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Kwok A. Risk Assessment and Optimization for Pregnancy in Patients with Rheumatic Diseases. Diagnostics (Basel) 2024; 14:1414. [PMID: 39001304 PMCID: PMC11241172 DOI: 10.3390/diagnostics14131414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/13/2024] [Accepted: 06/16/2024] [Indexed: 07/16/2024] Open
Abstract
Patients with rheumatic diseases frequently operate with incomplete or incorrect information while planning for and experiencing pregnancy, often due to variability in provider care and knowledge. Risk assessment at each stage of pregnancy-pre-conception, during pregnancy, and postpartum-is focused on reducing maternal and neonatal complications. This review aims to compile updated, evidence-based guidance on how to minimize risk factors contributing to adverse pregnancy outcomes (APOs). Mitigation of known causes of infertility, appropriate testing and monitoring, achieving low disease activity on pregnancy-safe disease-modifying antirheumatic drugs (DMARDs) prior to conception, controlling hypertension (a frequent comorbidity among patients with certain rheumatic diseases), and the use of appropriate adjunctive medications (such as low-dose aspirin when preeclampsia risk is high) can optimize fertility and prevent adverse maternal and neonatal outcomes.
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Affiliation(s)
- Alyssa Kwok
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Austin, TX 78712, USA
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Sigmo GD, Hauge S, Hufthammer KO, Wallenius M, Salvesen KÅ, Daltveit AKN, Bakland G, Fevang BTS. Male patients with inflammatory joint diseases are less likely than controls to be childless: results from a Norwegian population-based cohort study of 10 865 patients. Ann Rheum Dis 2024; 83:457-463. [PMID: 38262688 PMCID: PMC10958328 DOI: 10.1136/ard-2023-224998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To investigate the number of children per man and the proportion of childless men as a proxy of fertility in a national cohort of men with inflammatory joint diseases (IJDs), compared with matched controls from the general population. METHODS This is a nationwide, population-based retrospective cohort study. Male patients with IJDs (n = 10 865) in the Norwegian Arthritis Registry were individually matched 1:5 on birth year and county of residence with men without IJDs obtained from the National Population Register (n = 54 325). Birth data were obtained from the Medical Birth Registry of Norway. We compared the mean number of children per man and the proportion of childless men and analysed the impact of age and year of diagnosis. RESULTS The mean number of children per man in the patient group was 1.80 versus 1.69 in the comparison group (p <0.001), and 21% of the patients in the patient group were childless versus 27% in the comparison group (p <0.001). The finding of less childlessness and higher number of children per man remained consistent across age at diagnosis, except for those diagnosed at age 0-19 years. The difference in childlessness was most pronounced for men diagnosed after year 2000, especially when diagnosed at 30-39 years of age (22% vs 32%, p<0.001). CONCLUSION In this large cohort study we found that patients with IJD have a higher number of children and are less likely to be childless compared with controls. Factors associated with developing or having an IJD might influence fertility and this requires further investigation.
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Affiliation(s)
- Gudrun David Sigmo
- Department of Rheumatology, Stavanger University Hospital, Stavanger, Norway
| | - Solveig Hauge
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Marianne Wallenius
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Kjersti Nesje Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
- Department of Rheumatology, University of Tromsø, Tromsø, Norway
| | - Bjorg-Tilde Svanes Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Chung MK, Lee CH, Park JS, Lim HS, Lee J. Incidence and prevalence of seropositive rheumatoid arthritis among Korean women of childbearing age: a nationwide population-based study. Korean J Intern Med 2023; 38:125-133. [PMID: 35581954 PMCID: PMC9816689 DOI: 10.3904/kjim.2021.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/26/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND/AIMS Women with rheumatoid arthritis (RA) are often diagnosed with the disease during their reproductive years; however, its incidence and prevalence among women of childbearing age have not been studied. The objective of this study was to estimate the incidence and prevalence of seropositive rheumatoid arthritis (SPRA) among Korean women of childbearing age. METHODS Women aged 20 to 44 years with SPRA were identified from National Health Insurance Service-National Health Information Database (2009 to 2016). SPRA was defined by International Classification of Diseases, 10th revision code, M05. Incidence and prevalence were calculated per 100,000 person-years and stratified by year and age. RESULTS The average incidence and prevalence of SPRA from 2011 to 2016 among women of childbearing age was 24.1/100,000 person-years (95% confidence interval [CI], 23.7 to 24.5) and 105.2/100,000 person-years (95% CI, 100.9 to 109.5), respectively. The incidence increased annually from 21.0/100,000 person-years (95% CI, 20.1 to 21.9) in 2009 to 28.4 person-years (95% CI, 27.3 to 29.5) in 2016. Similarly, the prevalence increased annually from 95.7/100,000 person-years (95% CI, 93.7 to 97.6) in 2009 to 111.0 person-years (95% CI, 108.9 to 113.2) in 2015, with a slight decrease in 2016 (110.4 person-years; 95% CI, 108.2 to 112.6). The incidence and prevalence of SPRA increased with advancing age. The peak age for both incidence and prevalence of SPRA among women of childbearing age was 40 to 44 years. CONCLUSION The risk of SPRA is high in women during their childbearing years; this population bears a significant disease burden. This calls for special attention to this particular population group to reduce the risk and burden of this disease.
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Affiliation(s)
- Min Kyung Chung
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul,
Korea
| | - Chan Hee Lee
- Division of Rheumatology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Jin Su Park
- Division of Rheumatology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Hyun Sun Lim
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul,
Korea
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Scime NV, Hetherington E, Metcalfe A, Chaput KH, Dumanski SM, Seow CH, Brennand EA. Association between chronic conditions and urinary incontinence in females: a cross-sectional study using national survey data. CMAJ Open 2022; 10:E296-E303. [PMID: 35383034 PMCID: PMC9259416 DOI: 10.9778/cmajo.20210147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Urinary incontinence affects up to half of women, yet few speak to their health care provider about or receive treatment for the condition. To aid with identifying subpopulations at risk for urinary incontinence, we examined the associations between 10 chronic health conditions and urinary incontinence among Canadian adult females. METHODS We conducted a cross-sectional analysis of survey data from the Canadian Community Health Survey (2013-2014) involving female respondents aged 25 years or older living in a private dwelling. Presence of chronic conditions and urinary incontinence were measured by self-report. We used logistic regression modelling with sampling weights, controlling for age, income, ethnicity, body mass index and smoking. Multiple imputation and probabilistic bias analysis were used to address missing covariate data and unmeasured confounding from parity. RESULTS Our analysis included 60 186 respondents representing more than 12 million Canadian females, of whom 45.8% (95% confidence interval [CI] 45.0%-46.6%) reported at least 1 chronic condition. Chronic conditions were associated with more than twice the odds of urinary incontinence (adjusted odds ratio [OR] 2.42, 95% CI 2.02-2.89). Associations were largest for bowel disorders (adjusted OR 2.92, 95% CI 2.44-3.49); modest for chronic obstructive pulmonary disease (adjusted OR 2.00, 95% CI 1.63-2.45), asthma (adjusted OR 1.82, 95% CI 1.52-2.19), arthritis (adjusted OR 1.98, 95% CI 1.74-2.24) and heart disease (adjusted OR 1.73, 95% CI 1.48-2.02); and smallest for diabetes (adjusted OR 1.20, 95% CI 1.02-1.41) and high blood pressure (adjusted OR 1.27, 95% CI 1.12-1.44). Results slightly attenuated but did not substantively change after imputation and bias analysis. INTERPRETATION We found that chronic conditions are associated with significantly higher odds of comorbid urinary incontinence among Canadian adult females, which is consistent with previous research. Our findings support routine inquiry regarding urinary incontinence symptoms among women accessing health care for chronic conditions.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin Hetherington
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Amy Metcalfe
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Kathleen H Chaput
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Sandra M Dumanski
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Cynthia H Seow
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin A Brennand
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta.
