PhD defence H.W.T. (Jeroen) Smeele

Brief summary of the doctoral thesis:

Rheumatoid arthritis (RA) is one of the most common chronic conditions in women of childbearing age. Getting pregnant and being pregnant with a chronic disease like RA has its own specific challenges. Previous research showed that high disease activity of RA makes it more difficult for women to get pregnant and there is a higher risk of pregnancy complications. Moreover, treating women with RA who want to get pregnant or are pregnant is challenging. Indeed, key drugs commonly used to treat RA, such as methotrexate (MTX), are teratogenic. Older studies also show that up to half of all women with RA have active disease during pregnancy, resulting in harm to the mother and child. This thesis aimed to investigate whether the treatment of RA in the period before, during and after pregnancy could be improved. This was done primarily by investigating a treatment strategy, aimed at maximum suppression of disease activity, in women with a desire to have children, during pregnancy and in the postpartum period. This treatment is already common in the treatment of RA in non-pregnant women. In addition, it was examined whether certain commonly used questionnaires and laboratory determinations are useful in the treatment of pregnant women with RA. Finally, the study looked at whether improvements in treatment were also possible in the period after birth.