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. 2025 Mar 11;9(1):30.
doi: 10.1186/s41927-025-00479-x.

Disease activity during pregnancy in patients with rheumatoid arthritis or spondyloarthritis: results from the multicentre prospective GR2 study

Marion Couderc  1   2 , Céline Lambert  3 , Sabrina Hamroun  4   5 , Denis Gallot  6 , Nathalie Costedoat-Chalumeau  5   7 , Laure Gossec  8   9 , Gaëlle Guettrot-Imbert  7 , Veronique Le Guern  7 , Christophe Richez  10   11 , Martin Soubrier  12 , Anna Molto  4   5 ; GR2 Study group
Affiliations

Disease activity during pregnancy in patients with rheumatoid arthritis or spondyloarthritis: results from the multicentre prospective GR2 study

Marion Couderc et al. BMC Rheumatol. .

Abstract

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.

Keywords: Disease activity; Pregnancy; Rheumatoid arthrtis; Spondyloarthritis; Treatment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in compliance with the Declaration of Helsinki and its amendments. Informed consent was obtained from all the particpants, as required by the French authorities. The local ethics committee (CPP Ile de France VI) approved the study protocol on August 29, 2012. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study. GR2: “Groupe de Recherche sur la Grossesse au cours des maladies Rares”; RA: rheumatoid arthritis; SpA: spondyloarthritis. *Date of data base extraction
Fig. 2
Fig. 2
Disease activity during pregnancy in women with rheumatoid arthritis (A) and spondyloarthritis (B, C). All “trimester x relapse” interactions, assessed by linear mixed models, are non-significant. The central mark is the median, the edges of the box are the 25th and 75th percentiles, the upper whisker is calculated as the maximum of (75th percentile + 1.5 × (75th percentile ─ 25th percentile)), and the lower whisker is calculated as the minimum of (25th percentile ─ 1.5 × (75th percentile ─ 25th percentile)). ASDAS-CRP: ankylosing spondylitis disease activity index using the C-reactive protein; BASDAI: bath ankylosing spondylitis disease activity index; DAS28-CRP: disease activity score in 28 joints using the C-reactive protein; T: trimester
See this image and copyright information in PMC

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