Page 68 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 4
Table 3 - Logistic regression analysis of associations with miscarriage in patients with rheumatoid arthritis*
Variable OR
Complete model
Age per year 1.11 ACPA positive 2.49 DAS28 per point 1.27 MTX use in past 2.52
Reduced model
Age per year 1.12 ACPA positive 2.47
95% CI
0.99–1.25 0.86–7.20 0.86–1.88 0.86–7.36
0.99–1.25 0.86–7.08
* None of the odds ratios (ORs) were signi cant at P < 0.05.
95% CI = 95% con dence interval; ACPA = anti-citrullinated protein antibody; DAS28 = Disease Activity Score in 28 joints; MTX = methotrexate.
Followup after miscarriage
Twenty-one women were revisited after miscarriage. Six weeks after miscarriage, disease activity was measured in 19 women. The mean ± SD DAS28 was 4.3 ± 0.88, which was higher than the preconception DAS28 of 3.9 ± 1.0 in these women, but the difference was not signi cant (P = 0.064). Six of these women (32%) had experienced a moderate disease flare by 6 weeks after miscarriage. There were no severe flares. Nineteen women were visited again 12 weeks after miscarriage. At that time point, the mean ± SD DAS28 was 4.1 ± 1.3, and an additional woman had experienced a moderate flare, resulting in a total of 7 (33%) of 21 women who had experienced a flare of RA between the preconception period and 3 months after miscarriage. Two patients had to put their efforts to conceive on hold, because they had restarted treatment with MTX or etanercept. No new flares had occurred in the 10 women who were revisited 6 months after miscarriage.
After they miscarried, 4 women (14%) stopped trying to conceive and 3 women (11%) were lost to followup. All of the remaining women (21 (75%) of 28) conceived after the miscarriage. Nineteen women became pregnant again within 1 year after miscarriage. Two women achieved pregnancies after 20 and 47 months respectively. Two women (10%) experienced one more miscarriage, but thereafter each had a live birth in the subsequent pregnancy.
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