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Unexplained subfertility in RA may be tied to NSAID use.

Women with rheumatoid arthritis are more often diagnosed with unexplained subfertility, compared with women in the general population, a study showed.

This finding may imply that fertility in female rheumatoid arthritis (RA) patients is influenced by disease-related factors, specifically the use of periconceptional NSAIDs, according to the investigators.

"Fertility is compromised in women with rheumatoid arthritis. In 36%-42% of female RA patients, diagnosed before family completion, the time to pregnancy exceeds 12 months, whereas in the general population, this is only the case in 10%-17% of couples," reported Jenny Brouwer, MD, and her associates at Erasmus University Medical Center, Rotterdam, the Netherlands (Arthritis Care Res. 2016 Oct 4. doi: 10.1002/acr.23124).

In addition, when women with RA try to conceive, their antirheumatic treatment regimens need to be adjusted, which increases risk for permanent joint damage, the investigators reported, adding that "understanding the underlying mechanisms of subfertility in RA, and treatment of these mechanisms whenever possible, would be an important step forward in the care for these patients."

To study the outcome of fertility assessments in women with RA and subfertility, Dr. Brouwer and her associates performed a cross-sectional study of 260 female RA patients who were recruited from the Pregnancy-Induced Amelioration of RA study, a Dutch nationwide prospective observational trial of women diagnosed with RA who were in their first trimester of pregnancy or who were trying to conceive.

Each eligible participant received a questionnaire that included questions regarding reproductive history, time to pregnancy, mode of conception for prior pregnancies, fertility assessments, and fertility treatments. For the 178 women who returned completed questionnaires (68%), additional gynecologic histories and diagnoses were collected from medical histories and / or patient files.

Analysis of these data revealed that 82 women (46%; 95% confidence interval, 39%-53%) with RA were considered subfertile. Subfertility was most often unexplained (48% of known diagnoses) or caused by anovulation (28%) or semen abnormalities (16%).

"In comparison to the general population, female RA patients appear to be more often diagnosed with unexplained subfertility, whereas the percentage of subfertile women with anovulation was equal or slightly increased, compared to percentages found in the general population," the investigators wrote.

The majority of subfertile RA patients received fertility treatments, and "a considerable number of all pregnancies were conceived after women had been treated for subfertility," according to the researchers.

The use of periconceptional NSAIDs may have contributed to subfertility, based on a subanalysis. Nearly half (48%) of women with unexplained subfertility used NSAIDs periconceptionally, whereas only 17% of other subfertile RA patients did so (P = .013). No other disease-related factors, including disease activity and periconceptional prednisone use, were significantly associated with unexplained subfertility.

The significant association between periconceptional use of NSAIDs and unexplained subfertility "is in concordance with a previous study within the PARA cohort where we have shown that a longer [time to pregnancy] was associated with the periconceptional use of NSAIDs," Dr. Brouwer and her associates wrote.

"In daily practice, when an RA patient wishes to conceive, NSAIDs should be avoided, and early consultation with an expert rheumatologist and a fertility specialist should be considered to optimize the patient's chance of a complete family," the investigators recommended.

This study was funded by the Dutch Arthritis Foundation. One investigator reported receiving financial compensation from UCB Pharma; the other investigators reported having no relevant disclosures.

On Twitter @jessnicolecraig


Caption: Dr. Jenny Brouwer: "When an RA patient wishes to conceive, NSAIDs should be avoided."
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Title Annotation:RHEUMATOLOGY; Nonsteroidal anti-inflammatory drugs
Author:Craig, Jessica
Publication:Family Practice News
Geographic Code:1USA
Date:Nov 1, 2016
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