Contraception methods used by women with rheumatoid arthritis and psoriatic arthritis

Updating on pregnancy in rheumatoid arthritis

INTRODUCTION

Rheumatoid arthritis (RA), the most prevalent autoimmune disease in reproductive years, exhibits a higher incidence in females, suggesting involvement of estrogens, genetics and environmental factors in disease onset. Literature shows smaller families in RA patients, driving increased interest in Assisted Reproductive Techniques.

AREAS COVERED

This review elucidates how immunotolerance mechanisms contribute to favorable pregnancy outcomes in RA, emphasizing the need for a careful pregnancy planning to mitigate fetal complications and postnatal flares, which surpass those in the general population. A thorough medication evaluation, orchestrated by a multidisciplinary team, is imperative during pregnancy, weighing potential teratogenic effects against safer alternatives to balance medication safety with disease control. A systematic literature search on PubMed and MEDLINE, using specific terms, covered relevant academic journals up to the latest date.

EXPERT OPINION

This narrative review comprehensively addresses pregnancy-related considerations in RA patients, prioritizing meticulous disease management with pregnancy and breastfeeding-compatible drugs in line with the latest recommendations and registry data. The focus remains on evaluating glucocorticoids, conventional, and biological disease-modifying drugs for compatibility during pregnancy and breastfeeding. Additionally, the evolving landscape of targeted synthetic drugs during pregnancy is explored, providing insights into the latest developments in rheumatological care.

Patterns of contraceptive use through later reproductive years: A cohort study of Australian women with chronic disease

BACKGROUND

Pregnancies among women with chronic disease are associated with poor maternal and fetal outcomes. There is a need to understand how women use or don't use contraception across their reproductive years to better inform the development of preconception care strategies to reduce high risk unintended pregnancies, including among women of older reproductive age. However, there is a lack of high-quality longitudinal evidence to inform such strategies. We examined patterns of contraceptive use among a population-based cohort of reproductive aged women and investigated how chronic disease influenced contraceptive use over time.

METHODS AND FINDINGS

Contraceptive patterns from 8,030 women of reproductive age from the Australian Longitudinal Study on Women's Health (1973-78 cohort), who were at potential risk of an unintended pregnancy were identified using latent transition analysis. Multinomial mixed-effect logistic regression models were used to evaluate the relationship between contraceptive combinations and chronic disease. Contraception non-use increased between 2006 and 2018 but was similar between women with and without chronic disease (13.6% vs. 12.7% among women aged 40-45 years in 2018). When specific contraceptive use patterns were examined over time, differences were found for women with autoinflammatory diseases only. These women had increased odds of using condom and natural methods (OR = 1.20, 95% CI = 1.00, 1.44), and sterilisation and other methods (OR = 1.61, 95% CI = 1.08, 2.39) or no contraception (OR = 1.32, 95% CI = 1.04, 1.66), compared to women without chronic disease using short-acting methods and condoms.

CONCLUSION

Potential gaps in the provision of appropriate contraceptive access and care exist for women with chronic disease, particularly for women diagnosed with autoinflammatory conditions. Development of national guidelines as well as a clear coordinated contraceptive strategy that begins in adolescence and is regularly reviewed during care management through their main reproductive years and into perimenopause is required to increase support for, and agency among, women with chronic disease.

Pregnancy Outcumes and Contraceptive Use in Women with Rheumatoid Arthritis: A Comparative Study

Background. Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that has a female predominance and commonly affects women of childbearing age. It is shown to remit during pregnancy in most studies and improve in about half of the patients when assessed with objective disease activity measures.

Objective — to assess the pregnancy outcomes in women with RA prior and after the diagnosis and compare them with those in women with no chronic illness, to evaluate contraceptive practices and contraceptive method efficacy with the use of concomitant rheumatic medications (methotrexate, leflunomide).

Patients and Methods. Female patients diagnosed with RA according to ACR/EULAR 2010 classification criteria were compared with apparently healthy female controls matching in age in this case-control study. Data were collected by questionnaires and interviews. The questionnaires included demographic data and pregnancy outcomes, mode of delivery, contraceptive methods used by patients against the background of methotrexate and leflunomide therapy.

