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