Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Adverse Pregnancy Outcomes Before Symptom Onset Are Associated with a Worse Disease Outcome in Women with Recent-Onset Inflammatory Polyarthritis.
Camacho1, Elizabeth M., Verstappen1, Suzanne, Lunt1, Mark, Bunn2, Diane K., Symmons3, Deborah P.M.
A number of studies have suggested that female reproductive factors, such as parity or menopause status, may impact upon a woman's likelihood of developing rheumatoid arthritis (RA), and her subsequent disease severity. For example, there is some evidence that women with a history of adverse pregnancy outcomes (APOs) may be at greater risk of developing RA. Our aim was to investigate the relationship between pre-onset APO history (spontaneous abortion or stillbirth) and disease outcome (functional disability and disease activity) over time, in women with inflammatory polyarthritis (IP), a term which includes RA.
The Norfolk Arthritis Register (NOAR) is a primary-care-based cohort of patients with recent-onset IP; 1647 gravid women joined NOAR between 19902004. 46 women with subsequent pregnancies during follow-up and 12 women who only had pregnancies resulting in induced abortions were excluded from this cohort; 1586 women were included in the analysis. APO history was patient-reported and those with any history of APOs before symptom onset were further categorised into overlapping groups with one or more (1+), two or more (2+), or three or more (3+) APOs. Functional disability was assessed using the Stanford Health Assessment Questionnaire (HAQ) and, for a sub-group of patients for whom the relevant data were available, disease activity scores (DAS28CRP) were calculated. Linear random effects models were used to examine differences over time in HAQ and DAS28 score, by APO history, initially unadjusted, and then progressively adjusted for: (i) age at symptom onset and symptom duration; (ii) socio-economic status and smoking status; (iii) oral contraceptive use; (iv) comorbid conditions.
397 (25%) patients reported at least one APO before symptom onset; 125 (8%) women had 2+ APOs and 47 (3%) had 3+ APOs. The rates of APOs in NOAR were largely comparable to those in the general population of the United Kingdom. The median age at IP onset was significantly younger for women with a history of APOs than women with no APOs (52 vs. 55 years). Results from the maximally adjusted models showed that on average, women with a history of 2+ APOs had significantly higher HAQ and DAS28 scores over time than women with no APOs (mean difference: HAQ 0.13; 95% CI 0.002, 0.26; and DAS28 0.56; 95% CI 0.01, 1.11). This relationship was more pronounced, in women with 3+ APOs (mean difference: HAQ 0.23; 95% CI 0.02, 0.43; and DAS28 0.98; 95% CI 0.23, 1.74).
Women with APOs before IP-onset had greater functional disability and more active disease over time than women with no APOs. There was a dose response effect whereby an increasing number of APOs was associated with an increasing negative difference in HAQ and DAS28 score, when compared to women with no APOs.
To cite this abstract, please use the following information:
Camacho, Elizabeth M., Verstappen, Suzanne, Lunt, Mark, Bunn, Diane K., Symmons, Deborah P.M.; Adverse Pregnancy Outcomes Before Symptom Onset Are Associated with a Worse Disease Outcome in Women with Recent-Onset Inflammatory Polyarthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1873