Infertility in Rheumatoid Arthritis Linked to Disease Activity Save

Women with rheumatoid arthritis are said to have a normal number of pregnancies. However, most of these are conceived prior to the onset of RA. Once diagnosed, the RA patient who wishes to become pregnant may be faced with difficult medication choices if she is planning to become pregnant.

The PARA study is a prospective observational cohort study from the Netherlands.  245 RA women were enrolled preconception or during the first trimester. Fertility was assessed as the time to pregnancy (TTP). Those with a TTP >12 months were deemed subfertile. (Citation source http://buff.ly/1L7t2oA)

Overall, 42% of patients had a TTP that exceeded 12 months. Longer TTP was related to age, nulliparity, disease activity (and preconception use of NSAIDs and prednisone. These variables were independently associated with subfertility. The impact of prednisone use was dose dependent, with significantly longer TTP when daily dose was >7.5 mg. Smoking, disease duration, rheumatoid factor, anti-citrullinated protein antibodies, past methotrexate use, and preconception sulfasalazine use did not affect fertility.

Fertility was more likely in RA if patients are older or nulliparous, have high disease activity, use NSAIDs or use prednisone >7.5 mg daily. Hence, the ideal candidates for conception are those with well-controlled, low disease activity RA on the fewest medications.