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Women with arthritis take longer to conceive

Women with rheumatoid arthritis (RA) looking to get pregnant take longer to conceive than healthy women.

RA can, after all, have periods of mild discomfort, but it can also 'flare up' and become active. The chronic use of anti-inflammatory drugs (NSAIDs) and prednisone in doses of more than 7.5 mg per day also appear to have a negative effect on how quickly RA patients become pregnant.

ZwangerschapThese are the conclusions drawn by PhD student Jenny Brouwer after observing more than 300 young women with RA. The women, from the PARA cohort, were monitored long-term. Brouwer observed the effect of the disease on fertility and the effect of medication. It took women with RA an average of six months longer to become pregnant. In 40% of the women it took more than a year to conceive. On average, healthy women conceive within three months.

Women with RA are therefore advised to discuss their wish to conceive with a rheumatologist in good time. The physician can then start treatment with drugs that are safe during pregnancy, without having to use NSAIDs and prednisone in doses higher than 7.5 mg per day. After all, the aim is to strive for the lowest possible disease activity. Previous studies have shown that there are an increasing number of drugs available that can be used safely during pregnancy.

Another important finding according to Brouwer is that the so-called Anti-Müllerian Hormone level decreases faster in women with RA than in healthy women. "The Anti-Müllerian Hormone is a substance released during the early maturation of the eggs. The ovaries of women with an earlier decrease of this hormone will age faster." The decrease in the hormone level was measured in women who had suffered RA for longer periods. Especially women with the substance ACPA in their blood had lower Anti-Müllerian Hormone values, and the RA was more often active in these women. 

Disease activity
Brouwer suspects that the decrease of the hormone level is due to more accumulated disease activity over the years. "Previous studies had already shown that the patients start the menopause about one and half years earlier. This is why women with RA are advised to start thinking about family planning in good time." 

Brouwer also calls for close cooperation between rheumatologists and gynecologists. This is already the case at the Family Planning and Pregnancy outpatient clinic of Erasmus MC's department of Rheumatology. "Pregnant women and their unborn babies must be properly monitored. The treatment of the disease can be tailored to the patient. Good communication and cooperation between gynecologists and rheumatologists is very important. Preferably before the woman becomes pregnant." 

Jenny Brouwer is fertility physician and will receive her PhD for her research on 21 February. The study was made possible with funding from the Dutch Arthritis Association (Reumafonds).

See the press release.

Date published: 19 February 2018.

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