What is included in preconception counseling of women with rheumatoid arthritis (RA)?

Updated: May 11, 2018
  • Author: Katherine K Temprano, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

It is important to counsel women of childbearing age about the teratogenicity and adverse effects of the medications used to treat rheumatoid arthritis (RA) before starting therapy. These patients may need a reminder about the importance of using contraception during therapy with disease-modifying antirheumatic drugs (DMARDs), especially methotrexate, leflunomide, and cyclophosphamide. Educate patients that because of a prolonged half-life, some of these medications may need to be discontinued several months before conception is planned. In addition to discontinuation, some patients who take DMARDs may require treatment with other medications to enhance their clearance.

Fertility is compromised in women with RA. They report having fewer children than they intended to have and they are more often nulliparous that women without RA. In women with RA diagnosed before family completion, 36% to 42% will experience a time to pregnancy (TTP) greater than 12 months. 

Adjustments to antirheumatic treatment before women start trying to conceive coupled with longer TTP can result in a prolonged period with less adequately controlled disease and consequently an increased risk for permanent damage to the joints. [16]  Factors associated with longer time to pregnancy included age, nulliparous state, and preconception use of nonsteroidal anti-inflammatory drugs (NSAIDs) and prednisone (>7.5 mg/day). Thus preconception treatment strategies should aim at maximum suppression of disease activity, while taking into account possible negative effects of NSAID use and higher prednisone doses. [17]


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