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Hamroun S, Hamroun A, Bigna JJ, Allado E, Förger F, Molto A. Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 61:1314-1327. [PMID: 34297033 DOI: 10.1093/rheumatology/keab589] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the impact of spondyloarthritis (SpA) and its treatments on fertility and pregnancy outcomes, as well as the impact of pregnancy on disease activity. METHODS A systematic review and meta-analyses were performed, including studies in women with SpA (axial (axSpA) and peripheral SpA, including psoriatic arthritis (PsA)). The heterogeneity between studies was quantified (I2), and in case of substantial heterogeneity, the results were reported in a narrative review. RESULTS Within 4397 eligible studies, 21 articles were included, assessing overall 3566 patients and 3718 pregnancies compared to 42264 controls. Fertility suffers from a lack of data in the literature. We found an increased risk of preterm birth (pooled OR 1,64 [1,15-2,33], I2 =24% in axSpA and 1,62 [1,23-2,15], I2 =0,0% in PsA), small for gestational age (pooled OR 2,05, [1,09-3,89], I2 =5,8% in axSpA), preeclampsia (pooled OR 1,59, [1,11-2,27], I2 =0% in axSpA) and caesarean section (pooled OR 1,70 [1,44-2,00], I2 =19,9% in axSpA and 1,71 [1,14-2,55], I2 =74,3% in PsA), without any other unfavourable pregnancy outcome. Further analysis showed a significant higher risk for elective caesarean (pooled OR 2,64, [1,92-3,62], I2 =0,0% in axSpA and 1,47, [1,15-1,88], I2 =0,0% in PsA), without increased risk for emergency caesarean in PsA. During pregnancy, there appears to be a tendency for unchanged or worsened disease activity in axSpA and unchanged or improved disease activity in PsA. Both conditions tend to flare in postpartum period. CONCLUSION SpA seems to be associated with an increased risk of preterm birth, small for gestational age, preeclampsia, and caesarean section.
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Affiliation(s)
- Sabrina Hamroun
- Rheumatology Department, Cochin Hospital (AP-HP), rue du Faubourg Saint-Jacques, F-75014 Paris, France
| | - Aghilès Hamroun
- Lille University, University Hospital Center of Lille, rue Michel Polonovski, F-59037 Lille, France
| | - Jean-Joël Bigna
- School of Public Health, University Hospital of Le Kremlin-Bicêtre, rue du Général Leclerc, F-94270 Le Kremlin-Bicêtre, France
| | - Edem Allado
- Rheumatology Department, University Hospital of Nancy, Rue du Morvan, F-54500 Vandœuvre-lès-Nancy, France
| | - Frauke Förger
- University Hospital and University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Anna Molto
- INSERM (U-1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-City, rue du Faubourg Saint-Antoine, F-75014 Paris, France
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Bruze G, Askling J, Horne A, Neovius M. Juvenile Idiopathic Arthritis, Marriage and Parenthood: A Nationwide Matched Cohort Study. Rheumatology (Oxford) 2021; 61:1228-1232. [PMID: 34247241 PMCID: PMC8889284 DOI: 10.1093/rheumatology/keab536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To compare trajectories of marriage and parenthood in individuals with JIA vs the general population. Methods Patients with JIA (n = 4399) were identified in the Swedish National Patient Register (2001–2016) and individually matched to up to five general population comparators on birthyear, sex and residence county (n = 21 981). Marriage and parenthood data were retrieved from the Total Population Register from age 18 y, and parenthood from the Multigeneration Register from age 15 y, respectively. Hazard ratios (HRs) were estimated using Cox regression adjusted for parental education, parental marital status and number of siblings. Results During a median of 6.3 years of follow-up, 362 patients with JIA and 1744 comparators got married (12.9 vs. 12.5 per 1000 person-years; HR 1.03, 95%CI 0.93-1.15). During a median of 8.8 years of follow-up, 680 patients with JIA and 3477 matched comparators became parents (17.1 vs 17.8 per 1000 person-years; HR 0.94, 95%CI 0.87-1.01). In the subgroup of patients with systemic onset JIA (SJIA), the adjusted hazard ratios for marriage and parenthood were 0.79 (95%CI 0.53-1.17) and 0.73 (95%CI 0.55-0.97), respectively. Conclusion The times to first marriage and first parenthood are similar for patients with JIA and the general population, suggesting that adolescents with JIA transition into family life along a trajectory resembling their community peers. One exception is the subgroup of patients with systemic onset JIA, who become parents for the first time at a lower rate than general population comparators.
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Affiliation(s)
- Gustaf Bruze
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - AnnaCarin Horne
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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Nørgård BM, Catalini L, Jølving LR, Larsen MD, Friedman S, Fedder J. The Efficacy of Assisted Reproduction in Women with a Wide Spectrum of Chronic Diseases - A Review. Clin Epidemiol 2021; 13:477-500. [PMID: 34194244 PMCID: PMC8236837 DOI: 10.2147/clep.s310795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
Assisted reproductive technology (ART) treatments in women with underlying chronic diseases have become increasingly frequent. The objective of this review is to provide an overview of the literature examining the chance of having a live born child after ART in women with chronic diseases, compared to other women receiving ART. We focused on some of the most prevalent chronic diseases in women during their reproductive years, ie ulcerative colitis, Crohn's disease, rheumatoid arthritis, multiple sclerosis, epilepsy, hyperthyroidism, hypothyroidism, and diabetes mellitus. Secondly, we studied the chance of successful implantation. The literature search was performed in the database Pubmed.gov. including all studies published before October 2020. Title and abstracts of 58 papers were reviewed, 37 papers were excluded and other 8 studies were excluded after full-text evaluation. Only 13 papers were eligible for review. Results indicate that women with ulcerative colitis, Crohn's disease, rheumatoid arthritis, hyperthyroidism, and diabetes mellitus type 2 might have problems with low implantation rate or early embryo development during ART. On the contrary, the few studies on women with hypothyroidism, diabetes mellitus type 1, and epilepsy suggest an equivalent chance of a live birth compared to other women undergoing ART. A possible explanation behind these differences could reside in the disease-specific dysregulation of the innate or adaptive immune system. To our knowledge, this is the first review on ART in women with chronic diseases, and it has disclosed that the evidence in this area is indeed sparse. We encourage others to examine live birth after ART in women with chronic diseases.
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Affiliation(s)
- Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laura Catalini
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Due Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sonia Friedman
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jens Fedder
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Cavalcante AFDS, Martin P, Skare TL. Gynecological/Obstetric Background and Rheumatoid Arthritis: A Cross-sectional Study in Brazilian Patients. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:357-361. [PMID: 34077986 PMCID: PMC10304980 DOI: 10.1055/s-0041-1729149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To study a sample of rheumatoid arthritis (RA) patients for their gynecological/obstetric history and compare them to controls to determine their influences on number of pregnancies, menarche, menopause and reproductive years following RA onset. METHODS This is a cross-sectional study of 122 RA patients and 126 controls. Patients and controls were questioned about age of menarche, age of menopause, number of pregnancies and abortions. Reproductive years were calculated as the difference between age at menopause and age at menarche. For comparison, we used the Mann-Whitney, unpaired t, chi-squared, and Spearman tests. The adopted significance was 5%. RESULTS In the RA patients with disease beginning in the postmenopausal years, the period of reproductive years (age at menopause - age of menarche) showed a positive correlation with age at disease onset (rho = 0.46; 95% confidence interval [CI] = 0.20-0.55 with p = 0.0008). The number of pregnancies was higher in patients with postmenopausal disease onset when compared with those with premenopausal disease onset (median of 3 with interquartile range [IQR] = 2-4 versus median of 2 with IQR = 1-3; p = 0.009), and RA patients had more pregnancies than controls (p = 0.0002). CONCLUSION The present study shows that, in our population, the duration of reproductive years and the number of pregnancies are linked to the onset of RA.
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Valdeyron C, Soubrier M, Pereira B, Constantin A, Morel J, Gaudin P, Combe B, Gremeau AS, Dejou-Bouillet L, Pouly JL, Sapin V, Oris C, Brugnon F. Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort. Rheumatology (Oxford) 2021; 60:1863-1870. [PMID: 33147613 DOI: 10.1093/rheumatology/keaa535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/10/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation. METHODS Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n = 102; 18-37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit. RESULTS A gradual decrease in patients' serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (DAS28: r = -0.27, P = 0.003; CRP: r = -0.16, P = 0.06). CONCLUSION This is the first study to determine serum AMH levels of a large cohort of RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled. CLINICALTRIALS.GOV IDENTIFIER NCT03666091.
