What factors affect fertility in women with rheumatoid arthritis?

This study investigated why women with rheumatoid arthritis often have difficulty getting pregnant.

Rheumatoid arthritis is one of the most common inflammatory disease to affect women of childbearing age. For many female rheumatoid arthritis patients getting pregnant can be difficult and it can often take longer than 12 months. Rheumatoid arthritis patients also tend to have less children and use more fertility treatment than women without rheumatoid arthritis.  The reason for decreased fertility in rheumatoid arthritis patients is unclear but may be due to disease activity or medication.

This study included 245 women with rheumatoid arthritis. All patients were trying to get pregnant or were in the first 12 weeks of pregnancy. The authors analyzed links between various disease characteristics or medication use and prolonged time to get pregnant.

84% of patients were able to get pregnant. Of these patients, 31% took longer than 12 months to get pregnant. A number of factors were linked to an increased risk of delayed time to pregnancy.

The risk of delayed time to pregnancy increased by 4% for every year older a patient was. Women who had never been pregnant before had a 48% higher risk of delayed time to pregnancy. Women taking non-steroidal anti-inflammatory drugs (for example Advil, Nurofen) had a 34% higher risk of delayed time to pregnancy and women taking glucocorticoids (for example Deltasone, Sterapred) had a 39% higher risk. It took longer for patients taking more than 7.5 mg of glucocorticoids every day to get pregnant than patients taking lower doses.

Smoking, disease duration or past use of methotrexate (Trexall, Rheumatrex) did not affect how long it took women to get pregnant.

The authors concluded that treatment strategies for women before they get pregnant need to reduce disease activity. They also suggest that treatment should take into account the negative effect of anti-inflammatory drugs.