Factors Associated With Time to Pregnancy in Women With Axial Spondyloarthritis: A Registry‐Based Multicenter Study

Ursin, Kristin; Lydersen, Stian; Skomsvoll, Johan Fredrik; Salvesen, Kjell Å.; Koksvik, Hege Svean; Jakobsen, B.; Wallenius, Marianne

doi:10.1002/acr.24233

Cited by 16 publications

(7 citation statements)

References 33 publications

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“…Factors that may have a negative influence on fertility of patients with axSpA are older age, nulliparity and longer disease duration, although the time-to-pregnancy was found to be similar to that of patients with rheumatoid arthritis and was less than 12 months in nearly 80% of patients. 43 Biologics have not been shown to affect fertility, unlike nonsteroidal anti-inflammatory drugs, which may impair fertility by inducing luteinised unruptured follicle syndrome; this should be communicated to patients. 44 Patients who are already pregnant or wishing to conceive need to discuss the risks for fetal and maternal health and whether they should continue or discontinue treatment.…”

Section: Introductionmentioning

confidence: 99%

“…In most cases of pregnancy, female patients with axSpA are likely to show aggravated symptoms of back pain and impaired function, especially during the second trimester. 43 The withdrawal of TNFi at the beginning of pregnancy is associated with increased risk of flares during pregnancy. 45 The management of flares with corticosteroids is actually associated with preterm delivery; therefore, it is convenient to consider the use of TNFi during pregnancy, which are currently thought to be compatible with pregnancy with no increased risk for adverse fetal and maternal outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients

et al. 2021

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Emerging evidence suggests that axial spondyloarthritis (axSpA) should not be seen as a predominantly male disease, as the non-radiographic form occurs with roughly equal frequency in women and men. However, men and women experience this disease differently. The purpose of this review is to highlight sex-associated and gender-associated differences in the patient’s journey through the diagnosis and management of axSpA, in order to increase the awareness about the unmet needs of female axSpA patients.Female patients experience a longer diagnostic delay compared with men, possibly due to the different pattern of clinical presentations across genders. Therefore, it is crucial to sensitise physicians to pay attention and identify the red flags of axSpA in women and promote early referral to a rheumatologist. Women with a diagnosis of axSpA experience greater limitations in physical function, although they have less structural spinal damage compared with men. Women tend to have less adherence and a lower response to treatment, so more gender-oriented data are needed about drugs used for axSpA, especially biological disease-modifying antirheumatic drugs.Lifestyle factors have a strong impact on the disease course. Interventions regarding physical activity, smoking cessation and diet should be communicated to the patients, with particular attention to the gender-related cultural background.Patients of childbearing age living with axSpA should be engaged in a discussion about reproductive health, in terms of preservation of fertility, management of pregnancy and delivery and use of biologic drugs during pregnancy and breastfeeding.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients

et al. 2021

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“…In the field of rheumatology, impaired fertility has been reported in Norwegian women with inflammatory joint diseases (IJDs) 9–11. However, there is a lack of large studies regarding male fertility, a problem well summarised in several systematic reviews 12–14.…”

Section: Introductionmentioning

confidence: 99%

“…8 In the field of rheumatology, impaired fertility has been reported in Norwegian women with inflammatory joint diseases (IJDs). [9][10][11] However, there is a lack of large studies regarding male fertility, a problem well summarised in several systematic reviews. [12][13][14] The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding was the first international guideline to produce recommendations regarding prescription of antirheumatic drugs in male subjects wishing to father.…”

Section: Introductionmentioning

confidence: 99%

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

Sigmo,

Hauge,

Hufthammer

et al. 2024

Ann Rheum Dis

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ObjectivesTo 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.MethodsThis 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.ResultsThe 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).ConclusionIn 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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“…Data from the above-mentioned studies mainly derive from claims data analysis, Nordic registries or single-centre (hospital) cohorts. Data from prospectively followed patients with axSpA before, during and after pregnancy are however scarce and were mainly reported from the Norwegian pregnancy registry in rheumatology (RevNatus)8 9 and the Bern cohort 7 10…”

Section: Introductionmentioning

confidence: 99%

Pregnancy and neonatal outcomes in women with axial spondyloarthritis: pooled data analysis from the European Network of Pregnancy Registries in Rheumatology (EuNeP)

et al. 2022

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ObjectiveTo investigate outcome and course of pregnancies in women with axial spondyloarthritis (axSpA) in a pooled data analysis of pregnancy registries in rheumatology.MethodsProspectively followed women with axSpA, fulfilling ASAS classification criteria and for whom a pregnancy outcome was reported, were eligible for the analysis. Anonymised data of four registries was pooled. Rates of adverse pregnancy outcomes were calculated. Systemic inflammation, disease activity and treatment patterns with tumour necrosis factor inhibitor (TNFi) before, during and after pregnancy were analysed.ResultsIn a total of 332 pregnancies from 304 axSpA women, 98.8% of the pregnancies resulted in live birth. Mean maternal age was 31 years and disease duration 5 years. Most of these patients received pre-conception counselling (78.4%). Before pregnancy, 53% received TNFi treatment, 27.5% in first and 21.4% in third trimester. Pregnancy and neonatal outcomes were favourable with rates of 2.2% for pre-eclampsia, 4.9% for preterm birth, 3.1% for low birth weight and 9.5% for small for gestational age. Neonates were delivered by caesarean section in 27.7% of pregnancies, of which 47.4% were emergencies. Pooled mean CRP was 4 mg/L before conception peaking in the second trimester at 9.4 mg/L. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was below 4 at all time-points.ConclusionsPooled rates of most outcomes were better than what had been reported in the literature and within expected rates of those reported for the general population. Pre-conception counselling, planned pregnancies and a tight management in expert centres applying a tailored treatment approach may have contributed to the favourable pregnancy outcomes.

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Factors Associated With Time to Pregnancy in Women With Axial Spondyloarthritis: A Registry‐Based Multicenter Study

Cited by 16 publications

References 33 publications

Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients

Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients

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

Pregnancy and neonatal outcomes in women with axial spondyloarthritis: pooled data analysis from the European Network of Pregnancy Registries in Rheumatology (EuNeP)

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