Rheumatology (Oxford). 2025 Oct 24:keaf558. doi: 10.1093/rheumatology/keaf558. Online ahead of print.
ABSTRACT
OBJECTIVES: We evaluated real-world disease activity, treatment patterns, and pregnancy outcomes in women with rheumatoid arthritis (RA) utilizing a multicentre Japanese cohort. Feasibility and impact of a treat-to-target (T2T) approach during pregnancy were also examined.
METHODS: A retrospective observational study analysed 118 pregnancies in patients with RA from the multicentre ANSWER cohort (2013-2023) across eight Japanese academic institutions. Clinical characteristics, treatment regimens, and RA Disease Activity Scores of 28 joints, based on C-reactive protein (DAS28-CRP), were assessed at preconception, during each trimester, and postpartum. Pregnancy and neonatal outcomes were analysed.
RESULTS: Of 118 pregnancies, 92.8% achieved full-term deliveries (median birthweight: 2949 g). Remission or low disease activity was maintained in ∼85% of patients throughout pregnancy, with increased postpartum disease activity. Patients who continued biologic disease-modifying antirheumatic drugs (bDMARDs) during pregnancy (n = 35) exhibited significantly lower DAS28-CRP scores during the second and third trimesters compared with those who discontinued (n = 24) (p = 0.007 and p = 0.0002, respectively). Etanercept or certolizumab pegol use was associated with favourable disease control. Tocilizumab (n = 6) or abatacept (n = 2) was not associated with adverse maternal or neonatal outcomes. Glucocorticoid use was associated with increased disease activity. Salazosulfapyridine use correlated with increased birth weight (p = 0.003) and gestational age (p = 0.051).
CONCLUSION: T2T management, including selective continuation of bDMARDs, was associated with favourable maternal disease control and reassuring pregnancy outcomes. Although the absence of long-term follow-up is a limitation, these findings provide real-world evidence supporting this approach. Larger prospective studies are required to confirm maternal and neonatal safety beyond the early postpartum.
PMID:41134194 | DOI:10.1093/rheumatology/keaf558
