Study: Psoriatic Arthritis Improves in Pregnancy

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Pregnant women often worry how their psoriatic arthritis symptoms will change during the hormonal upswing of pregnancy. But a study published in September 2018 shows that many women with psoriatic arthritis experience remission or low disease activity during pregnancy.

That was evidently the case for Haylay Adkins, who found out she was pregnant with her second child in the fall of 2016, and didn’t know what to expect.

“With my first, my psoriatic arthritis was horrible,” the 26-year-old mother of two tells HealthCentral. She was diagnosed with psoriasis in high school and with psoriatic arthritis in young adulthood. Over the years she found medications that worked for her, but was advised to stop treatment during both pregnancies. To her surprise, shortly into pregnancy number two and without any medication in her system, her psoriasis and her joint pain subsided.

Adkins says she treated both pregnancies similarly; she stayed moisturized and she watched what she ate, avoiding dairy, gluten, and junk food.

“I think I had different reactions because it was different babies,” she says. “I actually was surprised because I thought it was going to be worse, like my first pregnancy.”

Adkins’s second, more positive pregnancy experience is not uncommon among women with psoriatic arthritis. In fact, the study mentioned above, conducted in Norway and published in Arthritis Care and Research, found that in 108 pregnancies in 103 women with PsA, about 75 percent experienced remission or low disease activity during pregnancy. The study was supported by the National Advisory Unit of Pregnancy and Rheumatic Diseases at St. Olavs Hospital in Trondheim, Norway.

While several studies focus on rheumatoid arthritis and pregnancy — one such study found that 60 percent of women with rheumatoid arthritis experience low disease activity during pregnancy — “the knowledge on pregnancy and spondyloarthritis, including psoriaticarthritis, [is] particularly poor,” Kristin Ursin, an author on the Norwegian study, noted in an email interview.

A second, more positive pregnancy experience is not uncommon among women with psoriatic arthritis.

Ursin and her co-authors tracked pregnancies in women with psoriatic arthritis from a Norwegian nationwide register, and she believes the beneficial effect cited in the study is mediated by the immune system.

“Psoriaticarthritis is a partly T helper cell 1 (Th1)-driven disease, whereas pregnancy is a partly Th2-driven process,” she wrote. “This probably plays a role in pregnancy’s impact on the disease, but we now know that both the pathophysiology of psoriaticarthritis and physiology of pregnancy are far more complicated immunological processes than we used to think.”

From her own clinic experience, Ursin says she was aware that many women with psoriatic arthritis experience low disease activity during pregnancy. But she and her co-authors were surprised that as many as 75 percent of women had an alleviation of symptoms throughout the study period.

“However," she advised, "it is important to remember that despite low disease activity, many women in our study reported considerable pain and reduced physical function, especially around six months after delivery."

According to Ursin’s research, the difference in disease activity between the preconception and postpartum periods was quite small. When the ameliorating effect of pregnancy fades, many women return to their disease baseline. It’s also possible, Ursin said, that the women experience a kind of “rebound reaction” from their immune systems after birthing their children.

“Whichever is true, it is important to note that the small peak six months postpartum happened despite about 40 percent having (re)started their TNF-inhibitor [drugs that include Humira, Enbrel and other biosimilars],” she wrote. “Maybe less women will experience this peak in disease activity when their child is six months old if more of them (re)start effective medication sooner.”

For Halay Adkins, her psoriatic arthritis symptoms reared almost immediately after she had her son in the spring of 2017. “They returned maybe a week after I gave birth from all the stress that was put on my body from labor,” she says, adding that her symptoms worsened for a period.

Today, Adkins is back on medication — Humira works for her, she says — and, along with clearer skin, she has a happy, healthy one-and-a-half-year-old son.