P256 Reproductive health outcomes in women with PsA

Abstract

Abstract Background There is quality data showing rheumatoid arthritis (RA) improves in pregnancy and flares postpartum and that active disease is associated with adverse foetal outcomes. For psoriatic arthritis (PsA), the data is less clear, with previous studies giving contrasting results. We prospectively monitored disease control, maternal and foetal outcomes in women with PsA attending our multidisciplinary service. Methods Age, medications, disease control, maternal and foetal outcomes were reviewed and descripitive statistics applied. Results 14 patients were reviewed. 12 became pregnant. There were 20 pregnancies in total. Eight patients had 1 pregnancy. Two patients had 3 pregnancies, 1 patient was pregnant twice and 1 patient had 4 pregnancies and is currently pregnant. Two patients failed to become pregnant. There were 13 live births (one set of twins), 7 vaginal deliveries and 5 Caesarean sections. There were 6 intrauterine deaths (4 1st trimester, 2 2nd trimester). Two patients had postpartum complications (grade 4 vaginal tear and Caesarean wound infection). Mean foetal birth weight was 3.54kg (national average 3.49kg). 8 infants (55%) were breastfeeding at 6 weeks (national average 62%). 14 patients were on a DMARD (including oral steroids) in pregnancy. There were 8 pregnancies on a bDMARD alone, one on a bDMARD plus prednisolone. The bDMARDs used were certolizumab (five times), adalimumab (twice), infliximab (once) and etanercept (once). Two patients were on prednisolone alone. One patient on sulfasalazine plus prednisolone. One pregnancy on sulfasalazine plus hydroxychloroquine, 1 on sulfasalazine alone. Two patients were on NSAIDs. Disease activity was measured using DAS28-CRP 3 as this is validated for use in RA during pregnancy. Overall, the mean disease activity scores decreased during pregnancy and increased postpartum. After applying the European League Against Rheumatism-defined response criteria disease activity, almost half of the women had at least a moderate response during pregnancy and more than one-third had at least a moderate flare post partum, particularly at 6 weeks. The postpartum flare may be underestimated as medication use was remarkably increased after delivery. At 6 weeks, in five cases the bDMARD therapies had already been restarted. In two cases, the patients missed this appointment. One patient was started on methotrexate at their 6-week review. Conclusion Disease activity generally improved during pregnancy and flared postpartum. Miscarriage rates were higher than the general population (32% v 20%). Birth weights and breastfeeding rates at six weeks were similar. Disclosures K. Murray None. L. Moore None. F. Young None. F. McAulliffe None. D. Veale None.