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Affiliation(s)
- Camille Valdeyron
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Martin Soubrier
- Rheumatology, CHU Gabriel-Montpied, Clermont-Ferrand University, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, France
| | | | - Jacques Morel
- Rheumatology, CHU Montpellier, Montpellier University, France
| | - Philippe Gaudin
- Rheumatology, Sud Echirolles Hospital, CHU Grenoble Alpes, France
| | - Bernard Combe
- Rheumatology, CHU Montpellier, Montpellier University, France
| | - Anne Sophie Gremeau
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Lydie Dejou-Bouillet
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Jean Luc Pouly
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic, CHU Clermont-Ferrand, France
| | - Charlotte Oris
- Biochemistry and Molecular Genetic, CHU Clermont-Ferrand, France
| | - Florence Brugnon
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France.,UCA, IMoST - INSERM 1240, Faculty of Medicine, Clermont-Ferrand University, France
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Ledón-LLanes L, Contreras-Yáñez I, Guaracha-Basáñez G, Valverde-Hernández SS, González-Marín A, Ballinas-Sánchez ÁDJ, Durand M, Pascual-Ramos V. Views of Mexican outpatients with rheumatoid arthritis on sexual and reproductive health: A cross-sectional study. PLoS One 2021; 16:e0245538. [PMID: 33507948 PMCID: PMC7842945 DOI: 10.1371/journal.pone.0245538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) impacts sexual and reproductive health (SRH), which is a prominent component of a patient´s quality of life and highly influenced by the cultural background. The aim of the study was to explore the interest of Mexican outpatients with RA in SRH and to examine patient view on SRH. METHODS This cross-sectional study surveyed 303 consecutive outpatients with RA on their perceptions of SRH importance, SRH satisfaction, access to SRH information, preferences regarding SRH communication with healthcare professionals, and understanding of SRH (qualitative open-ended descriptions). Descriptive statistics and inferential analysis were used. Patient knowledge of each dimension of SRH was rated based on pre-specified criteria. Two assessors assigned ten major themes to each patient´s description of both dimensions of SRH. RESULTS Patients perceived their SRH as an important component of their general health and wished to address the topic, although few had access to such communication. Female patients assigned lesser importance to SRH, showed lesser degree of satisfaction with SRH, and expressed preference for a truthful physician. Age showed a linear association with individual survey responses, except for satisfaction with reproductive health dimension. There was a linear association between increased age and decreased years of formal education with a lower level of SRH knowledge. Ten major themes emerged for each of the two dimensions of the SRH construct, although most individual descriptions were assigned to one or two major themes. CONCLUSIONS Further education and assessment of SRH in Mexican patients with RA is warranted.
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Affiliation(s)
- Loraine Ledón-LLanes
- Department of Biology of Reproduction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Salvador Saúl Valverde-Hernández
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anayanci González-Marín
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ángel de Jesús Ballinas-Sánchez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Durand
- Department of Biology of Reproduction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Nathan NO, Mørch LS, Wu CS, Olsen J, Hetland ML, Li J, Rom AL. Rheumatoid arthritis and risk of spontaneous abortion: a Danish nationwide cohort study. Rheumatology (Oxford) 2021; 59:1984-1991. [PMID: 31776579 DOI: 10.1093/rheumatology/kez565] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To investigate the influence of RA or preclinical RA on the risk of spontaneous abortion (SA) while taking age and duration of RA into consideration. METHODS By linkage of data from Danish national registries, we established a nationwide cohort of pregnancies in Denmark from 1 January 1977 to 31 December 2014. We used multiple logistic regression to estimate; odds ratios (OR) for SA in women with RA or preclinical RA, compared with women without, and OR for SA by maternal age in women with RA or preclinical RA. RESULTS A total of 2 612 529 pregnancies were included. Women aged <35 years diagnosed with RA <5 years before pregnancy had an increased risk of SA (OR = 1.25 95% CI: 1.07, 1.48), compared with women without RA aged <35. Women at the same age diagnosed with RA ≥5 years before pregnancy had an OR of 1.14 (0.96-1.34), compared with women without. Among women with RA aged ≥35 years and women with preclinical RA at time of pregnancy, no increased risk of SA was found. The risk of SA increased by maternal age in both women with RA, preclinical RA and in women without. CONCLUSION Among women aged <35 years, the risk of SA was higher in women with RA compared with women without. After the age of 35 years, the risk of SA was no different from that among women without RA, even though the risk of SA increased with increasing age.
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Affiliation(s)
- Nina O Nathan
- Department of Obstetrics, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen.,Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Lina S Mørch
- Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Chun S Wu
- Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense
| | - Jørn Olsen
- Department of Clinical Epidemiology, University of Aarhus, Aarhus, Denmark.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Merete L Hetland
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Rigshospitalet, Glostrup.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jiong Li
- Department of Clinical Epidemiology, University of Aarhus, Aarhus, Denmark
| | - Ane L Rom
- Department of Obstetrics, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen.,Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen
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12
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Yao Y, Cai X, Fei W, Ren F, Wang F, Luan X, Chen F, Zheng C. Regulating Gut Microbiome: Therapeutic Strategy for Rheumatoid Arthritis During Pregnancy and Lactation. Front Pharmacol 2020; 11:594042. [PMID: 33343364 PMCID: PMC7748111 DOI: 10.3389/fphar.2020.594042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation and bone destruction. Microbial infection is considered to be the most important inducement of RA. The pregnancy planning of women in childbearing age is seriously affected by the disease activity of RA. Gut microbiome, related to immunity and inflammatory response of the host. At present, emerging evidence suggested there are significant differences in the diversity and abundance of gut microbiome during pregnancy and lactation, which may be associated with the fluctuation of RA disease activity. Based on these research foundations, we pioneer the idea of regulating gut microbiome for the treatment of RA during pregnancy and lactation. In this review, we mainly introduce the potential treatment strategies for controlling the disease activity of RA based on gut microbiome during pregnancy and lactation. Besides, we also briefly generalize the effects of conventional anti-rheumatic drugs on gut microbiome, the effects of metabolic changes during pregnancy on gut microbiome, alteration of gut microbiome during pregnancy and lactation, and the effects of anti-rheumatic drugs commonly used during pregnancy and lactation on gut microbiome. These will provide a clear knowledge framework for researchers in immune-related diseases during pregnancy. Regulating gut microbiome may be a potential and effective treatment to control the disease activity of RA during pregnancy and lactation.
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Affiliation(s)
- Yao Yao
- Department of Pharmacy, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyu Cai
- Department of Pharmacy, Hangzhou First People's Hospital, Hangzhou, China
| | - Weidong Fei
- Department of Pharmacy, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fujia Ren
- Department of Pharmacy, Hangzhou Women's Hospital, Hangzhou, China
| | - Fengmei Wang
- Department of Pharmacy, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaofei Luan
- Department of Pharmacy, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengying Chen
- Department of Pharmacy, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Caihong Zheng
- Department of Pharmacy, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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13
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Bourg M, Ruyssen-Witrand A, Bettiol C, Parinaud J. Fertility and sexuality of women with inflammatory arthritis. Eur J Obstet Gynecol Reprod Biol 2020; 251:199-205. [PMID: 32540625 DOI: 10.1016/j.ejogrb.2020.05.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of the four main types of inflammatory arthritis (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PA), juvenile chronic arthritis (JCA)) on female fertility. DESIGN We performed a monocentric observational study, which took place in the Reproductive Medicine Department and the Rheumatology Department of the Toulouse University Hospital. An anonymous questionnaire was sent to patients aged 18-50 with RA, AS, PA or JCA who were diagnosed before the age of 40 and who consented to participate in the study. A section of the questionnaire was completed using the medical file of each patient. RESULTS Of the 521 eligible patients, 202 (39 %) answered the questionnaire. Before being diagnosed with a rheumatic disease, 87 % of patients with a desire for pregnancy had a spontaneously obtained live birth, compared to 75 % after (P < 0.05). However, this decrease only concerned RA (90 % before diagnosis vs 68 % after; P < 0.05). This difference was due to a lower rate of pregnancies achieved, but the number of miscarriages did not increase. Moreover, for patients who managed to conceive, the time required for conception did not increase, regardless of the type of rheumatic disease they had. Two thirds of patients reported a decrease in the frequency of sexual intercourse after diagnosis, mainly (75 %) because of the pain relating to the disease. CONCLUSION Our study shows a trend of decreased fertility in patients with RA, perhaps due to sexual problems, while no impact of AS and PA on the ability to conceive was found. This impact on fertility didn't seem to be related to the decrease of sexuality. Multidisciplinary care including treatment from a rheumatologist, gynecologist and sexologist would appear essential in order to provide RA patients with the necessary information concerning their fertility, answer their questions about pregnancy and thus optimize their care.
