WASHINGTON — A recent study presented at the American College of Rheumatology (ACR) 2024 Annual Meeting reveals that women suffering from rheumatoid arthritis (RA) can significantly enhance their fertility prospects when they undergo treatment guided by a treat-to-target (T2T) strategy that focuses on achieving remission. This groundbreaking research sheds light on an important aspect of reproductive health for this population.
In this study, it was found that over 50% of the women who adhered to the T2T methodology successfully conceived within just three months, a rate that Dr. Radboud Dolhain, MD, PhD—who leads the Department of Rheumatology at Erasmus University Medical Center in Rotterdam, the Netherlands—noted is “nearly equal to the general population.” This statistic provides a sense of hope for many women facing fertility challenges linked to RA.
While typically 10%-15% of the general population might face difficulties getting pregnant within a year of unprotected intercourse, the findings show that as many as 42% of women with RA encounter the same challenges. These statistics highlight the pressing need for targeted treatment strategies among those living with this chronic condition.
Dr. Mehret Birru Talabi, MD, PhD, who serves as the director of the Women’s and Reproductive Health Rheumatology Clinic at the University of Pittsburgh Medical Center, emphasized the critical importance of discussing effective RA treatment for women contemplating pregnancy. She emphasized, “For people who are thinking about pregnancy or want to plan for pregnancy, discussing how vital it is to ensure that their RA is well-treated is essential.”
Dolhain described the study as substantial, noting it demonstrates that effective treatment can notably reduce the time it takes for patients to achieve pregnancy, a finding that could reshape patient management plans moving forward.
Study Details
The research analyzed the time it took two groups of women with RA, both of whom aimed to conceive, to achieve pregnancy. The study participants were, on average, 32 years old, with almost 60% reporting no prior pregnancies.
The first group, participants in the Pregnancy-Induced Amelioration of RA (PARA) study, received standard care from their rheumatologists from 2002 through 2010. Among the 245 women in this cohort, one-third were prescribed sulfasalazine, 6% used hydroxychloroquine, and 4% were treated with a tumor necrosis factor (TNF) inhibitor. Notably, 36% of these individuals were not on any medication, while approximately one-fourth were taking nonsteroidal anti-inflammatory drugs (NSAIDs).
The second group was drawn from the Preconception Counseling in Active RA (PreCARA) study, taking place at Erasmus University Medical Center from 2012 to 2023. This cohort of 215 women underwent treatment using the T2T approach aimed explicitly at achieving remission or low disease activity. Among these participants, 69% were on sulfasalazine, 65% on hydroxychloroquine, and 53% received a TNF inhibitor. Furthermore, 45% took prednisone, but a notable 75% of those on prednisone utilized a daily dose of ≤ 7.5 mg.
The disparity in the median Disease Activity Score in 28 joints, calculated based on C-reactive protein levels, was marked, with the PreCARA cohort achieving a score of 2.33 compared to 3.84 in the PARA cohort, demonstrating better-controlled disease activity in the former group.
In terms of fertility outcomes, the median time to pregnancy was markedly lower for the PreCARA cohort, averaging just 84 days, while the PARA cohort averaged a significantly longer 196 days. Notably, while 42% of women in the PARA group struggled to conceive within a year, less than 25% of those in the PreCARA cohort faced the same issue, indicating a substantial benefit derived from the T2T approach.
Dolhain and colleagues observed that maternal age and nulliparity were significant factors associated with time to pregnancy in the PreCARA cohort, underscoring the importance of these variables in reproductive health assessments.
Dolhain remarked on the robustness of the data, highlighting that no significant correlations were found between time to pregnancy and disease activity, the use of NSAIDs, or prednisone, allowing for a more focused understanding of what influences successful conception.
Study ‘Will Make Patients Feel More Confident in Their Decisions’
Dr. Talabi noted that discussions surrounding medication use before and during pregnancy can create tension for some patients, affirming that studies like this provide vital reassurance that effective treatment aids in achieving reproductive goals.
Dr. Catherine Sims, MD, a rheumatologist at Duke Health who specializes in reproductive rheumatology, highlighted the clinical relevance of this study. She noted the necessity of demonstrating to patients the advantages of maintaining their treatment regimen in the preconception phase and during pregnancy, as the health of the mother is directly linked to the health of the pregnancy.
Sims stated, “What we try to drive home is that the health of the mother directly translates to the health of the pregnancy and that includes medications. We have demonstrated that pregnancies are safe while taking these medications.” Her positive remarks suggest that findings from this study could bolster patient confidence in decision-making regarding their treatment options.
Sims is a consultant for Amgen and has conducted research funded by GlaxoSmithKline. Dolhain and Talabi reported no relevant disclosures.
How can healthcare providers better support women with rheumatoid arthritis who are planning to conceive?
**Interview with Dr. Radboud Dolhain on Rheumatoid Arthritis and Fertility**
**Editor:** Welcome, Dr. Radboud Dolhain, to discuss your recent study presented at the ACR 2024 Annual Meeting. Your research on rheumatoid arthritis and fertility has generated significant interest. Can you briefly summarize the key findings for our audience?
**Dr. Dolhain:** Thank you for having me. Our study focused on the impact of a treat-to-target (T2T) treatment strategy on the fertility of women with rheumatoid arthritis (RA). We found that over 50% of women who adhered to this approach were able to conceive within three months, a rate similar to the general population. This is encouraging, especially considering that women with RA often face fertility challenges.
**Editor:** That’s remarkable. You noted that 42% of women with RA typically have difficulty conceiving within a year. How does your study address this disparity?
**Dr. Dolhain:** Correct. The study compared two groups: one receiving standard care and another following the T2T approach aimed at remission. The T2T cohort not only had better disease control but also a significantly shorter median time to pregnancy—just 84 days compared to 196 days in the standard care group. Hence, this targeted strategy may offer substantial benefits in reproductive outcomes.
**Editor:** What implications do the findings have for the management of women with RA who are planning to conceive?
**Dr. Dolhain:** Our research underscores the importance of actively managing RA before and during pregnancy. It’s crucial for healthcare providers to discuss effective treatment options and ensure disease control is prioritized for women considering pregnancy. This can significantly improve their fertility prospects and overall health outcomes.
**Editor:** Dr. Mehret Birru Talabi emphasized the necessity of discussions surrounding RA treatment for those thinking about pregnancy. How can healthcare providers support these women better?
**Dr. Dolhain:** Providers need to initiate open conversations about fertility and RA management early on. Women should be informed about the benefits of the T2T strategy and the available treatments that can aid in disease control while planning for pregnancy. Joint decision-making and personalized treatment plans are key to improving outcomes.
**Editor:** What are the next steps for this line of research?
**Dr. Dolhain:** We hope to further investigate the long-term impacts of T2T strategies on maternal and fetal health. Additionally, we aim to develop guidelines that can help clinicians adopt these findings to improve care for women with RA.
**Editor:** Thank you, Dr. Dolhain, for sharing your insights on this important topic. We look forward to seeing how this research progresses and its implications for women’s health.
**Dr. Dolhain:** Thank you for the opportunity to discuss this vital research!
