For women with inflammatory arthritis, fears and anxieties related to arthritis and infertility affected family size and reproductive experiences, according to study results published in ACR Open Rheumatology.

Researchers analyzed how inflammatory arthritis affects family planning, contraception, menstruation, and infertility using a comprehensive reproductive health survey developed with help from the organizations ArthritisPower and CreakyJoints. The online survey consisted of 183 questions regarding demographics, family size, history of infertility, effects of menstrual cycle, and oral contraception on arthritis, disease-modifying antirheumatic medication use, and perceptions related to inflammatory arthritis and pregnancy and childbearing. The survey participants were between the ages of 18 to 50 years, had been previously diagnosed with inflammatory arthritis, and were members of ArthritisPower or CreakyJoints.

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Of the 267 women included in this study, the average age was 39.6 years old, the average age at diagnosis was 27.2 years, 84% were white, 66% attained a college degree or higher, 79% had rheumatoid arthritis, 93% had used a disease-modifying antirheumatic medication, and 40% experienced infertility. With regard to family size, 58% had fewer children because of arthritis. Of those, 85% had fewer children because of a concern over their ability to adequately care for a child, 61% had fewer children because they believed arthritis medications could harm a developing fetus, and 52% had fewer children because of concern that their child(ren) could inherit arthritis. Women with self-reported inflammatory bowel disease had a greater occurrence of infertility (73% vs 38%), and 51% of women with confirmed infertility reported abnormality of the ovaries, ovulation, or premature menopause. With regard to arthritis disease activity during their menstrual cycle, 49% of the women reported variation, 32% did not report any changes, and 19% were unsure. Of the patients who used oral contraceptive pills, 70% of the women did not report changes, 8.8% reported improvement, and 10.2% reported worsening of symptoms.

Limitations of this study included a sample of participants from higher socioeconomic status, which could make the results less generalizable, a potential bias for women with infertility to answer a reproductive health survey, and lack of information about the timing of diagnosis and its relation to infertility.

The researchers concluded, “Women with inflammatory arthritis need more counseling about their specific pregnancy-associated risks, fertility, and contraception to help them to make well-informed decisions and safely achieve the family sizes that they truly desire.”

Several authors reported multiple associations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Talabi MB, Eudy AM, Jayasundara M, et al. Pregnancy, periods, and “the pill”: exploring the reproductive experiences of women with inflammatory arthritis [published online April 15, 2019]. ACR Open Rheumatol. doi:10.1002/acr2.1016