Disease Activity, Prednisone Linked to Conception Delay in RA

Brouwer J, Hazes JM, Lavel JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2014. [Online First: 15 May 2014] doi:10.1136/annrheumdis-2014-205383.

RA patients trying to conceive should strive for low disease activity, and avoid NSAIDS and daily dosages of prednisone greater than 7.5 mg, conclude the authors of this report.

Nearly one-third of women with rheumatoid arthritis (RA) have trouble becoming pregnant.  This is apparently the first study to link disease activity to reduced fertility in RA.

The 245 women with RA identified for this nationwide prospective study from the Netherlands were all actively trying to become pregnant or had already succeeded. Those who took longer than a year to conceive had scores higher than 5.1 for disease activity (DAS28) in 28 joints, used non-steroidal anti-inflammatory drugs (NSAIDs) prenatally, and took prednisone in doses higher than 7.5 mg a day.

RA patients with fertility problems also tended to be older than age 31 with no previous children, but age alone was not significant.

Previously prednisone was not thought to affect fertility in inflammatory diseases such as RA.

However, therapeutic doses of glucocorticoids have been shown to reduce surges of luteinizing hormone needed to trigger ovulation. Prednisone may also affect the endometrium to interfere with implantation of the ovum, and NSAIDS may affect ovulation, implantation, and formation of the placenta by dampening prostaglandin.

Time to conception was not affected by rheumatoid factor, anti-citrullinated protein antibodies, past methotrexate use, preconception use of sulfasalazine, or by smoking and disease duration.

However, two-thirds of the women in the study had a DAS28 over 3.2, indicating moderate disease activity. This may reflect suboptimal treatment and could also contribute to reduced fertility, the authors say.