Five-Year Delivery Rate and Time to Delivery Among Women With and Without Rheumatoid Arthritis: A Real-World Analysis...

Area of Science:

• Reproductive Health
• Rheumatology
• Clinical Epidemiology

Background:

• Rheumatoid arthritis (RA) affects women of reproductive age, necessitating disease-modifying antirheumatic drugs (DMARDs).
• Limited real-world data exists on reproductive outcomes in women with RA despite modern treatments like biologics.
• This study addresses the gap in understanding fertility and pregnancy outcomes in RA patients.

Purpose of the Study:

• To compare reproductive outcomes, specifically delivery rates and time to delivery, in women with and without rheumatoid arthritis.
• To evaluate the impact of RA and its treatments on fertility and pregnancy success.

Main Methods:

• Retrospective cohort study using a Japanese nationwide claims database (JMDC).
• Included 231,427 women aged 20-38 years.
• Propensity score matching compared 262 women with RA (defined by diagnosis and DMARDs) to 1310 controls without RA over a 5-year follow-up.

Main Results:

• Women with RA had significantly lower delivery rates (19.0% vs. 28.2%, p < 0.001).
• Kaplan-Meier analysis showed a longer time to delivery in the RA group (log-rank p = 0.0014).
• Methotrexate use in RA patients was associated with a longer mean time to delivery (38.1 months) compared to non-RA controls (32.2 months).

Conclusions:

• Women with RA experience significantly poorer reproductive outcomes, including lower delivery rates and longer time to conception.
• Findings underscore the need for integrated care, involving rheumatologists and obstetricians, for proactive reproductive health management in women with RA.
• Despite advancements in RA treatment, including biologics, fertility challenges persist, necessitating further research and patient support.