In this PhD thesis, embedded in the PARA (Pregnancy-induced Amelioration of Rheumatoid Arthritis) study, several clinical aspects of the spontaneously occurring pregnancy-induced improvement of rheumatoid arthritis (RA) are addressed. An overview is given of inflammatory rheumatic diseases and the current knowledge about their disease courses and treatment options during pregnancy and postpartum. This thesis focuses firstly on the description of tools to objectively measure the disease activity and functionality of RA before, during and after pregnancy. Associations with the disease course and patient’s characteristics are subsequently made. The influence on the pregnancy outcome of both disease activity and treatment of RA with prednisone, are assessed regarding pregnancy durations and birth weight. Postpartum however RA tends to flare again. The problems which patients with RA will encounter in parental function, while nursing their babies, are addressed.

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Keywords disease activity score, parenting disability index, pharmacological treatment, pregnancy, pregnancy outcome, rheumatoid arthritis
Promotor J.M.W. Hazes (Mieke)
Publisher Erasmus University Rotterdam
Sponsor Financial support for the publication of this thesis was kindly provided by the Dutch ArthritisAssociation (Reumafonds), ABBOTT B.V., Roche Nederland B.V., Schering-Plough B.V.,Wyeth Pharmaceuticals, and the Department of Rheumatology, Erasmus MC, UniversityMedical Center Rotterdam.
ISBN 978-90-814216-1-4
Persistent URL
de Man, Y.A. (2009, July). Clinical Aspects of Pregnancy-induced Amelioration of Rheumatoid Arthritis: PARA-study. Erasmus University Rotterdam. Retrieved from