Improvement of rheumatoid arthritis (RA) disease activity during pregnancy is not associated with changes in levels of autoantibodies during pregnancy, but may occur more frequently in the absence of anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF), say researchers.
“Pregnancy is the only natural situation where improvement of RA occurs and flares after delivery,” note Yaël de Man and colleagues from University Medical Center Rotterdam in The Netherlands.
“It is not known whether improvement during pregnancy and flare after delivery is associated with changes in levels of anti-CCP and RF; nor whether the presence of these autoantibodies may predict the clinical course of RA during and after pregnancy,” they add.
To investigate, de Man and team measured levels of anti-CCP, immunoglobulin (Ig)M-RF, IgG-RF, IgA-RF and the Disease Activity Score of 28 joints before conception, at each trimester and at 6, 12, and 26 weeks postpartum in a 118 patients who were taking part in the Pregnancy-induced Amelioration of Rheumatoid Arthritis study.
To determine whether changes in autoantibody levels between first and third trimester were associated with improvement of RA during pregnancy, the researchers classified patients’ clinical response according to the European League Against Rheumatism criteria.
As reported in the Annals of Rheumatic Diseases, the median levels of anti-CCP and all subclasses of RF during pregnancy were stable. Postpartum, however, median levels of anti-CCP, IgM-RF, and IgA-RF decreased significantly, but were not associated with the occurrence of flares.
When the researchers classified patients as being positive or negative for autoantibodies they found that the percentage of women whose disease activity improved during pregnancy was significantly higher in the group that was negative for both anti-CCP and RF, compared with women who were positive for either or both autoantibodies (75% vs 39%).
Since no association was found between autoantibody levels and RA improvement during pregnancy, de Man and co-authors conclude: “Further investigations will be needed to discover whether improvement during pregnancy is related to other roles of B cells beyond autoantibody production.”
Woohoo! This is encouraging. I am seriously considering having a third in the next few years, rather than waiting. I am RF and anti-CCP negative. Of course I have BIG considerations before deciding to do so. I thought about waiting until my health was stabalized but now I figure that I'd better have the third before I'm in the high risk category post 35....because with RA and thyroid issues I'll have to deal with enough. I felt GREAT during first pregnancy, not great during second, but not awful. Was able to work the whole time, etc. Very motivated to drop 10 pounds before I get pregnant. I am 130 now, about what I was for the second pregnancy. I was 120 for the first and felt so much better. Okay ending ramble...but this is encouraging for me personally!
Personally I do not feel all that much better. I am almost 17 weeks so into my second trimester where I shouldn't be this tired and should be feeling better, supposedly. I felt better with my other two pregnancies for sure which were both pre RA. I am RF positive and anti-ccp neg.