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Research project


Status: Ongoing project, inclusion closed

Prospective cohort study on treatment strategies in women with inflammatory arthritis and a wish to conceive or pregnant

What we do

About our project

To improve the care for women with arthritis and a wish to conceive, a specialized outpatient clinic was established at the department of Rheumatology.

Women attending this clinic are invited to participate in the PreCARA cohort, which combines care with research. Patients are seen before pregnancy (every 3 months), every trimester of pregnancy and at 6, 12 and 26 weeks after delivery. At all time-points disease activity is scored and medication adjusted in order to achieve low disease activity or remission.

The goal of the PreCARA study is to determine whether a treat-to-target approach aimed at low disease activity or remission is feasible in RA-patients with a wish to conceive or pregnant and to determine what the impact of such an approach is on disease activity, time to pregnancy, pregnancy outcomes and the child.

Our research focus

In previous research we have shown that the majority of Rheumatoid Arthritis (RA) patients still had active RA during pregnancy. This was despite treatment, that was considered compatible with pregnancy during that era (2001-2010). In addition, we found that active RA and certain medication (NSAIDs and high dose prednisone) were associated with increased time to pregnancy. Finally, we found that active RA and the use of prednisone impaired pregnancy outcomes. We found that there were no indications that active RA or prednisone use during pregnancy may have long term consequences for the newborn.

Nowadays for (non-pregnant) RA-patients a treat-to-target approach is recommended aimed at achieving low disease activity or remission. Strategies used in this approach are the combination of medications instead of monotherapy and the addition of biologicals, in particular TNF-inhibitors.

There is increasing evidence that TNF-inhibitors can safely be prescribed in women with a wish to conceive. However, the vast majority of safety data only consider exposure during first trimester and only look at birth defects as outcome measure. No to hardly any data is available on other outcome measures, including time to pregnancy, miscarriages, gestational age, birth weight, maternal infections during pregnancy, growth of children etc. These other outcome measures can often not be derived from large safety databases since they are influenced by many factors like: disease activity, other medication, maternal factors (parity, age, smoking etc.).

The first results of the PreCARA study show that a modern treatment approach results in low disease activity in 90% of pregnant rheumatoid arthritis patients. 

Our team

Contact us: precara@erasmusmc.nl

Prof. Radboud Dolhain, MD PhD

Laura Kranenburg van Koppen, MD Msc

Esther Röder, MD PhD

Luis Perez, MD

Lydia Witte - Quaack, MD

Margot Bongenaar, MD

Hetty Wintjes

Anneke van Steensel - Boon

Ron Buijs