AB0164 THE EFFECT OF RHEUMATOID ARTHRITIS ON FEMALE FERTILITY
Authors: S. Ben Jemaa, G. Mouna, A. Hriz, A. Feki, H. Fourati, S. Baklouti
Journal: Annals of the Rheumatic Diseases (2021)

Background: Infertility is a disease of the reproductive system defined by the failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Although rheumatoid arthritis (RA) tends to have a late onset, the disease also occurs during child-bearing years and may interfere with procreation. Objectives: The aim of this study was to compare fertility rates in women with RA with birth-year-matched references from the general population. Methods: This is a case-control study. Menopausal married women who were diagnosed in the department of Rheumatology at Hedi Chaker Hospital before the age of forty were recruited into this study as cases and apparently healthy age matched married women were recruited as controls. Demographic, clinical, immunological, radiological and therapeutic data were collected from each case using the medical record of patient. Data obtained included age, age of RA onset, duration of RA, extra-articular manifestations, Rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (ACPA), the presence of erosions on radiographs of hands and feet and the therapy. Rheumatoid arthritis and controls women were asked to state their menstrual regularity, age at menarche, age at menopause, gestity, parity, number of living children, time to first pregnancy, presence of primary or secondary infertility, the interpregnancy interval, presence of miscarriage or in utero foetal death (IUFD) or preterm delivery and their number. Results: The mean ages of the cases and controls was 54 ± 8,11 years [39, 69]. The median duration since onset of RA in the patients was 22,5 ± 10,53 years [1, 47]. The mean age of onset of the disease was 31,4 ± 6,3 [18, 39] years. Forty-nine percent (49%) of patient had extra-articular manifestations: ocular sicca syndrome in 43,8% of cases, pulmonary fibrosis in 5,3% of cases and rheumatoid nodules in 1,8 % of cases. Rheumatoid factor (RF) was present in 61,4% of cases while anti-CCP anti-body was present in 59,6% of cases. Erosive polyarthritis was found in 80,7% of patients. The mean rate of RF was 319,7 ± 462,4 UI/ml and the mean rate of anti-CCP was 185,8 ± 264. Women with RA had a statistically significant mean time to pregnancy longer than the control group. Primary infertility was seen in 15 (26,3%) patients and 2 (3,5%) controls, whereas secondary infertility was seen in 31 (54,5%) patients and 2 (3,5 %) controls. The patients were significantly more likely to have primary and secondary infertility. There were no significant differences in the age at menarche, the number of children, the gestity and the parity between the two groups. The age at menopause was statistically significant lower in the group patients than controls. Conclusion: Our study showed that RA women are more likely to have reduced fertility than general population. Although this study cannot definitively address the issue of impaired fertility among women with RA, the results are suggestive enough to warrant further research into the link between RA and fertility that takes women’s childbearing choices into account. References: [1]Clowse ME, Chakravarty E, Costenbader KH, Chambers C, Michaud K. Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 2012; 64: 668-74. [2]Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2015; 74: 1836-41. [3]Pope JE, Bellamy N, Stevens A. The lack of associations between rheumatoid arthritis and both nulliparity and infertility. Semin Arthritis Rheum 1999; 28:34250. [4]Akintayo RO, Aworinde O, Ojo O, Akintayo FC, Akinlade OM, Awodun RO, Isa SO. Is rheumatoid arthritis an innocent bystander in female reproductive problems? A comparative study of fertility in Nigerian women with and without rheumatoid arthritis. Eur J Rheumatol 2018; 5(3): 179-83. Disclosure of Interests: None declared