Disease activity of juvenile idiopathic arthritis during and after pregnancy: A prospective multicenter study

Objective. To study disease activity in women with juvenile idiopathic arthritis (JIA) during and after pregnancy. There is little previous knowledge about this topic. Methods. Our study included 135 pregnancies in 114 women with JIA. Disease activity was assessed at 7 timepoints before, throughout, and after pregnancy with the Disease Activity Score–28–C-reactive protein 3 (DAS28-CRP3). Scores assessed at each visit were analyzed in a linear mixed model. The same statistical method was used to study self-reported physical function, pain, and mental health. Results. Almost 80% of the women were in remission or had low disease activity during and after pregnancy. Although disease activity was stable throughout the study period, we found that DAS28 6 weeks postpartum increased significantly compared to the first trimester (2.78 vs 2.51, p = 0.005) and third trimester (2.78 vs 2.56, p = 0.011), respectively. DAS28 decreased significantly between 6 weeks and 12 months postpartum (2.78 vs 2.54, p = 0.014). Self-reported mental health was significantly better 6 weeks postpartum than before pregnancy (Medical Outcomes Study Short Form-36 Mental Health subscale 80.7 vs 76.5, p = 0.039). Self-reported pain was stable. Physical function was significantly worse in the third trimester of pregnancy than postpartum (Modified Health Assessment Questionnaire 0.57 vs 0.39, p < 0.001). Conclusion. In women with JIA, disease activity was highest 6 weeks postpartum, but altogether low and stable in the period from planning pregnancy to 1 year after delivery

Psoriatic arthritis disease activity during and after pregnancy: A prospective multicenter study

Objective To study disease activity in women with peripheral psoriatic arthritis (PsA) during and after pregnancy. Previous knowledge on this topic is sparse. Methods The study included 108 pregnancies in 103 women with PsA from a Norwegian nationwide register. Disease activity was assessed prospectively at 7 time points before, throughout, and after pregnancy with the 3‐variable Disease Activity Score in 28 joints (DAS28) using C‐reactive protein levels and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Scores assessed at each time point were analyzed in a linear mixed model. We did additional analyses with “tumor necrosis factor inhibitor (TNFi) in pregnancy” as a covariate. The same statistical method was used to study self‐reported physical function, pain, and mental health. Results Approximately 75% of the women were in remission or had low disease activity during and after pregnancy according to the DAS28‐CRP score. Although disease activity was altogether stable, we found that it decreased in pregnancy and increased within 6 months postpartum. Disease activity at 6 months postpartum was significantly higher than at 6 weeks postpartum (mean DAS28‐CRP score 2.71 versus 2.45; P = 0.016). Women using TNFi in pregnancy had significantly lower disease activity than women not using TNFi (mean DAS28‐CRP score at 6 months postpartum 2.22 versus 2.72; P = 0.043). BASDAI scores were also low and stable during pregnancy but significantly higher at 6 months postpartum than at 6 weeks postpartum (mean BASDAI score 3.69 versus 2.95; P = 0.013). Conclusion Studying women with PsA, we found that disease activity was highest at 6 months postpartum but altogether low and stable in the period from planning pregnancy to 1 year after delivery. Women using TNFi in pregnancy had significantly lower disease activity

Factors associated with time to pregnancy in women with axial spondyloarthritis: A registry-based multicenter study

Objective To study time to pregnancy (TTP) and factors associated with TTP in women with axial spondyloarthritis (axSpA), compared to women with rheumatoid arthritis (RA). Methods We included 274 women with axSpA and 317 women with RA from the Norwegian nationwide registry RevNatus. For all the women, we had retrospectively collected data on TTP, and a subgroup also had prospectively collected data. We compared TTP in women with axSpA to women with RA using Kaplan‐Meier plots and log‐rank test. To identify factors associated with TTP, we used Cox proportional hazard regression. Results TTP exceeded 12 months in 21% of women with axSpA. In the subgroup followed prospectively, 32% had TTP which exceeded 12 months. Longer TTP was associated with older age, nulliparity, and longer disease duration, with hazard ratios of 0.97 (95% CI 0.94 to 1.00), 0.66 (95% CI 0.50 to 0.88), and 0.94 (95% CI 0.91 to 0.98) respectively. Disease activity, medication, and self‐reported health‐related quality of life were not associated with TTP. We found no statistically significant differences between axSpA and RA in regard to TTP. Conclusion In women with axSpA, longer TTP was associated with older age, nulliparity, and longer disease duration

