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Læknablaðið - jún. 2019, Blaðsíða 19

Læknablaðið - jún. 2019, Blaðsíða 19
LÆKNAblaðið 2019/105 275 R A N N S Ó K N Signý Rut Kristjánsdóttir1 Þóra Steingrímsdóttir1,2 Gerður Gröndal3,4 Ragnheiður I. Bjarnadóttir2,5 Kristjana Einarsdóttir6 Björn Guðbjörnsson1,4 on behalf of ICEBIO Introduction: To collect nationwide data in Iceland on pregnancy and its outcomes among female patients with active inflammatory arthritides we linked two registers, the ICEBIO register and the Ice- landic Medical Birth Register. Methods: We used multivariate analysis to evaluate the risk of pre- term birth, Caesarean section, low Apgar score at 5-minutes and low birth weight among females with inflammatory arthritis (rheuma- toid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) in comparison with healthy controls matched on age and par- ity. We also investigated pregnancies before and after the diagnosis of respective rheumatic disease and especially in respect to treat- ment with TNFα inhibitors (TNFi). Results: In the end of 2016, 723 female patients were registered in ICEBIO as they had received treatment with TNFi due to inflamma- tory arthritis. Of those, 412 women had given birth to 801 children, whereof 597 were delivered before confirmed diagnosis of the mother and 53 were delivered after the start of the TNFi treatment. Relative risk of Caesarean section among these female with vari- ous arthritis conditions were 1.47 (95% CI: 1.19-1.82; p < 0,001) compared to controls and was highest in the group with PsA or 2.06 (1.41-3.02; p<0,001). We did not find increased risk of preterm delivery or low Apgar score. Patients with inflammatory arthritis had lower risk of children with low birth weight or 0.37 compared to healthy controls (95% CI: 0.36-0.37; p < 0.05). Due to low numbers of deliveries after the initiation of TNFi therapy (n=53) we were not able to perform any analysis for that group. Conclusion: Icelandic female patients with inflammatory arthritis are at an increased risk of Caesarean section in comparison to healthy controls. However, their newborns are in good condition and healthy at birth. Analysis of the impact of treatment with TNFi on pregnancy is not yet possible due to limited data. Pregnancy outcomes in Icelandic female patients with inflammatory arthritides. Nationwide results from the ICEBIO and the Icelandic Medical Birth Register ENGLISH SUMMARY 1Faculty of Medicine and 6Centre of Public Health Sciences, University of Iceland. 2Department of Obstetrics and Gynecology, 3Department of Rheumatology and 4Centre for Rheumatology Research, Landspitali University Hospitaland 5Health Care of the Capital Area, Reykjavik Iceland Key words: Ankylosing spondylitis, ICEBIO, pregnancy outcome, psoriatic arthritis, rheumatoid arthritis, TNFα inhibitor. Correspondence: Björn Guðbjörnsson, bjorngu@landspitali.is 1. Geirsson AJ, Eyjolfsdottir H, Bjornsdottir G, Kristjansson K, Gudbjornsson B. Prevalence and clinical characteristics of ankylosing spondylitis in Iceland ­ a nationwide study. Clin Exp Rheumatol 2010; 28: 333­40. 2. Love TJ, Gudbjornsson B, Gudjonsson JE, Valdimarsson H. Psoriatic arthritis in Reykjavik, Iceland: prevalence, demographics, and disease course. J Rheumatol 2007; 34: 2082­8. 3. Englund M, Jöud A, Geborek P, Felson DT, Jacobsson LT, Petersson IF. Prevalence and incidence of rheumatoid arthritis in southern Sweden 2008 and their relation to prescribed biologics. Rheumatology 2010; 49: 1563­9. 4. Ince­Askan H, Dolhain RJ. Pregnancy and rheumatoid arthritis. Best Pract Res Clin Rheumatol 2015; 29: 580­96. 5. Østensen M, Cetin I. Autoimmune connective tissue disea­ ses. Best Pract Res Clin Obstet Gynaecol 2015; 29: 658­70. 