Page 29 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

INTRODUCTION
Conceiving a child is a major life event and most adults try to have a child during their
reproductive life span. In women with inflammatory rheumatic disease, however, it 2 seems to be more dif cult to achieve parenthood.1
Rheumatoid arthritis (RA) is one of the most prominent inflammatory diseases affecting women of child-bearing age. Nearly one-third of female RA patients diagnosed before completion of child-bearing experience fertility problems.2 They have a prolonged time to pregnancy (TTP), the time between the start of actively trying to conceive and actually becoming pregnant.3 Pregnant RA patients are more likely to have had fertility treatment than pregnant controls.3,4 Women with RA have fewer children than women without RA,5-9 and more often fail to conceive at all.7 Hence fertility as well as fecundity seems to be compromised in women with RA.
Subfertility in RA has been studied only in retrospective studies or comparisons of registries.2,3,5-9 None of these studies have extensively examined the causes underlying the higher subfertility in RA, which may include disease activity, anti-rheumatic medication and immunological factors.
To identify clinical factors associated with a higher rate of subfertility in women with RA, we studied the TTP in consecutive RA patients who participated in a large prospective cohort study in the Netherlands on Pregnancy-induced Amelioration of Rheumatoid Arthritis (the PARA study).10
METHODS
Patients
Patients were drawn from the PARA study, an observational nationwide prospective cohort study on pregnancy in RA.10 The study was approved by the Erasmus MC medical ethics review board.
From May 2002 until August 2008, rheumatologists in the Netherlands recruited RA patients de ned according to the 1987 revised criteria of the American College of Rheumatology (ACR).11 To be eligible for the PARA study, patients should be actively
Fertility in RA – clinical factors
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