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Patient-Reported Disease Activity and Pregnancy
Arthritis Care Res; ePub 2018 Jun 15; Harris, et al
For women with rheumatoid arthritis (RA), patient‐reported measures of disease activity may be useful adjuncts to physician‐reported measures in identifying pregnancies at greater risk, according to a recent study. In contrast, in systemic lupus erythematosus (SLE), no patient‐reported measures were associated with adverse outcomes while physician measures of disease activity helped predict several adverse pregnancy outcomes. Univariate and multivariable regression models were used to assess the relationship between patient and physician‐reported measures of disease activity and adverse pregnancy outcomes in 225 patients with lupus or RA enrolled in a prospective registry at a single academic center from 2008‐2016. Researchers found:
- In women with RA, patient‐reported disease activity is associated with preterm birth and gestational age.
- The physician assessment of disease activity also predicted preterm, small for gestational age births, and gestational age in weeks.
- On the other hand, SLE patient‐reported disease activity measures—including the Health Assessment Questionnaire (HAQ), pain, or global health measures—are not associated with adverse pregnancy outcomes.
- However, physician measures of SLE disease activity are associated with preterm birth, cesarean delivery, and preeclampsia.
Harris N, Eudy A, Clowse M. Patient‐reported disease activity and adverse pregnancy outcomes in systemic lupus erythematosus and rheumatoid arthritis. [Published online ahead of print June 15, 2018]. Arthritis Care Res. doi: 10.1002/acr.23621.
Patient self-reported assessment questionnaires are widely used and are often included in electronic medical records so that patients may generate longitudinal data for research analysis. Adverse pregnancy outcomes in patients with rheumatoid arthritis (RA), such as pre-term birth and gestational age, were associated with both increased patient and physician assessment. Although this study is limited to pregnancy outcomes, these findings suggest that caution should be exercised when interpreting the results of research analyses that are based on data obtained from self-reported assessments from patients.—Harold E. Paulus, M.D.; Emeritus Professor; University of California, Los Angeles; Division of Rheumatology.