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Affiliation(s)
- Mona Bourg
- Department of Reproductive Medicine, Toulouse University Hospital, France
| | | | - Célia Bettiol
- Department of Reproductive Medicine, Toulouse University Hospital, France
| | - Jean Parinaud
- Department of Reproductive Medicine, Toulouse University Hospital, France; Groupe de Recherche en Fertilité Humaine (Human Fertility Research Group) EA 3694, Université Paul Sabatier, Toulouse, France.
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14
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Fertility and infertility implications in rheumatoid arthritis; state of the art. Inflamm Res 2020; 69:721-729. [PMID: 32458007 DOI: 10.1007/s00011-020-01362-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
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.
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15
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Pluma A, Micu MC, Julià A, Marsal S, Förger F, Østensen M. A questionnaire-based study on contraceptive practice in patients with rheumatic disease found no significant difference in age-matched healthy controls. Rheumatol Int 2020; 40:1473-1480. [PMID: 32424615 DOI: 10.1007/s00296-020-04598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Birth control is crucial in preventing unplanned pregnancy. The study analyzed contraceptive practice in women and men with rheumatic disease. METHODS A questionnaire-based study investigated the actual contraceptive practices in patients of reproductive age from three European countries and compared them to age-matched healthy women and men. Associations between patient characteristics and contraception behavior were analyzed by association analysis. RESULTS No significant difference in the frequency of contraception use was found in 133 rheumatic patients compared to 122 healthy controls. The main reason for not using contraception was lack of partner or the wish to become pregnant, whereas the current use of contraception was predominantly to limit family size in general or at this stage of life. Both patients and controls preferred barrier methods (48% and 45%, respectively) followed by hormonal contraceptives (31% and 38%, respectively). Characteristics associated with less use of contraception in patients were living single, having no children, and for being religious, whereas gender and education had no influence. Treatment with teratogenic drugs was no major patient concern, and 13 of 30 female patients using methotrexate, mycophenolate mofetil, or leflunomide did not practice birth control. CONCLUSION Patients used contraception less frequently than healthy individuals, and the main reason for use was to limit family size. Contraception should be an integral part of counseling patients of fertile age, since the patient-preferred methods in case of active disease or therapy with teratogenic drugs were unreliable for the prevention of pregnancy.
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Affiliation(s)
- Andrea Pluma
- Department of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain.,Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Mihaela C Micu
- Department of Rheumatology, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
| | - Antonio Julià
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Sara Marsal
- Department of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain.,Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Frauke Förger
- Department of Rheumatology, Immunology and Allergology, University Hospital Inselspital, Bern, Switzerland
| | - Monika Østensen
- Department of Rheumatology, Sorlandet Hospital, Kristiansand, Norway.
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16
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Ursin K, Lydersen S, Skomsvoll JF, Salvesen KÅ, S S Koksvik H, Jakobsen B, Wallenius M. Factors Associated With Time to Pregnancy in Women With Axial Spondyloarthritis: A Registry-Based Multicenter Study. Arthritis Care Res (Hoboken) 2020; 73:1201-1209. [PMID: 32353185 DOI: 10.1002/acr.24233] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The present study was undertaken to study time to pregnancy (TTP) and factors associated with TTP in women with axial spondyloarthritis (SpA) compared to women with rheumatoid arthritis (RA). METHODS We included 274 women with axial SpA and 317 women with RA from the Norwegian nationwide registry RevNatus. For all the women, we had retrospectively collected data on TTP, and a subgroup also had prospectively collected data. We compared TTP in women with axial SpA to women with RA using Kaplan-Meier plots and a log rank test. To identify factors associated with TTP, we used Cox proportional hazards regression. RESULTS TTP exceeded 12 months in 21% of women with axial SpA. In the subgroup followed prospectively, 32% had TTP that exceeded 12 months. Longer TTP was associated with older age, nulliparity, and longer disease duration, with hazard ratios of 0.97 (95% confidence interval [95% CI] 0.94-1.00), 0.66 (95% CI 0.50-0.88), and 0.94 (95% CI 0.91-0.98), respectively. Disease activity, medication, and self-reported health-related quality of life were not associated with TTP. We found no statistically significant differences between axial SpA and RA in regard to TTP. CONCLUSION In women with axial SpA, longer TTP was associated with older age, nulliparity, and longer disease duration.
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Affiliation(s)
- Kristin Ursin
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan F Skomsvoll
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kjell Å Salvesen
- Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hege S S Koksvik
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bente Jakobsen
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Wallenius
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway
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17
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Zhang-Jian SJ, Yang HY, Chiu MJ, Chou IJ, Kuo CF, Huang JL, Yeh KW, Wu CY. Pregnancy outcomes and perinatal complications of Asian mothers with juvenile idiopathic arthritis - a case-control registry study. Pediatr Rheumatol Online J 2020; 18:9. [PMID: 31973755 PMCID: PMC6979350 DOI: 10.1186/s12969-020-0404-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/06/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUNDS In order to provide juvenile idiopathic arthritis (JIA) patients with better pre-conceptional and prenatal counselling, we investigated the obstetrical and neonatal outcomes among women with Asian descent. METHODS Through the linkage of Taiwan National Health Insurance database and National Birth Registry, we established a population-based birth cohort in Taiwan between 2004 and 2014. In a case control study design, first children born to mothers with JIA are identified and matched with 5 non-JIA controls by maternal age and birth year. Conditional logistic regression was used to calculate odds ratios for maternal and neonatal outcomes crude and with adjustment. RESULTS Of the 2,100,143 newborn, 778 (0.037%) were born to JIA mothers. Among them, 549 first-born children were included in this research. Our result suggested that babies born to mothers with JIA were more likely to have low birth body weight, with an adjusted OR of 1.35(95% CI: 1.02 to 1.79) when compared to babies born to mothers without. No differences were observed in other perinatal complications between women with and without JIA including stillbirth, prematurity, or small for gestational age. The rate of adverse obstetrical outcomes such as caesarean delivery, preeclampsia, gestational diabetes, postpartum hemorrhage and mortality were also similar between the two. CONCLUSIONS Adverse obstetrical and neonatal outcomes were limited among Asian mothers with JIA. Intensive care may not be necessary for JIA mothers and their newborns.
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Affiliation(s)
| | - Huang-Yu Yang
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDepartment of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-Jun Chiu
- 0000 0001 0711 0593grid.413801.fCenter for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Jun Chou
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDivision of Neurology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDepartment of Rheumatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jing-Long Huang
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDivision of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDivision of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Chang Gung University, College of Medicine, Taoyuan, Taiwan. .,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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18
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Cavalcante MB, Cavalcante CTDMB, Sarno M, da Silva ACB, Barini R. Antinuclear antibodies and recurrent miscarriage: Systematic review and meta-analysis. Am J Reprod Immunol 2019; 83:e13215. [PMID: 31821640 DOI: 10.1111/aji.13215] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022] Open
Abstract
Studies have investigated the relationship between antinuclear antibodies (ANA) and recurrent miscarriage (RM). The objective of this paper is to evaluate the presence of ANA as a risk factor for spontaneous abortion in patients with RM. By considering the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis, the authors performed systematic review and meta-analysis by searching the databases of PubMed/Medline and SCOPUS. Review Manager, Version 5.3 performed the statistical analysis. Binary variables were analyzed by odds ratio (ORs) and 95% confidence interval (CI). The subgroup analysis compared the effect of different ANA titers. The authors analyzed the ANA patterns of immunofluorescence staining. Seven case-control studies were selected. The frequency of positive ANA was statistically higher in the RM group (20.6%, 288/1400) as compared to the control group (6.7%, 72/1080). The meta-analysis of the positive ANA showed a statistical difference between the two groups (OR 3.30, 95% CI 1.41-7.73; I2 = 87%, P = .006). Studies have revealed different frequencies of ANA patterns of immunofluorescence. This meta-analysis suggested that positive ANA might increase the risk of RM. However, it was not possible to conclude which ANA pattern of immunofluorescence staining is more frequent in the RM group.
