Rheumatic Diseases and Pregnancy: How do Outcomes Correlate to Patient-Reported Measures?

Tuesday, April 9, 2019

Megan Clowse, MD, MPH, associate professor of medicine (Rheumatology and Immunology), has been collecting data about disease activity and pregnancy outcomes from pregnant women with rheumatoid disease since 2007. The registry includes patient questionnaires, blood samples, and medical records. Originally called Duke Autoimmunity in Pregnancy (DAP), the registry has been renamed Maternal Autoimmune Disease Research Alliance (MADRA) and expanded to include patients from other institutions.

When a woman with rheumatic disease is pregnant, she may experience many symptoms--some from her underlying disease and some from pregnancy itself. Which of these symptoms signal increased risk for preterm delivery?

Nathaniel Harris, MD, PhD, an intern in the Duke internal medicine residency program, spent his third year of medical school, also at Duke, plumbing the DAP registry for insights into this question. He found that among women with rheumatoid arthritis, those who reported more disability, such as trouble climbing stairs or difficulty using their hands, were more likely to deliver preterm. These were the same women that Clowse reported as having active disease in the medical records.

The story was different with lupus. Among these women, those who reported more disability were not more likely to deliver early. They were also less likely to be identified by Clowse as having active disease. “This was a bit surprising to us,” Clowse says, “but then we realized that many of the women with internal organ lupus activity--especially kidney disease called lupus nephritis--were the women who delivered early. Lupus nephritis is a very serious condition and can lead to kidney failure, but it often doesn’t make a woman feel poorly.”

The takeaway?

For women with rheumatoid arthritis, self-reported measures are a good indication of disease activity, which in turn is a risk factor for preterm delivery.

For women with lupus, on the other hand, laboratory testing to check for kidney disease may be a better indication of preterm delivery risk.

The results of this study were published in June 2018 in the journal Arthritis Care and Research in an article by Harris, Clowse, and Amanda Eudy.

Read more in the series

Helping Women with Rheumatic Disease Have Families

New Lupus Subtyping System Improves Care and Communication

Rheumatic Diseases and Pregnancy: Should HCQ Dose Change in Pregnancy?

This story was written by Mary-Russell Roberson, a freelance writer for the Department of Medicine.