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Research ArticleArticle

Disease Activity of Juvenile Idiopathic Arthritis during and after Pregnancy: A Prospective Multicenter Study

Kristin Ursin, Stian Lydersen, Johan F. Skomsvoll and Marianne Wallenius
The Journal of Rheumatology December 2017, jrheum.161410; DOI: https://doi.org/10.3899/jrheum.161410
Kristin Ursin
From the National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology (NTNU); Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU, Trondheim, Norway. Supported by the Department of Rheumatology, Trondheim University Hospital, and the Research Fund of the Norwegian Organization for People with Rheumatic Diseases. K. Ursin, MD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU; S. Lydersen, PhD, Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU; J.F. Skomsvoll, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; M. Wallenius, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU. Address correspondence to Dr. K. Ursin, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Postbox 3250 Sluppen, NO-7006 Trondheim, Norway. E-mail: kristin.ursin@ntnu.no. Accepted for publication September 8, 2017.
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Stian Lydersen
From the National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology (NTNU); Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU, Trondheim, Norway. Supported by the Department of Rheumatology, Trondheim University Hospital, and the Research Fund of the Norwegian Organization for People with Rheumatic Diseases. K. Ursin, MD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU; S. Lydersen, PhD, Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU; J.F. Skomsvoll, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; M. Wallenius, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU. Address correspondence to Dr. K. Ursin, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Postbox 3250 Sluppen, NO-7006 Trondheim, Norway. E-mail: kristin.ursin@ntnu.no. Accepted for publication September 8, 2017.
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Johan F. Skomsvoll
From the National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology (NTNU); Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU, Trondheim, Norway. Supported by the Department of Rheumatology, Trondheim University Hospital, and the Research Fund of the Norwegian Organization for People with Rheumatic Diseases. K. Ursin, MD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU; S. Lydersen, PhD, Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU; J.F. Skomsvoll, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; M. Wallenius, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU. Address correspondence to Dr. K. Ursin, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Postbox 3250 Sluppen, NO-7006 Trondheim, Norway. E-mail: kristin.ursin@ntnu.no. Accepted for publication September 8, 2017.
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Marianne Wallenius
From the National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology (NTNU); Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU, Trondheim, Norway. Supported by the Department of Rheumatology, Trondheim University Hospital, and the Research Fund of the Norwegian Organization for People with Rheumatic Diseases. K. Ursin, MD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU; S. Lydersen, PhD, Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU; J.F. Skomsvoll, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital; M. Wallenius, MD, PhD, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, and Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU. Address correspondence to Dr. K. Ursin, National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Postbox 3250 Sluppen, NO-7006 Trondheim, Norway. E-mail: kristin.ursin@ntnu.no. Accepted for publication September 8, 2017.
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Abstract

Objective To study disease activity in women with juvenile idiopathic arthritis (JIA) during and after pregnancy. There is little previous knowledge about this topic.

Methods Our study included 135 pregnancies in 114 women with JIA. Disease activity was assessed at 7 timepoints before, throughout, and after pregnancy with the Disease Activity Score–28–C-reactive protein 3 (DAS28-CRP3). Scores assessed at each visit were analyzed in a linear mixed model. The same statistical method was used to study self-reported physical function, pain, and mental health.

Results Almost 80% of the women were in remission or had low disease activity during and after pregnancy. Although disease activity was stable throughout the study period, we found that DAS28 6 weeks postpartum increased significantly compared to the first trimester (2.78 vs 2.51, p = 0.005) and third trimester (2.78 vs 2.56, p = 0.011), respectively. DAS28 decreased significantly between 6 weeks and 12 months postpartum (2.78 vs 2.54, p = 0.014). Self-reported mental health was significantly better 6 weeks postpartum than before pregnancy (Medical Outcomes Study Short Form-36 Mental Health subscale 80.7 vs 76.5, p = 0.039). Self-reported pain was stable. Physical function was significantly worse in the third trimester of pregnancy than postpartum (Modified Health Assessment Questionnaire 0.57 vs 0.39, p < 0.001).

Conclusion In women with JIA, disease activity was highest 6 weeks postpartum, but altogether low and stable in the period from planning pregnancy to 1 year after delivery.

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The Journal of Rheumatology: 45 (4)
The Journal of Rheumatology
Vol. 45, Issue 4
1 Apr 2018
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Disease Activity of Juvenile Idiopathic Arthritis during and after Pregnancy: A Prospective Multicenter Study
Kristin Ursin, Stian Lydersen, Johan F. Skomsvoll, Marianne Wallenius
The Journal of Rheumatology Dec 2017, jrheum.161410; DOI: 10.3899/jrheum.161410

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Disease Activity of Juvenile Idiopathic Arthritis during and after Pregnancy: A Prospective Multicenter Study
Kristin Ursin, Stian Lydersen, Johan F. Skomsvoll, Marianne Wallenius
The Journal of Rheumatology Dec 2017, jrheum.161410; DOI: 10.3899/jrheum.161410
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