POSTPARTUM disease activity differed markedly between inflammatory rheumatic diseases, with rheumatoid arthritis patients experiencing significantly more flares after pregnancy, while spondyloarthritis activity remained stable during the same period in a prospective French cohort study.
Understanding Postpartum Disease Activity in Rheumatic Disorders
Pregnancy has traditionally been associated with improved rheumatoid arthritis symptoms, although postpartum flare risk remains recognised. However, limited evidence exists regarding postpartum disease activity in spondyloarthritis or the influence of breastfeeding on inflammatory rheumatic conditions. Researchers therefore analysed disease activity, treatments, and breastfeeding patterns during postpartum follow-up.
Prospective Cohort Evaluation of Postpartum Outcomes
This ancillary analysis used data from the French multicentre prospective GR2 cohort between October 2014 and October 2022. Pregnant women with rheumatoid arthritis or spondyloarthritis who completed at least one postpartum visit were eligible. The study included 94 rheumatoid arthritis patients and 124 spondyloarthritis patients. Investigators evaluated disease activity, flare occurrence, biologic Disease-Modifying Antirheumatic Drug use, and breastfeeding duration. Breastfeeding groups were classified as never, less than 6 months, or at least 6 months. Primary outcomes included postpartum disease activity and flare frequency compared with pregnancy. Secondary outcomes included treatment continuation, biologic therapy restarting, and associations between breastfeeding and disease activity.
Postpartum Flares Increased in Rheumatoid Arthritis
Among rheumatoid arthritis patients, the proportion experiencing at least one flare during the first 6 months postpartum was significantly higher than during pregnancy, at 62.0% versus 43.5% (p=0.02). In contrast, spondyloarthritis patients showed no difference in disease activity at 6 months postpartum compared with pregnancy, with identical rates of 40.7% versus 40.7% (p=0.999). Disease activity during postpartum did not differ according to breastfeeding duration in either disease group. Continuation of biologic Disease-Modifying Antirheumatic Drugs throughout pregnancy and postpartum occurred in 13 of 91 rheumatoid arthritis patients (14.3%) and 29 of 123 spondyloarthritis patients (23.6%). Among those delivering without Disease-Modifying Antirheumatic Drugs, 43 of 78 rheumatoid arthritis patients (55.1%) and 56 of 94 spondyloarthritis patients (59.6%) restarted biologic therapy postpartum.
Implications for Postpartum Rheumatology Care
These findings suggest postpartum monitoring may be particularly important for rheumatoid arthritis patients because of elevated flare risk after delivery. Breastfeeding did not appear to worsen disease activity in either condition. Researchers highlighted the need for improved guidance regarding biologic therapy continuation and reintroduction during pregnancy and early postpartum management.
Reference
Hornez M et al. Impact of postpartum on patients with rheumatoid arthritis and spondyloarthritis: an ancillary analysis of the GR2 prospective cohort. RMD Open. 2026;12:e006593.
Featured image: Татьяна Ивашкова on Adobe Stock
