For clinicians

Juvenile idiopathic arthritis (in adulthood)

JIA, juvenile idiopathic arthritis, juvenile arthritis

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Bottom lineBottom line: adults with JIA generally have good pregnancy outcomes with preserved fertility. In the largest prospective cohort (RevNatus, 135 pregnancies), about 80% were in remission or had low activity throughout, with a characteristic early postpartum flare peaking at 6 weeks that calls for tight early-postpartum follow-up. Management mirrors adult inflammatory arthritis (compatible DMARDs and biologics; stop methotrexate/leflunomide pre-conception). Pre-existing joint damage matters practically: hip and pelvic involvement affects delivery planning, and cervical spine or temporomandibular involvement is relevant to anaesthetic assessment.

By domain

Will pregnancy affect my JIA? ●●○○low evidenceconditional

In the RevNatus prospective cohort (135 pregnancies, 114 women), almost 80% were in remission or had low DAS28-CRP3 activity from preconception to 12 months postpartum. Activity was low and stable overall but rose significantly by 6 weeks postpartum (2.78 vs 2.51 in the first trimester, P=0.005; vs 2.56 in the third trimester, P=0.011), then fell again by 12 months (2.78 vs 2.54, P=0.014). The mean change was small (0.27, below the >=1.2 meaningful threshold), but about 1 in 5 (22%) with paired data had a clinically meaningful postpartum flare, and EULAR remission fell from 72% to 53% between the first trimester and 6 weeks postpartum. The flare peaks early, at 6 weeks (earlier than the 6-month peak in the sister PsA cohort), and may even be underestimated here since biologic use roughly doubled after 6 weeks postpartum. This supports tight follow-up in the first weeks after delivery. Functionality was worst in late pregnancy, while self-reported mental health was good and slightly better at 6 weeks postpartum. DAS28-CRP3 is validated in pregnant RA, not specifically JIA, and RevNatus holds no JIA subtype data, so subtype-specific patterns are unknown.[3]

Pregnancy outcomes and fertility ●●○○low evidenceconditional

Fertility is generally preserved; outcomes are good, best with controlled disease at conception.[1]

Medicines ●●●○moderate evidenceconditional

As for adult inflammatory arthritis: compatible DMARDs and TNF inhibitors; discontinue methotrexate and leflunomide pre-conception.[1, 2]

Joints, delivery, and anaesthesia ●●○○low evidenceconditional

Assess hip and pelvic involvement for delivery planning, and cervical spine and temporomandibular involvement (microstomia, reduced neck mobility) for anaesthetic risk; arrange pre-anaesthetic review where relevant.[1]

Eye history ●●○○low evidenceconditional

A history of JIA-associated uveitis warrants continued ophthalmology input; treat flares with compatible therapy.[1]

Key points

PointEvidence
Damage-pattern assessment (hip/pelvis, cervical spine, TMJ) informs delivery and anaesthetic planning.[1]●●○○low evidenceconditional

References

  1. Sammaritano LR, et al. 2020 ACR Guideline for the Management of Reproductive Health in RMD. Arthritis Rheumatol. 2020;72(3):529-556. https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.41191
  2. Ruegg L, et al. EULAR recommendations for antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025;84(6):910-926. https://ard.eular.org/article/S0003-4967(25)00818-0/fulltext
  3. Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Disease Activity of Juvenile Idiopathic Arthritis during and after Pregnancy: A Prospective Multicenter Study. J Rheumatol. 2018;45(2):257-265. https://doi.org/10.3899/jrheum.161410