PMID- 33568387
OWN - NLM
STAT- MEDLINE
DCOM- 20210802
LR  - 20210802
IS  - 1468-2060 (Electronic)
IS  - 0003-4967 (Print)
IS  - 0003-4967 (Linking)
VI  - 80
IP  - 7
DP  - 2021 Jul
TI  - Modern treatment approach results in low disease activity in 90% of pregnant 
      rheumatoid arthritis patients: the PreCARA study.
PG  - 859-864
LID - 10.1136/annrheumdis-2020-219547 [doi]
AB  - OBJECTIVES: In patients with rheumatoid arthritis (RA), high disease activity 
      impairs fertility outcomes and increases the risk of adverse pregnancy outcomes. 
      The aim of this study was to determine the feasibility of a modern treatment 
      approach, including treat-to-target (T2T) and the prescription of tumour necrosis 
      factor (TNF) inhibitors, in patients with RA with a wish to conceive or who are 
      pregnant. METHODS: Patients were derived from the Preconception Counseling in 
      Active RA (PreCARA) cohort. Patients with a wish to conceive or who are pregnant 
      were treated according to a modified T2T approach, in which the obvious 
      restrictions of pregnancy were taken into account. Results of the PreCARA study 
      were compared with results of the Pregnancy-induced Amelioration of Rheumatoid 
      Arthritis (PARA) study, a historic reference cohort on RA during pregnancy. 
      Patients in the PARA cohort were treated according to the standards of that time 
      (2002-2010). Differences in disease activity over time between the two cohorts 
      were tested using a linear mixed model. RESULTS: 309 patients with RA were 
      included in the PreCARA study, 188 children were born. 47.3% of the patients used 
      a TNF inhibitor at any time during pregnancy. Mean disease activity over time in 
      the PreCARA cohort was lower than in the reference cohort (p<0.001). In the 
      PreCARA cohort, 75.4% of the patients were in low disease activity (LDA) or 
      remission before pregnancy increasing to 90.4% in the third trimester, whereas in 
      the PARA cohort, these percentages were 33.2% and 47.3%, respectively. 
      CONCLUSIONS: This first study on a modern treatment approach in pregnant patients 
      with RA shows that LDA and remission are an attainable goal during pregnancy, 
      with 90.4% of patients achieving this in the third trimester.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Smeele, Hieronymus Tw
AU  - Smeele HT
AUID- ORCID: 0000-0001-7724-7712
AD  - Rheumatology, Erasmus MC, Rotterdam, The Netherlands h.smeele@erasmusmc.nl.
FAU - Roder, Esther
AU  - Roder E
AD  - Rheumatology, Erasmus MC, Rotterdam, The Netherlands.
FAU - Wintjes, Hetty M
AU  - Wintjes HM
AD  - Rheumatology, Erasmus MC, Rotterdam, The Netherlands.
FAU - Kranenburg-van Koppen, Laura Jc
AU  - Kranenburg-van Koppen LJ
AD  - Rheumatology, Erasmus MC, Rotterdam, The Netherlands.
FAU - Hazes, Johanna Mw
AU  - Hazes JM
AD  - Rheumatology, Erasmus MC, Rotterdam, The Netherlands.
FAU - Dolhain, Radboud Jem
AU  - Dolhain RJ
AD  - Rheumatology, Erasmus MC, Rotterdam, The Netherlands.
LA  - eng
PT  - Clinical Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210210
PL  - England
TA  - Ann Rheum Dis
JT  - Annals of the rheumatic diseases
JID - 0372355
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Tumor Necrosis Factor Inhibitors)
SB  - IM
MH  - Adult
MH  - Antirheumatic Agents/*therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - Pregnancy Complications/*drug therapy
MH  - *Treatment Outcome
MH  - Tumor Necrosis Factor Inhibitors/*therapeutic use
PMC - PMC8237196
OTO - NOTNLM
OT  - arthritis
OT  - certolizumab pegol
OT  - rheumatoid
OT  - tumour necrosis factor inhibitors
COIS- Competing interests: None declared.
EDAT- 2021/02/12 06:00
MHDA- 2021/08/03 06:00
PMCR- 2021/06/28
CRDT- 2021/02/11 05:44
PHST- 2020/11/18 00:00 [received]
PHST- 2021/01/28 00:00 [revised]
PHST- 2021/02/04 00:00 [accepted]
PHST- 2021/02/12 06:00 [pubmed]
PHST- 2021/08/03 06:00 [medline]
PHST- 2021/02/11 05:44 [entrez]
PHST- 2021/06/28 00:00 [pmc-release]
AID - annrheumdis-2020-219547 [pii]
AID - 10.1136/annrheumdis-2020-219547 [doi]
PST - ppublish
SO  - Ann Rheum Dis. 2021 Jul;80(7):859-864. doi: 10.1136/annrheumdis-2020-219547. Epub 
      2021 Feb 10.