR: 5.4, 95%CI: 1.1 to 27.3) for SpA patients.
CONCLUSION
Disease activity remained stable during pregnancy in women with RA and SpA but almost a quarter required major changes to their treatment.
背景
妊娠可能对类风湿关节炎（RA）的疾病活动有有益影响，但在脊柱关节炎（SpA）中证据更具矛盾性。本研究的目的是分析RA和SpA女性患者孕期的疾病活动及复发情况。
方法
2014年至2022年，连续纳入患有RA或SpA的孕妇参与这项法国多中心观察性队列研究。分析纳入至少进行两次产前检查（包括一次孕早期检查）的女性。疾病复发定义为治疗强化（启动或更换一种改善病情抗风湿药[DMARD]）或疾病活动评分增加（RA患者为DAS28-CRP；SpA患者为ASDAS-CRP和/或BASDAI）。
结果
纳入的124名孕妇中，53名患有RA，71名患有SpA。共有18名（35%）RA患者和44名（62%）SpA患者在孕期接受了肿瘤坏死因子（TNF）抑制剂治疗。在组水平上，疾病活动指数在孕早期、孕中期和孕晚期保持稳定。孕期疾病复发发生在17名（32%）RA患者和28名（39%）SpA患者中，其中30名（24%）需要强化治疗。多变量分析中，RA患者疾病复发的相关因素为未生育（比值比[OR]：6.5，95%置信区间[CI]：1.1至37.9）和受孕前12个月内疾病发作（OR：8.2，95%CI：1.6至42.7），SpA患者为生物DMARD使用史（OR：5.4，95%CI：1.1至27.3）。
结论
RA和SpA女性患者孕期疾病活动保持稳定，但近四分之一的患者需要对治疗进行重大调整。
Zotero 插件