Family Planning, Fertility, and Rheumatoid Arthritis

As treatment options continue to evolve and rheumatoid arthritis (RA) becomes less disabling, more women with the disease may choose to pursue pregnancy. However, meeting the family planning needs of these patients requires frank discussion and careful coordination.

For as many as 42% of female patients with RA diagnosed with the disease before family completion, the time to pregnancy exceeds 12 months, as compared with only 10% to 17% of the general population.¹ Because antirheumatic treatment has to be adjusted for most women with RA before they start trying to conceive, a longer time to pregnancy can mean prolonged periods with less adequate RA control and an increased risk for permanent joint damage.¹ Understanding the underlying mechanisms of subfertility in patients with RA and treating those mechanisms whenever possible is an important step forward in the care of patients with RA who are planning to grow their families.

“Women with RA who wish to become pregnant may be reassured that many women with RA have successful pregnancies, particularly when their diseases are well controlled at the time of conception,” says Nicole Hunt of the Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh.²

Reasons for Reduced Family Size With RA

Research has shown that for more than 60 years women with RA have had smaller families and higher rates of nulliparity than women without the disease.² In a Dutch study of 245 women with RA, 42% reported a delay of more than 12 months to conception.³

Reasons that women with RA have trouble growing their families include^2,3:

• higher rates of miscarriage;

• physical disability that limits sexual activity;

• maternal age;

• menstrual irregularity;

• disease activity;

• reduced levels of anti-Mullerian hormone, which is an indicator for ovarian reserve in women;

• daily dose of prednisolone higher than 7.5 mg.

• use of non-steroidal anti-inflammatory drugs (NSAIDs);

• ovulatory dysfunction; and

• endometriosis.

This article originally appeared on Rheumatology Advisor