6. Williams M, Chakravarty EF. Rheumatoid arthritis and pregnancy: impediments to optimal management of both biologic use before, during and after pregnancy. Curr Opin Rheumatol 2014; 26: 341­6. 7. Østensen M, Villiger PM, Förger F. Interaction of pregn­ ancy and autoimmune rheumatic disease. Autoimmun Rev 2012; 11: A437­A46. 8. Argilés JM, Carbó N, López­Soriano FJ. TNF and pregn­ ancy: the paradigm of a complex interaction. Cytokine Growth Factor Rev 1997; 8: 181­8. 9. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Koldingsnes W, Mikkelsen K, et al. Postpartum onset of rheumatoid arthritis and other chronic arthritides: results from a patient register linked to a medical birth registry. Ann Rheum Dis 2010; 69: 332­6. 10. Komaki F, Komaki Y, Micic D, Ido A, Sakuraba A. Outcome of pregnancy and neonatal complications with anti-tumor­necrosis­factor-α­use­in­females­with­immune­ mediated diseases; a systematic review and meta­analysis. J Autoimmun 2017; 76:3 8­52. 11. Björgúlfsson Þ, Gröndal G, Blöndal Þ, Guðbjörnsson B. Skimun fyrir berklum meðal gigtarsjúklinga sem hófu­ meðferð­ með­ TNFα-hemlum­ á­ Íslandi­ 1999-2014.­ Læknablaðið 2018; 104: 231­35. 12. Guðbjornsson B. ICEBIO ­ kerfisbundin meðferðarskrán­ ing. Gigtin 2009; 2: 9­12. 13.­ Embætti­ landlæknis.­ Fæðingaskrá.­ landlaeknir.is/tol­ fraedi-og-rannsoknir/gagnasofn/gagnasafn/item12340/ Fadingaskra ­ júní 2016. 14. Østensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse MEB, et al. State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmn Rev 2015; 14: 376­86. 15. Brouwer J, Hazes JMW, Laven JSE, Dolhain RJEM. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2015; 74: 1836­41. 16. Hagstofa Íslands. Frjósemi og fólksfjölgunarhlutfall 1853-2016.­ px.hagstofa.is/pxis/pxweb/is/Ibuar/Ibuar__ Faeddirdanir__Faeddir__faedingar/MAN05202.px/?rx­ id=0bfa37d0­4a44­4cf1­950b­898b26520b78. 17. Nørgaard M, Larsson H, Pedersen L, Granath F, Askling J, Kieler H, et al. Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Int Med 2010; 268: 329­37. 18. van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS­EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76: 978­91. 19. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria:­An­American­College­of­Rheumatology/European­ League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62: 2569­81. 20. Jakobsson GL, Stephansson O, Askling J, Jacobsson LTH. Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study. Ann Rheum Dis 2016; 75: 1838­42. 21. Langen ES, Chakravarty EF, Liaquat M, El­Sayed YY, Druzin ML. High rate of preterm birth in pregnancies complicated by rheumatoid arthritis. Am J Perinatol 2014; 31: 9­14. 22. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, et al. Pregnancy and deli­ very in women with chronic inflammatory arthritides with a specific focus on first birth. Arthritis Rheum 2011; 63: 1534­42. 23. Embætti landlæknis. Skýrsla Fæðingaskrár fyrir árið 2015. Reykjavík 2017. 24. Reed SD, Vollan TA, Svec MA. Pregnancy outcomes in women with rheumatoid arthritis in Washington State. Matern Child Health J 2006; 10: 361­6. 25. Clowse MEB, Scheuerle AE, Chambers C, Afzali A, Kimball AB, Cush JJ, et al. Pregnancy outcomes after exposure to certolizumab pegol updated results from a pharmacovigilance safety database. Arthritis Rheum 2018; 70: 1399­407. 26. Rekommendationer avseende anti­inflammator­ isk och immun­modulerande behandling i samband med­ graviditet­ och­ amning.­ svenskreumatologi.se/ wp-content/uploads/2019/03/graviditet-och-amning_rikt­ linjedokument-graviditet-_amning-2019.pdf­­-­apríl­2019. Heimildir Barst til blaðsins 11. febrúar 2019, samþykkt til birtingar 29. apríl 2019.

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