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Affiliation(s)
- Marcelo Borges Cavalcante
- Department of Obstetrics and Gynecology, Fortaleza University (UNIFOR), Fortaleza, Brazil.,CONCEPTUS - Reproductive Medicine, Fortaleza, Brazil
| | | | - Manoel Sarno
- Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador, Brazil.,Harris Birthright Research Center for Fetal Medicine, King's College Hospital and Department of Fetal Medicine, University College, London, UK
| | - Arlley Cleverson Belo da Silva
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital and Department of Fetal Medicine, University College, London, UK
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, Brazil
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Abstract
Decades of research into stress responses have highlighted large variation among individuals, populations, and species, and the sources of this variation have been a center of research across disciplines. The most common measure of the vertebrate stress response is glucocorticoids. However, the predictive power of glucocorticoid responses to fitness is surprisingly low. This is partly because the hormone levels rapidly change in response to stressor exposure and elevated levels at one time point can indicate either that glucocorticoids are helping the organism cope with the stressor or that dysregulation of hormone release is harming the organism. Meaning, the fitness consequences of the stressor depends on how efficient the stress responses are at negating the harmful impacts of stressors to cells and tissues. To encompass the idea of the efficiency of stress responses and to integrate cellular and organismal stress responses, a new theoretical model called the Damage-Fitness Model was developed. The model focuses on the downstream effects of stress responses and predicts that the accumulation of damage in cells and tissues (e.g., persistent damage to proteins, lipids, and DNA) negatively impacts fitness components. In this mini-review, we examine evidence supporting the Damage-Fitness Model and explore new directions forward.
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Affiliation(s)
- Haruka Wada
- Department of Biological Sciences, Auburn University, Auburn, AL 36849, USA
| | - Britt Heidinger
- Department of Biological Sciences, North Dakota State University, Fargo, ND 58108, USA
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Kishore S, Mittal V, Majithia V. Obstetric outcomes in women with rheumatoid arthritis: Results from Nationwide Inpatient Sample Database 2003–2011✰. Semin Arthritis Rheum 2019; 49:236-240. [DOI: 10.1016/j.semarthrit.2019.03.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/10/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022]
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21
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Remaeus K, Stephansson O, Johansson K, Granath F, Hellgren K. Maternal and infant pregnancy outcomes in women with psoriatic arthritis: a Swedish nationwide cohort study. BJOG 2019; 126:1213-1222. [PMID: 31188526 DOI: 10.1111/1471-0528.15836] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Studies on pregnancy outcomes in psoriatic arthritis (PsA) are scarce and typically of small size. Available studies have reported conflicting results. The aim of this study was to describe maternal and infant pregnancy outcomes among women with PsA compared with women without PsA. DESIGN Nationwide cohort study. SETTING Nationwide Swedish registers. POPULATION A total of 41 485 singleton pregnancies in 1997-2014, of which 541 pregnancies were identified with PsA exposure and 40 944 pregnancies were unexposed. METHODS By linkage of national health and population register data, we obtained information on individual pregnancies and compared outcomes among pregnancies with PsA and non-PsA pregnancies. Relative risks were estimated by odds ratios (ORs) with 95% CIs using a generalised linear regression model with generalised estimating equations. Adjustments were made for maternal factors and calendar year of birth. MAIN OUTCOME MEASURES Maternal and infant pregnancy outcomes. RESULTS Pregnancies to women with PsA had increased risks of preterm birth (adjusted OR 1.63; 95% CI 1.17-2.28), elective and emergency caesarean deliveries (adjusted OR 1.47; 95% CI 1.10-1.97 and adjusted OR 1.43; 95% CI 1.08-1.88, respectively) compared with non-PsA pregnancies. No increased risks were observed for pre-eclampsia, stillbirth or other infant outcomes apart from preterm birth. CONCLUSION The majority of women with PsA have uneventful pregnancies with respect to adverse outcomes. In the present study, we found increased risks of preterm birth and caesarean delivery compared with non-PsA pregnancies. TWEETABLE ABSTRACT Women with psoriatic arthritis have uneventful pregnancies but are at increased risk of preterm birth and caesarean delivery.
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Affiliation(s)
- K Remaeus
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - O Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - K Johansson
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - F Granath
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - K Hellgren
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
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Polachek A, Polachek Shlomi I, Spitzer K, Pereira D, Ye JY, Chandran V, Laskin CA, Gladman DD. Outcome of pregnancy in women with psoriatic arthritis compared to healthy controls. Clin Rheumatol 2019; 38:895-902. [PMID: 30535992 DOI: 10.1007/s10067-018-4385-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The mean age at onset of psoriatic arthritis (PsA) ranges between the 4th-6th decades of life. However, little is known about fertility and pregnancy outcome in PsA patients. The aim of this study was to examine whether fertility and pregnancy outcome of PsA patients are different from healthy controls and to evaluate PsA and psoriasis disease activity perception during pregnancy and the year postpartum. METHODS A questionnaire-based study, including demographic, fertility, pregnancy outcome, and disease activity questions, was conducted in PsA patients and healthy controls. The inclusion criterion was diagnosis of PsA before at least 1 pregnancy. Descriptive statistics are provided. T tests and Pearson chi-square tests were used to analyze the differences between continuous and categorical variables, respectively. RESULTS The 74 PsA patients and 74 healthy controls were not significantly different in most of the demographic variables. The mean number of pregnancies, children, and infertility diagnosis were not significantly different between the groups. The pregnancy outcomes in the PsA group (n = 151) and in the control group (n = 189) were similar in: live birth (76% vs. 76%, P = 0.3), vaginal delivery (48% vs. 51%, P = 0.6), gestation age (38.5 vs. 38.3, P = 0.3), weight at birth (3.4 kg vs. 3.4 kg, P = 0.5), low rate of maternal and fetal complications, and the duration and rate of breastfeeding. Most (58%) patients reported favorable joint activity during pregnancy and 50% reported worsening during the 1st postpartum year. CONCLUSIONS PsA patients do not have more infertility or worse pregnancy outcomes compared to healthy controls.
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Affiliation(s)
- Ari Polachek
- Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Polachek Shlomi
- Reproductive life Stages Program, Women's College Hospital, Toronto, Ontario, Canada
- Beer Yaakov- Ness Ziona Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Spitzer
- TRIO Fertility, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Pereira
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Justine Yang Ye
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vinod Chandran
- Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Carl A Laskin
- Departments of Medicine (Rheumatology) and Obstetrics and Gynecology (REI), TRIO Fertility, University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Disease, Toronto Western Hospital, 399 Bathurst Street 1E-410B, Toronto, Ontario, M5T 2S8, Canada.
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Nørgård BM, Larsen MD, Friedman S, Knudsen T, Fedder J. Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study. Ann Rheum Dis 2019; 78:328-334. [PMID: 30636215 DOI: 10.1136/annrheumdis-2018-214619] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/25/2018] [Accepted: 12/03/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES No studies have examined the efficacy of assisted reproductive technology (ART) treatment in women with rheumatoid arthritis. Therefore, we examined the chance of live birth after ART treatment in women with rheumatoid arthritis compared with women without rheumatoid arthritis. METHODS Our cohort study is based on nationwide Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 30 June 2017. The cohorts comprised 1149 embryo transfers in women with rheumatoid arthritis, and 198 941 embryo transfers in women without rheumatoid arthritis. Our outcome was live birth per embryo transfer, and we controlled for multiple covariates in the analyses. In subanalyses, we examined a chance of biochemical/clinical pregnancy after ART and a possible impact of corticosteroid use prior to embryo transfer. RESULTS The adjusted OR (aOR) for a live birth per embryo transfer in women with rheumatoid arthritis, relative to women without rheumatoid arthritis, was 0.78 (95% CI 0.65 to 0.92). The aORs for biochemical and clinical pregnancies were 0.81 (95% CI 0.68 to 0.95) and 0.82 (95% CI 0.59 to 1.15), respectively. Corticosteroid prescription prior to embryo transfer increased the OR for live birth (aOR=1.32 (95% CI 0.85 to 2.05)). CONCLUSIONS The chance of a live birth was significantly reduced in women with rheumatoid arthritis receiving ART treatment, relative to women without rheumatoid arthritis, and our result suggested that the problem was related to an impaired chance of embryo implantation. The role of corticosteroid use prior to embryo transfer must be a subject for further research.
