A modern therapeutic strategy including treat-to-target and the prescription of tumor necrosis factor inhibitors results in low disease activity or remission in 90% of pregnant individuals suffering from rheumatoid arthritis. 

An analysis was performed to assess the feasibility of a modern therapeutic strategy, including treat-to-target and the prescription of tumor necrosis factor inhibitors in individuals having rheumatoid arthritis who are pregnant or who have a desire to conceive.

From the Preconception Counseling in Active rheumatoid arthritis (PreCARA) cohort, the participants were derived. Subjects who are pregnant or have a desire to conceive were managed based on the modified treat-to-target approach. In this, the apparent pregnancy restrictions were considered. 

The findings of the PreCARA analysis were comparatively assessed with the findings of the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) analysis, a historic reference group on rheumatoid arthritis during pregnancy. Subjects in the PARA arm were managed based on the standards of that time (2002–2010). With the help of a linear mixed model, the between-group differences in disease activity over time were tested. 

Overall, 309 individuals suffering from rheumatoid arthritis were incorporated in the PreCARA analysis, 188 children were born. Overall, 47.3% of the patients used a tumor necrosis factor inhibitor at any time during pregnancy. The mean disease activity over time in PreCARA arm was reduced compared to the reference cohort. The percentage of participants in low disease activity or remission prior to pregnancy and in the third trimester in the PreCARA and PARA cohort is shown in the following table:

Patients can get pregnant with the tumor necrosis factor inhibitor they already used prior to pregnancy, and tumor necrosis factor inhibitors can be switched during pregnancy, without a rise in disease activity. 

In pregnant rheumatoid arthritis individuals, both remission and low disease activity are a feasible goal, with 90.4% of the participants in low disease activity in pregnancy's third trimester. In rheumatoid arthritis individuals with a desire to conceive or who are pregnant, healthcare professionals should strive for remission or low disease activity.