Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Issue 6 (20th February 2018)

• Record Type: Journal Article
• Authors: Eudy, Amanda M; Siega-Riz, Anna Maria; Engel, Stephanie M; Franceschini, Nora; Howard, Annie Green; Clowse, Megan E B; Petri, Michelle
• Is Part Of: Annals of the rheumatic diseases. Volume 77:Issue 6(2018)
• Page Start: 855
• Page End: 860
• Publication Date: 2018-02-20
• Subjects: systemic lupus erythematosus -- disease activity -- epidemiology; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2017-212535
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objective: Prior studies found conflicting results about whether lupus is likely to flare during or after pregnancy. Using a large cohort of pregnant and non-pregnant women with lupus, we estimated the effect of pregnancy on disease flares in systemic lupus erythematosus. Methods: Data were collected in the Hopkins Lupus Cohort 1987–2015. Women aged 14–45 years with >1 measurement of disease activity were included. The time-varying exposures were classified as pregnancy, postpartum or non-pregnant/non-postpartum periods. Flares were defined as: (1) change in Physician Global Assessment (PGA)≥1 from previous visit and (2) change in Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI)≥4 from previous visit. A stratified Cox model estimated HRs with bootstrap 95% CIs. Results: There were 1349 patients, including 398 pregnancies in 304 patients. There was an increased rate of flare defined by PGA during pregnancy (HR: 1.59; 95% CI 1.27 to 1.96); however, this effect was modified by hydroxychloroquine (HCQ) use, with the HR of flares in pregnancy compared with non-pregnant/non-postpartum periods estimated to be 1.83 (95% CI 1.34 to 2.45) for patients with no HCQ use and 1.26 (95% CI 0.88 to 1.69) for patients with HCQ use. The risk of flare was similarly elevated among non-HCQ users in the 3 months postpartum, but not for women taking HCQ after delivery. Conclusions: Our study supports and extends previous findings that the incidence of flare is increased during pregnancy and within the 3 months postpartum. Continuing HCQ, however, appeared to mitigate the risk of flare during and after pregnancy.