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Affiliation(s)
- Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark .,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Due Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sonia Friedman
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Torben Knudsen
- Department of Medical Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Jens Fedder
- Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark.,Research Unit of Human Reproduction, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hegvik TA, Instanes JT, Haavik J, Klungsøyr K, Engeland A. Associations between attention-deficit/hyperactivity disorder and autoimmune diseases are modified by sex: a population-based cross-sectional study. Eur Child Adolesc Psychiatry 2018; 27:663-675. [PMID: 28983730 PMCID: PMC5945751 DOI: 10.1007/s00787-017-1056-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/21/2017] [Indexed: 12/18/2022]
Abstract
Several studies have demonstrated associations between neuropsychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD), and the immune system, including autoimmune diseases. Since ADHD and many autoimmune diseases show sex-specific properties, such associations may also differ by sex. Using Norwegian national registries, we performed a cross-sectional study based on a cohort of 2,500,118 individuals to investigate whether ADHD is associated with common autoimmune diseases. Associations between ADHD and autoimmune diseases in females and males were investigated with logistic regression and effect modification by sex was evaluated. Several subanalyses were performed. The strongest association was found between ADHD and psoriasis in females, adjusted odds ratio (adjOR) = 1.57 (95% confidence interval: 1.46-1.68) and males, adjOR = 1.31 (1.23-1.40); p value for interaction < 0.0001. Furthermore, among females, ADHD was associated with Crohn's disease, adjOR = 1.44 (1.16-1.79) and ulcerative colitis, adjOR = 1.28 (1.06-1.54). In contrast, males with ADHD had lower odds of Crohn's disease, adjOR = 0.71 (0.54-0.92), in addition to a trend for lower odds of ulcerative colitis, adjOR = 0.86 (0.71-1.03); p values for interaction < 0.0001 and 0.0023, respectively. In a group of females where information on smoking and body mass index was available, adjustment for these potential mediators did not substantially alter the associations. Our findings support previously reported associations between ADHD and diseases of the immune system. The associations differ by sex, suggesting that sex-specific immune-mediated neurodevelopmental processes may be involved in the etiology of ADHD.
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Affiliation(s)
- Tor-Arne Hegvik
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway.
- K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway.
| | - Johanne Telnes Instanes
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Domain for Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Bergen/Oslo, Norway
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Abstract
Fertility is impaired in women with rheumatoid arthritis (RA), whereas less is known about male fertility problems. Pregnancy outcome in patients with RA is slightly less favorable compared with the general population, especially in patients with active disease. Disease activity usually improves during pregnancy, but less than previously thought. Although several antirheumatic drugs are contraindicated in pregnancy, more treatment options are available. There is evidence on the safety of TNF inhibitors in pregnancy. Given the impact of active disease on fertility and pregnancy outcome, a treat-to-target strategy is recommended for patients who are pregnant or have a wish to conceive.
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Abstract
Infertility and subfertility, menstrual irregularities, and decreased parity may occur in women with autoimmune diseases due to multiple factors, including underlying inflammatory disease, gonadotoxic medications, and psychosocial issues related to living with chronic disease. Awareness of these factors, as well as validation and support of patients confronting reproductive challenges, is important for providing comprehensive care to these women. An understanding of the expanding options for fertility preservation strategies during gonadotoxic medications is essential. Referral to a reproductive endocrinology clinic is indicated in this patient population.
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Affiliation(s)
- Emily C Somers
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA; Department of Obstetrics and Gynecology, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA; Department of Environmental Health Sciences, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Wendy Marder
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA; Department of Obstetrics and Gynecology, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA.
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Neville A, Bernatsky S, Kuriya B, Bujold E, Chakravarty E, Platt RW, Bérard A, Vinet É. Outcomes in mothers with rheumatic diseases and their offspring workshop. Lupus Sci Med 2017. [PMCID: PMC5337735 DOI: 10.1136/lupus-2016-000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This conference report describes six presentations that were given during a Canadian Institutes for Health Research-funded workshop. The goal of the workshop was to discuss key knowledge gaps in the study of outcomes in mothers with rheumatic diseases and their offspring. Presentations focused on epidemiological and methodological issues associated with the reproductive and perinatal health of women with rheumatic diseases. Discussions of relevant recent research allowed for discovery of potential data sources that could facilitate interdisciplinary research and created the opportunity for future collaborations.
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Affiliation(s)
- Autumn Neville
- Division of Rheumatology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, Research Institute of the McGill University Health Centre, Montreal, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Emmanuel Bujold
- Department of Obstetrics and Gynecology, Université Laval, Quebec City, Canada
| | - Eliza Chakravarty
- Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - Robert W Platt
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Anick Bérard
- Faculty of Pharmacy, Université de Montreal, Montreal, Canada
| | - Évelyne Vinet
- Division of Rheumatology, Research Institute of the McGill University Health Centre, Montreal, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
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Levy RA, de Jesús GR, de Jesús NR, Klumb EM. Critical review of the current recommendations for the treatment of systemic inflammatory rheumatic diseases during pregnancy and lactation. Autoimmun Rev 2016; 15:955-63. [PMID: 27490204 DOI: 10.1016/j.autrev.2016.07.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 07/07/2016] [Indexed: 02/08/2023]
Abstract
The crucial issue for a better pregnancy outcome in women with autoimmune rheumatic diseases is appropriate planning, with counseling of the ideal timing and treatment adaptation. Drugs used to treat rheumatic diseases may interfere with fertility or increase the risk of miscarriages and congenital abnormalities. MTX use post-conception is clearly linked to abortions as well as major birth defects, so it should be stopped 3months before conception. Leflunomide causes abnormalities in animals even in low doses. Although in humans, it does not seem to be as harmful as MTX, when pregnancy is detected in a patient on leflunomide, cholestyramine is given for washout. Sulfasalazine can be used safely and is an option for those patients who were on MTX or leflunomide. Azathioprine is generally the immunosuppressive of choice in many high-risk pregnancy centers because of the safety profile and its steroid-sparing property. Cyclosporine and tacrolimus can also be used as steroid-sparing agents, but experience is smaller. Although prednisone and prednisolone are inactivated in the placenta, we try to limit the dose to the minimal effective one, to prevent side effects. Antimalarials have been broadly studied and are safe during pregnancy and breastfeeding. Among biologic disease modifying anti-rheumatic agents (bDMARD), the anti-TNFs that have been used for longer are the ones with greater experience. The large monoclonal antibodies do not cross the placenta in the first trimester, and after conception, the decision to continue medication should be taken individually. The experience is larger in women with inflammatory bowel diseases, where anti-TNF is generally maintained at least until 30weeks to reduce fetal exposure. Live vaccines should not be administrated to the infant in the first 6months of life. Pregnancy data for rituximab, abatacept, anakinra, tocilizumab, ustekinumab, belimumab, and tofacitinib are limited and their use in pregnancy cannot currently be recommended.
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Affiliation(s)
- Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Guilherme R de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Obstetrics, Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nilson R de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro M Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Martínez López JA, García Vivar ML, Cáliz R, Freire M, Galindo M, Hernández MV, López Longo FJ, Martínez Taboada V, Pego Reigosa JM, Rubio E, Trujillo E, Vela-Casasempere P. Recommendations for the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding. ACTA ACUST UNITED AC 2016; 13:264-281. [PMID: 27321859 DOI: 10.1016/j.reuma.2016.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/02/2016] [Accepted: 05/07/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To develop recommendations on the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, post-partum and breastfeeding based on the best evidence and experience. METHODS Recommendations were generated using nominal group and Delphi techniques. An expert panel of 12 rheumatologists was established. A systematic literature review and a narrative review (websites, clinical guidelines and other relevant documentation) were performed and presented to the panel in its 1st meeting to be discussed and to help define recommendations. A first draft of recommendations was generated and circulated for comments and wording refinement. A national survey analyzing different aspects of this topic was undertaken separately, followed by a Delphi process (2 rounds). Agreement with each recommendation was ranked on a scale of 1 (total disagreement) to 10 (total agreement), and was considered to be achieved if at least 70% voted≥7. The level of evidence and grade of recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS A total of 14 recommendations were generated for the preconception period (oral and hormonal contraception, reproductive techniques), pregnancy (planning, treatment and follow-up), and breastfeeding (treatment and follow-up). High-risk situations such as lupus or antiphospholipid syndrome were included. A consensus>90% was reached for all but one recommendation. CONCLUSIONS These recommendations are intended to provide rheumatologists, patients, families and other stakeholders with a consensus on the evaluation and management of patients with autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding.
