Fertility in RA Linked to Disease Activity, NSAIDs and Prednisone Save

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.