New research shows that more than half of women with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have fewer children than desired. While patient choice has some influence on the smaller family size, findings published today in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR), suggest that higher rates of infertility and miscarriage may also impact the number of offspring born to women with these chronic conditions.
According to the ACR up to 322,000 U.S. adults have systemic lupus—a disease in which the body's immune system becomes overactive and attacks healthy cells, tissues, or organs. Roughly 1.3 million adult Americans suffer from RA, a chronic autoimmune disease that causes painful joint inflammation. Medical evidence reports that both RA and SLE are more common in women, and onset often occurs during reproductive years which can lead to challenges in family-building.
To further understand the role of infertility, pregnancy loss and family size choice in women with RA and SLE, Megan Clowse, M.D., Kaleb Michaud, Ph.D. and colleagues from institutes across the U.S. surveyed 1,017 female participants in the National Data Bank for Rheumatic Diseases. Respondents to the reproductive-health questionnaire included 578 women with RA and 114 with SLE, who based upon their responses, were then categorized as: those interested in having children at symptom onset who had either fewer children than planned (group A) or the same number as planned (group B), and those no longer interested in having children at diagnosis (group C).
Study findings reveal that over 60% of respondents were in group C. Researchers found that 55% of women with RA and 64% with SLE had fewer children than originally planned. Women with RA who were in group A had an infertility rate 1.5 times higher than those in group B, but both groups had similar rates of miscarriage. Women with SLE in group A had a similar number of pregnancies as those in group B, but a 3-fold higher miscarriage rate.
Overall the infertility rate among participants with RA was 42% in women who had fewer children than desired. In women diagnosed with RA during childbearing years the infertility rate was higher than in those diagnosed after childbearing was complete. For participants with SLE no significant increase in infertility was noted. However, among women with lupus having fewer children than desired was associated with pregnancy loss. The authors suggest that patient education to enhance awareness of safe medical options during pregnancy and effective control of these autoimmune diseases will assist women with achieving their childbearing goals.
"Our study highlights important reproductive-health concerns for women with RA and lupus," said Dr. Clowse. Study findings reported that concerns about inability to care for their children, adverse effects from medications taken during pregnancy, and genetic transmission of their disease to offspring lead to fewer pregnancies in women with RA and SLE. "Further study of the underlying causes of infertility and pregnancy loss in women with RA and SLE is needed to help fulfill their desire for children," concludes Dr. Clowse.
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Full citation: "The Effects of Infertility, Pregnancy Loss, and Patient Concerns on Family Size of Women with Rheumatoid Arthritis and Systemic Lupus Erythematosus." Megan E. B. Clowse, Eliza Chakravarty, Karen H. Costenbader, Christina Chambers, Kaleb Michaud. Arthritis Care & Research; Published Online: February 16, 2012 (DOI: 10.1002/acr.21593).
About the Journal: Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed research publication that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR). For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2151-4658.
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Arthritis Care & Research