Results and discussion. One hundred patients with RA were included. The mean age of the patients and controls was 38.4±5.1 and 36.7±4.5 years, respectively. The live births significantly decreased in female patients with RA compared to the controls and the period before the diagnosis (p=0.01, p=0.002, respectively). Caesarean section frequency was higher in the control group compared to patients with RA (p=0.001). But in patients with RA, frequency of caesarean section increased after the diagnosis (p=0.021). Frequency of unplanned pregnancy significantly decreased after the diagnosis of RA compared to the period before the diagnosis (p<0.001). About 75.4% of patients had the desired number of children in their family before the diagnosis, and 24.6% feared the effect of RA on themselves and their children. 81% of 100 women with RA used methotrexate, 43.2% of them received rheumatological consultation regarding the contraceptive methods, and 56.8% did not. 30.86% of patients treated with methotrexate used ineffective contraceptive methods, 27.16% — long-acting reversible methods, 14.81% — effective contraceptive methods, and 24.69% did not use any contraceptive methods. 19% of RA patients used leflunomide, and 73.7% of them received rheumatological consultation regarding the type of contraceptive methods, 36.84% used effective methods of contraception, 31.58% — long-acting reversible methods, 15.79% — ineffective contraceptive methods and 15.79% did not use any contraceptive methods.

Conclusion. There is a decrease in live births and an increase in preterm birth frequency as well as caesarean sections in Iraqi female patients with RA. There is lack of knowledge about the importance of contraceptive methods efficacy in relation to teratogenic medications (methotrexate, and leflunomide).

Contraceptive Use in Women of Childbearing Ability With Rheumatoid Arthritis

BACKGROUND/OBJECTIVE

Rheumatoid arthritis (RA) is a complex disease that may require treatment with one or several disease-modifying antirheumatic drugs (DMARDs). Many DMARDs have potential teratogenic effects or are newer agents with limited safety data in pregnancy. This study evaluated 20 common RA medications and the rate of contraceptive prescribing and counseling patterns in women with RA of childbearing ability.

METHODS

This was an observational study of women with RA and childbearing ability aged 18 to 44 years who were seen at an academic rheumatology clinic from April 1, 2014, to March 31, 2016. Descriptive statistics and univariate logistic regression were used for analysis.

RESULTS

One hundred fifty women were included in the analysis. The majority of patients were taking methotrexate (55.3%), followed by chronic prednisone (31.3%) and hydroxychloroquine (28.7%). A documented method of contraception was noted in 64/150 (42.7%). For women on contraception, most used combined oral contraceptives (31/64, 48.4%) or levonorgestrel intrauterine device (10/64, 15.6%). Of the 86 patients not on contraception, 19 (22.1%) received counseling regarding a pregnancy plan.

CONCLUSIONS

Most women with RA of childbearing age and ability were not using contraception. Among these patients, only a minority prescribed DMARD therapy had documented pregnancy or contraceptive counseling. Women with RA who were prescribed with a DMARD should discuss the use of effective contraception with their provider if sexually active and not desiring pregnancy or wanting to avoid potential teratogenic effects. Potential strategies are discussed to improve healthcare delivery to this population in hopes of avoiding unintended pregnancy and potential teratogenic effects of RA medications.

Fertility and infertility implications in rheumatoid arthritis; state of the art

BACKGROUND

A bulk of investigations imply that women with rheumatoid arthritis (RA) deliver fewer children in comparison to healthy women.

PURPOSE

This review article attempts to clarify the involvement of infertility-related issues in both RA men and women. Moreover, the effect of RA disease on the fertility quality and quantity will be discussed.

RESULTS

Declined fertility rate in RA women seems to stem from modified inflammatory settings, advanced maternal age, limited sexual activity, and adverse effects of drugs on ovarian function. Women with RA may have smaller families and seem to be slower to conceive relative to their peer women. The chance of gestation in RA women may drop due to suppressed sexual function through pain and fatigue. In addition, treatment of RA women with non-steroidal anti-inflammatory drugs (NSAIDs) may prevent ovulation and therefore hinder the conception.

CONCLUSIONS

A complex interaction between RA disease and fertility related issues is present. Despite an increase rate of infertility in RA females or males, the mechanisms involved in this outcome is still unknown. Plausible causes of the decreased fertility rate in RA patients might be due to inflammatory cytokines, suppressed sexual activity, drug treatments, mother age, personal choice, or a combination of these elements.