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Affiliation(s)
| | - M Luz García Vivar
- Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, España
| | - Rafael Cáliz
- Unidad de Gestión de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Mercedes Freire
- Servicio de Reumatología, Complexo hospitalario Universitario A Coruña (CHUAC), A Coruña, España
| | - María Galindo
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - Víctor Martínez Taboada
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, España; Facultad de Medicina, Universidad de Cantabria, Santander, España
| | - Jose María Pego Reigosa
- Servicio de Reumatología, Hospital Meixoeiro-Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - Esteban Rubio
- Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Elisa Trujillo
- Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
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Straub RH, Schradin C. Chronic inflammatory systemic diseases: An evolutionary trade-off between acutely beneficial but chronically harmful programs. EVOLUTION MEDICINE AND PUBLIC HEALTH 2016; 2016:37-51. [PMID: 26817483 PMCID: PMC4753361 DOI: 10.1093/emph/eow001] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/23/2015] [Indexed: 12/14/2022]
Abstract
It has been recognized that during chronic inflammatory systemic diseases (CIDs) maladaptations of the immune, nervous, endocrine and reproductive system occur. Maladaptation leads to disease sequelae in CIDs. The ultimate reason of disease sequelae in CIDs remained unclear because clinicians do not consider bodily energy trade-offs and evolutionary medicine. We review the evolution of physiological supersystems, fitness consequences of genes involved in CIDs during different life-history stages, environmental factors of CIDs, energy trade-offs during inflammatory episodes and the non-specificity of CIDs. Incorporating bodily energy regulation into evolutionary medicine builds a framework to better understand pathophysiology of CIDs by considering that genes and networks used are positively selected if they serve acute, highly energy-consuming inflammation. It is predicted that genes that protect energy stores are positively selected (as immune memory). This could explain why energy-demanding inflammatory episodes like infectious diseases must be terminated within 3–8 weeks to be adaptive, and otherwise become maladaptive. Considering energy regulation as an evolved adaptive trait explains why many known sequelae of different CIDs must be uniform. These are, e.g. sickness behavior/fatigue/depressive symptoms, sleep disturbance, anorexia, malnutrition, muscle wasting—cachexia, cachectic obesity, insulin resistance with hyperinsulinemia, dyslipidemia, alterations of steroid hormone axes, disturbances of the hypothalamic-pituitary-gonadal (HPG) axis, hypertension, bone loss and hypercoagulability. Considering evolved energy trade-offs helps us to understand how an energy imbalance can lead to the disease sequelae of CIDs. In the future, clinicians must translate this knowledge into early diagnosis and symptomatic treatment in CIDs.
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Affiliation(s)
- Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Division of Rheumatology, Department of Internal Medicine, University Hospital Regensburg, Regensburg, Germany;
| | - Carsten Schradin
- Université De Strasbourg, IPHC-DEPE, 23 Rue Becquerel, Strasbourg 67087, France; CNRS (Centre National De La Recherche Scientifique), UMR7178, Strasbourg 67087, France; School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
Fertility is impaired in female patients with rheumatoid arthritis (RA), which is related to disease activity and the use of certain medication. During pregnancy, disease activity usually improves, but less than previously thought. Especially in women with high disease activity, the pregnancy outcome is also impaired. All of this underscores the importance of strict control of disease activity in RA patients who wish to conceive. Management of RA disease activity during pregnancy might be a challenge as the treatment options are limited. Evidence is accumulating that tumor necrosis factor (TNF) blockers can be safely used during pregnancy, particularly during the first trimester and the beginning of the second trimester. Far less is known about the problems faced by male RA patients who wish to conceive, in terms of not only fertility and pregnancy outcome but also the safety of medication. In this paper, the fertility issues in patients with RA, the pregnancy-associated improvement of RA, the pregnancy outcomes, including the long-term effects on the offspring, and treatment options, including those during lactation and for male patients wishing to conceive, will be reviewed.
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Affiliation(s)
- Hilal Ince-Askan
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Bermas BL, Sammaritano LR. Fertility and pregnancy in rheumatoid arthritis and systemic lupus erythematosus. FERTILITY RESEARCH AND PRACTICE 2015; 1:13. [PMID: 28620518 PMCID: PMC5424288 DOI: 10.1186/s40738-015-0004-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/10/2015] [Indexed: 11/25/2022]
Abstract
Background Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are disorders that commonly impact reproductive aged women. Findings Both women with RA and SLE have smaller sized families than do controls. In the case of RA factors other than fertility contribute, while in women with SLE there may be diminished ovarian reserve due to cyclophosphamide therapy and advanced maternal age. RA pregnancies can be complicated by preterm birth and small-for-gestational aged infants. SLE pregnancies have higher rates of fetal loss, in particular in those patients with co-existing antiphospholipid syndrome. SLE pregnancies are also more likely to be complicated by pre-eclampsia and hypertension and to result in preterm birth and small-for-gestational aged infants. Conclusion Appropriate fertility evaluation and careful pregnancy planning with coordinated obstetrical care help ensure better outcomes in these patient populations.
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Affiliation(s)
- Bonnie L Bermas
- Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Lisa R Sammaritano
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, USA
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Henes M, Froeschlin J, Taran FA, Brucker S, Rall KK, Xenitidis T, Igney-Oertel A, Lawrenz B, Henes JC. Ovarian reserve alterations in premenopausal women with chronic inflammatory rheumatic diseases: impact of rheumatoid arthritis, Behçet’s disease and spondyloarthritis on anti-Müllerian hormone levels: Fig. 1. Rheumatology (Oxford) 2015; 54:1709-12. [DOI: 10.1093/rheumatology/kev124] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Indexed: 11/12/2022] Open
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Østensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse MEB, Costedoat-Chalumeau N, Cutolo M, Dolhain R, Fenstad MH, Förger F, Wahren-Herlenius M, Ruiz-Irastorza G, Koksvik H, Nelson-Piercy C, Shoenfeld Y, Tincani A, Villiger PM, Wallenius M, von Wolff M. State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmun Rev 2014; 14:376-86. [PMID: 25555818 DOI: 10.1016/j.autrev.2014.12.011] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
Throughout the last decade, increasing awareness has been raised on issues related to reproduction in rheumatic diseases including basic research to clarify the important role of estrogens in the etiology and pathophysiology of immune/inflammatory diseases. Sub- or infertility is a heterogeneous condition that can be related to immunological mechanisms, to pregnancy loss, to disease burden, to therapy, and to choices in regard to family size. Progress in reproductive medicine has made it possible for more patients with rheumatic disease to have children. Active disease in women with rheumatoid arthritis (RA) affects their children's birth weight and may have long-term effects on their future health status. Pregnancy complications as preeclampsia and intrauterine growth restriction are still increased in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), however, biomarkers can monitor adverse events, and several new therapies may improve outcomes. Pregnancies in women with APS remain a challenge, and better therapies for the obstetric APS are needed. New prospective studies indicate improved outcomes for pregnancies in women with rare diseases like systemic sclerosis and vasculitis. TNF inhibitors hold promise for maintaining remission in rheumatological patients and may be continued at least in the first half of pregnancy. Pre-conceptional counseling and interdisciplinary management of pregnancies are essential for ensuring optimal pregnancy outcomes.
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Affiliation(s)
- Monika Østensen
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olavs Hospital, University Hospital of Trondheim, Norway.
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Antonio Brucato
- Department of Internal Medicine, Ospedale papa Giovanni XXIII Bergamo, Italy
| | - Irene Cetin
- Department of Mother and Child, Hospital Luigi Sacco, University of Milano, Italy
| | - Christina Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093-0828, USA
| | - Megan E B Clowse
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nathalie Costedoat-Chalumeau
- Université Paris-Descartes, Paris, France; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Paris, France
| | - Maurizio Cutolo
- Research Laboratories and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Radboud Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H Fenstad
- Department of Immunology and Transfusion Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Frauke Förger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, CH-3010 Bern, Switzerland
| | - Marie Wahren-Herlenius
- Department of Medicine, Centre for Molecular Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain
| | - Hege Koksvik
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olavs Hospital, University Hospital of Trondheim, Norway
| | | | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel
| | - Angela Tincani
- Department of Rheumatology and Clinical Immunology, Ospedale Civile and University of Brescia, Brescia, Italy
| | - Peter M Villiger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland
| | - Marianne Wallenius
- National Service for Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway; Dept of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Berne, Switzerland
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Abstract
PURPOSE OF REVIEW The purpose of this study is to encourage discussion of reproduction issues in all patients of fertile age in order to prevent unplanned and ill-timed pregnancies in patients with rheumatoid arthritis (RA). RECENT FINDINGS Counselling patients who desire children requires consideration of relevant reproductive health issues, including fertility, interaction of pregnancy and RA, and management during pregnancy and lactation. RA patients have no disease-related restrictions in regard to contraception, but need to be counselled on safe birth control particularly during treatment with potentially teratogenic drugs. In spite of mostly beneficial effects of pregnancy on RA, active disease and aggressive drug treatment can impair pregnancy outcomes. Options for drug therapy, though limited, may help to maintain low disease activity during pregnancy and lactation. SUMMARY Careful preconception counselling and risk assessment is important in RA women, with a particular focus on preventing unplanned pregnancy by information on contraception. Antibody status and all medications need to be reviewed before pregnancy. Maintaining low disease activity before and during pregnancy is crucial for good outcomes. Preconceptional counselling shared with all health professionals engaged in the care of a patient helps to ensure healthy pregnancy outcomes for mother and child.
