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The impact of pregnancy in an autoimmune disease


International Journal of Pregnancy & Child Birth
Mariana Formigo, Cristina Silva, Olinda Miranda, Ana Goncalves, Sara Freitas, Glória Alves, Jorge Cotter

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Abstract

Psoriatic arthritis is a chronic inflammatory disease associated with psoriasis. Arthritis has a significant impact on quality of life in patients with psoriasis. Studies on pregnancy and birth outcomes in women with psoriasis are insufficient with varying results. Pregnancy is
associated  with  hormonal  changes  in  estrogens  and  progesterone  modifying  the  immune  response.  Various  hormonal  states  are  known  to  be  associated  with  improvement  and  worsening of psoriasis and PsA. A 34-year-old woman with psoriasis since 2006 presents persistent inflammatory lower back pain, stiffness, nail pitting, small psoriatic lesions on her feet, left sacroiliac pain and limitation  of  motion  of  the  lumbar  spine.  She  was  diagnosed  with  psoriatic  arthritis and  started NSAID with good clinical response. She got pregnant and presented worsening oflower back pain and spreading of psoriatic lesions throughout the lower limbs. She started topical  emollients  and  low-dose  systemic  steroid  with  good  response  during  8  weeks. During the remaining months of pregnancy, psoriatic lesions slowly disappeared and lower back pain improved. On postpartum period she presented worsening of lower back pain, a BASFI score of 8.3 and a BASDAI score of 6.6. At this moment, she is awaiting hospital approval for biological therapy.Controlling disease activity with immunosuppressive agents is often necessary to achieve a remission or a low or minimal disease activity state.

Keywords

pregnancy, psoriatic arthritis, psoriasis, sacroiliitis, lower back pain, autoimmunity, immunosuppression

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