Thursday, 20 Feb 2020

You are here

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

Add new comment

More Like This

Overmedication of America

Recent research from the Lown Institute reports that 750 older Americans are hospitalized daily because of serious side effects from and the core problem is that of polypharmacy, especially in the elderly. 

Best of 2019 - Biologic Safety Guidelines from the British Society for Rheumatology

In the United Kingdom, NICE has looked to the British Society of Rheumatology (BSR) to develop evidence based guidance on the safe use of biologic DMARDs in patients with inflammatory arthritis. This guidance document on biologic safety covers baseline screening, monitoring, effect of co-morbidities, and when or under what circumstances biologic therapy should be interrupted.

Best of 2019 - Methotrexate and the Risk of Lung Disease

Rheumatology has a comprehensive overview of methotrexate (MTX) and the risk of lung injury, MTX-related pneumonitis and interstitial lung disease (RA-ILD) with rheumatoid arthritis (RA). Past reports suggest the frequence of MTX-pneumonitis to be between 0.3 and 11.6%; recent studies suggest it may be much lower.

No Cancer Risk with Systemic Necrotizing Vasculitis

The French Vasculitis Study Group has published that patients with systemic necrotizing vasculitis do not have an increased risk of malignancy; in fact they have a risk that is similar to the general population.

Previous reports have suggested either no risk or a declining risk in the era of better therapies for vasculitis. 

FDA Warns 15 CBD Manufacturers

Today, the U.S. Food and Drug Administration issued warning letters to 15 companies for illegally selling products containing cannabidiol (CBD) in ways that violate the Federal Food, Drug, and Cosmetic Act (FD&C Act).  This warning affirms that the FDA has not determined the many preparations of cannabidiol to be safe or effective.