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Does Rheumatoid Arthritis Really Improve During Pregnancy? A Systematic Review and Metaanalysis

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Jethwa H1, Lam S1, Smith C1, Giles I1. J Rheumatol. 2018 Nov 1. pii: jrheum.180226. doi: 10.3899/jrheum.180226. [Epub ahead of print]

Abstract

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1 From the Rheumatology Department, London North West Healthcare National Health Service (NHS) Trust; General Medicine, Croydon University Hospital; Statistics Department, Royal Free Hospital; Centre for Rheumatology Research, Rayne Institute, University College London, London, UK. This work was undertaken at University College London Hospitals, which received a proportion of funding from the UK Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. H. Jethwa, Specialist Registrar in Rheumatology, BSc, MBChB, MRCP, Rheumatology Department, London North West Healthcare NHS Trust; S. Lam, General Practitioner Trainee, BSc, MBBS, General Medicine, Croydon University Hospital; C. Smith, Research Statistician, PhD, Statistics Department, Royal Free Hospital; I. Giles, Consultant Rheumatologist, PhD, FRCP, Centre for Rheumatology Research, Rayne Institute, University College London. H. Jethwa and S. Lam contributed equally to this study. Address correspondence to H. Jethwa, Rheumatology Department, Ealing Hospital, Uxbridge Road, Southall UB1 3HW, UK. E-mail: hannahjethwa@nhs.net. Accepted for publication July 24, 2018.

Abstract

OBJECTIVE: We performed a systematic review and metaanalysis to assess rheumatoid arthritis (RA) disease activity during pregnancy using objective disease activity scoring systems.

METHODS: A systematic review of PubMed, EMBASE/Medline, Cochrane, and LactMed databases was performed. Our inclusion criteria for analysis were prospective studies, more than 5 patients per study, and data on RA using an objective scoring system conducted by a clinician/health professional.

RESULTS: Ten studies were eligible for final analysis, which included 237 patients, of which prepartum data were available for 204 patients. Postpartum disease activity was recorded in 135 pregnancies.

CONCLUSION: Disease activity improved in 60% of patients with RA in pregnancy and flared in 46.7% postpartum.