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Abstract
PURPOSE OF REVIEW Despite decades of evidence suggesting that women with rheumatoid arthritis (RA) have fewer children than their healthy peers, this information is not widely known among clinicians. The causes of decreased fertility in this population have been largely unexplored, but likely revolve around altered inflammation, increased age when conception is attempted, limited sexual function, and possibly medications limiting ovarian function. RECENT FINDINGS Several large Scandinavian cohorts and a cohort study in the United States demonstrate that women with RA have smaller families and are slower to conceive compared with other women. Personal choice to limit family size plays some role, as does infertility. Sexual function in women with RA is hampered by pain and fatigue, perhaps decreasing the opportunity for conception. Finally, data about the role of NSAIDs in preventing ovulation suggest that continued use of these medications may hinder conception. SUMMARY Infertility in women with RA is an under-recognized, but remarkably common phenomenon. Although research continues into the underlying causes, physicians can discuss this topic and refer women to reproductive endocrinology when needed, thereby helping patients to build the families that they desire.
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Brouwer J, Hazes JMW, Laven JSE, Dolhain RJEM. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2014; 74:1836-41. [PMID: 24833784 DOI: 10.1136/annrheumdis-2014-205383] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/01/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Many female rheumatoid arthritis (RA) patients attempting to conceive have a time to pregnancy (TTP) of >12 months. During this period RA often cannot be treated optimally. We sought to identify clinical factors associated with prolonged TTP in female RA patients. METHODS In a nationwide prospective cohort study on pregnancy in RA patients (PARA study), women were included preconceptionally or during the first trimester. Cox regression analysis was used to study the association of disease characteristics and medication use with TTP. RESULTS TTP exceeded 12 months in 42% of 245 patients. Longer TTP was related to age, nulliparity, disease activity (DAS28), and preconception use of non-steroidal anti-inflammatory drugs (NSAIDs) and prednisone. These variables were independently associated with TTP, with HRs for occurrence of pregnancy of 0.96 (95% CI 0.92 to 1.00) per year of age, 0.52 (0.38 to 0.70) for nulliparity, 0.81 (0.71 to 0.93) per point increase in DAS28, 0.66 (0.46 to 0.94) for NSAIDs and 0.61 (0.45 to 0.83) for prednisone use. 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 prolong TTP. CONCLUSIONS TTP in RA is longer if patients are older or nulliparous, have higher disease activity, use NSAIDs or use prednisone >7.5 mg daily. Preconception treatment strategies should aim at maximum suppression of disease activity, taking account of possible negative effects of NSAIDs use and higher prednisone doses.
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Affiliation(s)
- Jenny Brouwer
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Uzunaslan D, Saygin C, Hatemi G, Tascilar K, Yazici H. No appreciable decrease in fertility in Behçet's syndrome. Rheumatology (Oxford) 2013; 53:828-33. [PMID: 24369417 DOI: 10.1093/rheumatology/ket436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Behçet's syndrome (BS) follows an active course during the childbearing years in both men and women. We formally surveyed the infertility rate and the effect of drugs and types of organ involvement on fertility in BS. METHODS We compared fertility among BS patients with and without major organ involvement with those with FMF, AS and healthy controls. A structured interview was performed and the medical records of the patients were reviewed to confirm the sites of involvement and drugs they used during their entire follow-up. RESULTS The number of female patients who were not able to ever conceive, who were not able to conceive before or after disease onset or who were able to conceive late or only with assisted reproductive technology was not increased among the BS group. The same was true for the male patients to successfully achieve a conception and/or father a child. The average number of children, miscarriages, terminations and ectopic pregnancies were similar among the groups. Infertility was more common in BS patients with major organ involvement who used cyclophosphamide (CYC) compared with those who did not (P = 0.009). CONCLUSION Infertility is not appreciably increased among BS patients attending a dedicated outpatient clinic. Major organ involvement does not increase the risk of infertility and CYC is the only drug that seems to compromise fertility in BS.
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Affiliation(s)
- Didem Uzunaslan
- Cerrahpasa Tip Fakultesi, Ic Hastaliklari Anabilim Dali, Romatoloji Bilim Dali, Fatih, Istanbul 34098, Turkey.
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Chen JS, Ford JB, Roberts CL, Simpson JM, March LM. Pregnancy outcomes in women with juvenile idiopathic arthritis: a population-based study. Rheumatology (Oxford) 2013; 52:1119-25. [PMID: 23382363 DOI: 10.1093/rheumatology/kes428] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this study is to describe pregnancy outcomes among women with JIA. METHODS Women who gave birth in New South Wales (NSW), Australia, were linked to hospital discharge records from 2000 to 2010. Women with an ICD-10-AM code of M08 or M09 in the hospital records were considered to have JIA. Logistic regression was used to calculate odds ratios for pregnancy outcomes and the lack of independence in study outcomes for multiple pregnancies in the same woman was taken into account using generalized estimating equations. RESULTS During the study period, 601,659 women had 941,496 births. Of these births, 78 births could be attributed to 50 women with JIA. Of 78 JIA pregnancies, 53 (68%) were delivered by either Caesarean section (n = 40, 51%) or instrumental delivery (n = 13, 17%); compared with other women, those with JIA had significantly higher rates of pre-eclampsia, postpartum haemorrhage and severe maternal morbidity. Compared with other infants, those with mothers with JIA were more likely to be born prematurely, but were not at increased risk of being small for gestational age, requiring neonatal intensive care, having a low Apgar score at 5 min or severe neonatal morbidity. CONCLUSION Infants of women with JIA did not have an increased risk of adverse neonatal outcomes. Intensive obstetric care might be required during pregnancy for women with JIA given the increased risk of maternal morbidity.
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Affiliation(s)
- Jian Sheng Chen
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Australia.
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Ateka-Barrutia O, Nelson-Piercy C. Management of rheumatologic diseases in pregnancy. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ijr.12.54] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Janković SM, Djeković A, Bugarčić Ž, Janković SV, Lukić G, Folić M, Čanović D. Effects of aurothiomalate and gold(III) complexes on spontaneous motility of isolated human oviduct. Biometals 2012; 25:919-25. [DOI: 10.1007/s10534-012-9558-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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Wallenius M, Skomsvoll JF, Salvesen KA. [Chronic inflammatory arthritis and pregnancy]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:658-62. [PMID: 22456146 DOI: 10.4045/tidsskr.11.0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Chronic inflammatory arthritis often appears first in women of fertile age. Their pregnancies are considered to be of low risk compared with pregnancies in women with systemic inflammatory connective tissue disease. METHOD The article is based on literature searches in PubMed for studies of the pregnancy outcomes of women with chronic inflammatory arthritis. Studies without a reference group or studies based on analyses of mixed populations of inflammatory arthritis and connective tissue disease patients were excluded. RESULTS Recurrent findings in the published literature were: low mean birth weight, a higher proportion of children with a birth weight of less than 2500 grams, children born small for gestational age, preterm births and a higher proportion of Caesarean sections. A high level of disease activity is associated with the risk of low birth weight and preterm birth. However, serious complications are not frequently reported. Glucocorticosteroids and disease-modifying medicines such as sulphasalazine and hydroxychloroquine may be used during pregnancy. Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be used until gestational week 32. Methotrexate is contraindicated and must be terminated three months before conception. The TNF inhibitors adalimumab, etanercept and infliximab may be used until conception. INTERPRETATION Pregnancy is seldom absolutely contraindicated for women with inflammatory arthritis. Pregnancy should be planned carefully and preferably be confined to periods with a low level of disease activity. First pregnancies require special attention. Interdisciplinary collaboration between rheumatologists and gynaecologists is recommended for monitoring patients with active arthritis.
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Affiliation(s)
- Marianne Wallenius
- Nasjonalt kompetansesenter for svangerskap og revmatisk sykdom Revmatologisk avdeling, Klinikk for ortopedi, revmatologi og hudsykdommer, St. Olavs hospital, Norway.
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Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, Mikkelsen K, Kaufmann C, Kvien TK. Parity in patients with chronic inflammatory arthritides childless at time of diagnosis. Scand J Rheumatol 2012; 41:202-7. [DOI: 10.3109/03009742.2011.641582] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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