Block scheduling at magnetic resonance imaging labs

This paper considers a tactical block scheduling problem at a major Norwegian hospital. Here, specific patient groups are reserved time blocks for scanning at a heterogeneous set of Magnetic Resonance Imaging (MRI) labs. The time blocks consist of several time slots, and one or more patients from the same group are scanned in a block. A total weekly number of time slots for each specific patient group is given through demand forecast and negotiations, and several restrictions apply to the allocation of time blocks. Only part of the week is allocated to blocks for the specific patient groups. The rest is classified as open time. Thus, the MRI block scheduling problem consists of finding a cyclic weekly plan where one or more time blocks are to be allocated to each specific patient group, by deciding the day, start time and length, to minimise unfavourable patient group allocations, as well as allocations of open time. For the problem, we propose an integer programming model with an objective function that combines penalties for allocating time blocks to patient groups at unfavourable time slots and labs, and rewards for advantageous positioning of open time slots. The aim of the optimisation model is to facilitate the coordination of the MRI resources between the hospital departments, that are responsible for the specific patient groups, to achieve a fair distribution of time slots to the specific patient groups and open time blocks. The computational study is based on the real problem as well as artificially generated instances. Real-sized instances for our case hospital can be solved in short time. We illustrate how the model can be used to produce Pareto optimal solutions, and how these solutions can provide the decision makers with managerial insight

Influence of disease activity and medications on offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus: a population-based study

Objectives Exploring the associations between disease activity and medications with offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus (SLE). Methods Data from the Medical Birth Registry of Norway (MBRN) were linked with data from RevNatus, a nationwide observational register recruiting women with inflammatory rheumatic diseases. Singleton births in women with SLE included in RevNatus 2006–2015 were cases (n=180). All other singleton births registered in MBRN during this time (n=498 849) served as population controls. Z-score for birth weight adjusted for gestational age and gender was calculated. Disease activity was assessed using Lupus Activity Index in Pregnancy. We compared z-scores for birth weight, pre-eclampsia and preterm birth in cases with inactive disease, cases with active disease and population controls. Results Z-scores for birth weight in offspring were lower in inactive (−0.64) and active (−0.53) diseases than population controls (−0.11). Inactive disease did not predict pre-eclampsia while active disease yielded OR 5.33 and OR 3.38 compared with population controls and inactive disease, respectively. Preterm birth occurred more often in inactive (OR 2.57) and active (OR 8.66) diseases compared with population controls, and in active compared with inactive disease (OR 3.36). Conclusions SLE has an increased odds for low birth weight and preterm birth, amplified by active disease. The odds for pre-eclampsia is elevated in active, but not inactive disease. This calls for tight follow-up targeting inactive disease before and throughout pregnancy

Women with systemic lupus erythematosus get pregnant more easily than women with rheumatoid arthritis

Objectives To examine possible differences in the ability to get pregnant and time to pregnancy (TTP) in women with SLE and RA, and to study possible influencing factors. Methods Data from RevNatus, a Norwegian nationwide prospective observational register including women with inflammatory rheumatic diseases when planning pregnancy or after conception, was used. We compared rate of achieved pregnancy, the pregnancy outcomes live birth or pregnancy loss, and TTP between women with SLE (n = 53) and women with RA (n = 180). TTP was compared between the groups using Kaplan-Meier plots, and Cox proportional hazard regression was performed adjusting for maternal age, parity and medication use. RAND-36 was used to assess health-related quality of life (HRQoL) in women achieving and not achieving pregnancy. Results Women with SLE had a pregnancy ratio of 1.91 (95% CI: 1.27, 2.88, P = 0.002) compared with women with RA, and a substantially shorter median TTP (3.0 vs 7.0 months, P = 0.001). Higher maternal age, medication use and low HRQoL in the physical domains may influence the ability to achieve pregnancy and prolong TTP in women with RA. Women with SLE not achieving pregnancy had lower HRQoL scores than SLE-women achieving pregnancy, while women with RA had generally low scores in physical domains whether or not achieving pregnancy, indicating poor HRQoL. Conclusions In the studied cohort, women with SLE got pregnant more easily than women with RA

Disease activity during pregnancy and the first year postpartum in women with systemic lupus erythematosus

Objective Disease activity measured by validated methods has been sparsely examined during and after pregnancy in women with systemic lupus erythematosus (SLE). The aim of this study was to describe the longitudinal course of disease activity during pregnancy and the first year postpartum using the Lupus Activity Index in Pregnancy (LAI‐P). Methods RevNatus is a nationwide Norwegian prospective observational register including women diagnosed with inflammatory rheumatic diseases. LAI‐P is a modified version of the LAI, with a good ability to assess disease activity in pregnant women with SLE. These indexes were used to assess disease activity at 6 visits (in trimesters 1, 2, and 3, and at 6 weeks, 6 months, and 12 months postpartum). The longitudinal course of disease activity was analyzed using an ordinal logistic mixed model. Results A total of 757 visits (145 pregnancies) in women with SLE were included in the analysis. More than half (51.6%) of the disease activity scores indicated remission, and only 6.3% indicated moderate disease activity. The model showed a statistically significant and clinically relevant change in disease activity over time, and a higher disease activity 6 and 12 months postpartum compared to the third trimester and 6 weeks postpartum. Conclusion The majority of women had low or no disease activity at conception and during pregnancy, with higher disease activity at 6 and 12 months after delivery. This points to the importance of tight disease control not only before and during pregnancy but also in the first year postpartum