The effect of RA and medication on female fertility

Østensen, Monika

doi:10.1038/nrrheum.2014.113

Cited by 14 publications

(15 citation statements)

References 11 publications

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“…With regard to fertility in RA as reported in other reports, 113 a recent study observed unexplained subfertility and anovulation in 48% and 28%, respectively, of 178 women. 114 Moreover, RA itself impairs the sexual function in up to 70% of women, 115 with a direct correlation with the disease activity.…”

Section: Fertility and Sexuality In Ra Patients Treated With Biologicsupporting

confidence: 59%

Personalization of biologic therapy in patients with rheumatoid arthritis: less frequently accounted choice-driving variables

Niccoli

Nannini

Blandizzi

et al. 2018

TCRM

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ObjectiveTo propose appropriate statements that drive the choice of biologic therapies in patients with rheumatoid arthritis (RA), factoring in their impact on the following issues: anti-drug antibody (ADAb) formation, suspicion and management of infections, lupus-like syndrome (LLS), effects on bone mass and sexual sphere, and relationship between RA and periodontal disease (PD).MethodsAn overview of existing evidence was undertaken by an expert panel on behalf of the Italian board for the TAilored BIOlogic therapy (ITABIO). Data were extracted from controlled trials, national registries, national health care databases, post-marketing surveys, and, when required by the paucity of controlled studies, from open-label clinical series. Anti-tumor necrosis factor (anti-TNF) and non-anti-TNF-targeted biologics approved for RA were investigated.ResultsADAb formation is chiefly associated with anti-TNFs, and it is reduced by combination therapy with methotrexate. To date, ADAb titration is not advisable for clinical practice, and, in case of anti-TNF secondary failure, a non-anti-TNF biologic is indicated. LLS is observed in anti-TNF receivers and, in most cases, resolves without anti-TNF withdrawal. A non-anti-TNF biologic is advisable in patients experiencing LLS. Non-anti-TNFs demonstrated a low or absent infection risk and are preferable in patients with comorbidities. Due to their positive effects on bone mass, anti-TNFs are indicated in women at osteoporosis risk, whereas non-anti-TNF have been poorly investigated. The emerging evidence of the relationship between RA and PD and the effects on anti-TNF efficacy should lead clinicians to consider the periodontal status in RA patients. Anti-TNFs may exert a positive effect on fertility and sexuality, and clinicians should explore these aspects in RA patients.ConclusionThe optimization of biologic therapies by taking into proper account the above issues would improve patient outcomes.

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Section: Fertility and Sexuality In Ra Patients Treated With Biologicsupporting

confidence: 59%

Personalization of biologic therapy in patients with rheumatoid arthritis: less frequently accounted choice-driving variables

Niccoli

Nannini

Blandizzi

et al. 2018

TCRM

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“…Smaller family sizes have been observed among women with inflammatory arthritis, which may also reflect clinical factors, such as physical disability, subfertility that is due to highly active disease or use of certain drugs, and/or higher rates of miscarriage . However, this patient‐driven reproductive health survey underscores the importance of women's decision‐making as a determinant of family size, as 58% of women chose to limit childbearing because of their arthritis.…”

Section: Discussionmentioning

confidence: 94%

“…Many women with inflammatory arthritis are diagnosed during their childbearing years. A number of studies have found that these women have fewer children as compared with healthy women; postulated reasons for the smaller family sizes have included physical limitations to sexual activity, subfertility from the arthritis or from use of certain medications (eg, methotrexate), or higher rates of fetal loss . Relatively little is known, however, about how female patients conceptualize pregnancy and childbearing or how their attitudes and beliefs about their diseases may ultimately influence their family sizes.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy, Periods, and “The Pill”: Exploring the Reproductive Experiences of Women with Inflammatory Arthritis

Talabi

Eudy

Jayasundara

et al. 2019

ACR Open Rheumatology

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ObjectiveWomen with inflammatory arthritis appear to have fewer children as compared with healthy women, but few studies have assessed how patients' attitudes and decision making influence their family sizes. Little is also known about how patients experience other aspects of their reproductive lives, such as menstruation and contraception.MethodsWe partnered with ArthritisPower, a patient‐powered research network, and its associated online patient community, CreakyJoints, to create and disseminate a survey among female members aged 18‐50 years with inflammatory arthritis.ResultsWomen in the final sample (n = 267) were 40 years old on average; most had rheumatoid arthritis (79%) and were predominantly white and college educated. Many women chose to limit childbearing because of their arthritis (58%); they feared that their arthritis was heritable, their diseases and medications could directly harm a fetus, they would be incapable of physically caring for a child, and arthritis could cause premature death, preventing them from raising their children. Infertility affected 40% of the sample. Half of women experienced subjective arthritis flares around the time of menstruation. Oral contraceptive pills (OCPs) did not worsen disease activity for most women and even prevented menstrual‐associated arthritis flares for a subset of women.ConclusionOur findings suggest that infertility, but also potentially outsized fear and anxiety related to their diagnoses, may affect the family sizes of women with inflammatory arthritis. The observation that menstruation worsens disease activity for some women requires additional study, and OCP use should be explored as a possible treatment for menstrual‐associated arthritis. Clinicians may wish to consider how they communicate patients' individual pregnancy‐associated risks, reassure patients when appropriate, and help to guide and support patients to make well‐informed reproductive decisions.

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“…Hydrocortisone administration was found that it alters pituitary ovarian axis by reducing LH pulse frequency and concentration [18]. Therefore menstrual cycle irregularity may be a result of corticosteroids intake in SLE patients [19]. In contrast, a small size study of juvenile onset SLE revealed that menstrual cycle irregularity was not different in patients on daily low dose (10 mg) or high dose (>20 mg) of prednisone [20].…”

Section: Glucocorticoidsmentioning

confidence: 99%

Ovarian Functions and Reproductive Preservation in Patients with Systemic Lupus Erythematosus: A Review of Literature

Altraigey¹,

Talaat²

2016

JFIV Reprod Med Genet

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Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease of unknown etiology. The course of SLE is highly variable, with recurrent remission and exacerbation. The prevalence of the disease is affected by race, age and gender. In this review of literature, we tried to surf the web searching for all of articles concerned with ovarian functions, reserve and preservation among patients with SLE.

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The effect of RA and medication on female fertility

Cited by 14 publications

References 11 publications

Personalization of biologic therapy in patients with rheumatoid arthritis: less frequently accounted choice-driving variables

Personalization of biologic therapy in patients with rheumatoid arthritis: less frequently accounted choice-driving variables

Pregnancy, Periods, and “The Pill”: Exploring the Reproductive Experiences of Women with Inflammatory Arthritis

Ovarian Functions and Reproductive Preservation in Patients with Systemic Lupus Erythematosus: A Review of Literature

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