Deciphering the influence of pregnancy on rheumatoid arthritis and psoriatic arthritis: insights from musculoskeletal ultrasound dynamics.

Abstract

Objective: This prospective observational, hypothesis-generating study aims to investigate the impact of pregnancy on disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) using musculoskeletal ultrasound (MSUS) and to explore the potential of MSUS to enhance disease monitoring during pregnancy.

Methods: The study enrolled female participants divided into four groups: pregnant women with RA or PsA, non-pregnant women with RA or PsA, healthy pregnant women, and healthy non-pregnant women. Disease activity was assessed using the Rheumatoid Arthritis Impact of Disease (RAID) score and the Psoriatic Arthritis Impact of Disease (PsAID) score, as well as self-reported questionnaires on health perception. MSUS was performed using the Butterfly iQ portable ultrasound scanner, with synovial hypertrophy and joint effusion assessed via the Advanced Sonography of Large Joints in Rheumatology (aSOLAR) score.

Results: A total of 105 participants were included: 15 pregnant women with RA or PsA, 30 non-pregnant women with RA or PsA, 30 healthy pregnant women, and 30 healthy non-pregnant women. In pregnant women with RA, conventional disease activity scores and the aSOLAR score showed lower values over the course of pregnancy. In contrast, non-pregnant RA patients generally presented with higher scores in both conventional assessments and the aSOLAR score. Among pregnant PsA patients, conventional scores appeared lower over time, while the aSOLAR score showed comparatively higher values in later pregnancy. Self-reported health perception was more favorable in pregnant RA and PsA patients than in their non-pregnant counterparts. The CRP levels tended to be lower in later pregnancy phases among both RA and PsA patients.

Conclusion: This pioneering study demonstrates the potential impact of pregnancy on the disease activity of RA and PsA. It emphasizes the exploratory potential of MSUS as an imaging biomarker in the assessment of these conditions during pregnancy. The observed discrepancies between conventional, self-reported diagnostic tools and ultrasound findings support the hypothesis that objective imaging modalities may improve disease monitoring. Our findings warrant further validation in larger, confirmatory studies.