Tuesday, 17 Sep 2019

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Fertility in RA Linked to Disease Activity, NSAIDs and Prednisone

Brouwer and colleagues from the University Medical Center Rotterdam in The Netherlands have studied the issue of infertility in a cohort of RA patients followed prospectively.  The PARA study included 245 women who were enrolled preconception or during the first trimester.

The primary outcome was a delay in the time to pregnancy (TTP), meaning >12 months to conceive. TTP was seen in 42% of 245 RA women followed. Longer TTP was related to age, nulliparity, disease activity, and preconception NSAID or prednisone use. Thus there was a 19% prolongation of TTP per point increase in DAS28. The impact of prednisone use was dose dependent, with significantly longer TTP when daily dose was >7.5 mg.

Factors not associated with infertility included smoking, disease duration, rheumatoid factor, anti-citrullinated protein antibodies, past methotrexate use, and preconception sulfasalazine.

Infertility is more prevalent in RA patients who are older or nulliparous, have higher disease activity, use NSAIDs or use prednisone >7.5 mg daily.

Optimal control of disease activity is necessary for those wishing to become pregnant.  The possible negative effects of NSAIDs use and higher prednisone doses should be considered as well.

The author has no conflicts of interest to disclose related to this subject

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