Background: Rheumatoid Arthritis (RA) is one of the most common chronic inflammatory disease in women in reproductive age. It seems difficult to acheive parenthood in RA, therefore, reproductive health in these patients is an important issue. Many factors may interfere with procreation such as high disease activity and medication. Female perception and behavior towards fertility are not often assessed.

Objectives: We aimed to evaluate the fertility perceptions and related behavior among young women with RA.

Methods: We conducted a cross sectional study involving young female patients with RA (2010 ACR-EULAR criteria). Sociodemographic data and the following disease-related parameters were collected: diseases activity score (DAS28CRP) and NSAID (Non steroidal Anti-inflammatory Drugs), prednisone and DMARDs being used. We asked the patients about their knowledge about the risk of infertility due to the disease itself, the activity of RA and medication.

Results: Sixty-two females patients were included. The average age was 26.1 ±2.1 years [20-35]. The majority of patients, 54 women, live in rural enviroment and 8 women live in urban enviroment. Forty-two women (67%) were illiterate, ten women (16%) had primary or secondary school level and ten women (16%) had university school level. Only twenty percent (20%) were employed. There were no smokers included. Sixty-six percent (66%) were married. Forty-one women (66%) aimed to have children: 35 women got pregnant and 6 still didn’t get pregnant. The average of gestity was 1.6 [0-4]. The average of parity was of 1.2 [0-3]. The average of time to pregnancy (TTP) was 12 months ± 2 [6-24]. Pregnancy resulted in a live-born baby in 30 women (73%), 4 women (9%) miscarried and there was one intra-uterine fetal death (2%). Ten pregnant women had had fertility treatment to get pregnant. The mean duration of the RA was 3.1 years ± 1.2 [2-10]. The mean DAS28CRP were 3.1 ± 1.25[2-3.9]. Both rheumatoid factor and anti-citrullinated peptides antibodies were positive in 58 women (93%). RA was erosive in 48 cases (76.1%) and deformed in 2 cases (3%). Half of patient were using NSAID daily and 60% were using prednisone with an average daily dose of 5.1 mg/day [2.5-7.5]. Sixty-one percent (61%) of patients were using Methotrexate with an average weekly dose of 15.1 mg/week [10-22.5], 10% Leflunomide, 10% Sulfasalazine, and 45% biotherapy. About half of patient think that RA may cause fertility problems, infertility in 60% and abortion in 40% and they had this information in 60% from media, 30% from siblings and only 10.1% from their rheumatologist. None of patients think that disease activity may interfere with pregnancy and that they should strive low disease activity before trying to conceive. None of patients think that NSAID or COX2 inhibitor or prednisone may interfere with fertility and about 10 women used NSAID in pregnancy. About 24% think that DMARDs may interfere with procreation especially infertility (100%) with respectively: MTX (70%), Leflunomide (3%), Sulfasalazine (5%), biotherapy (20%). Women who didn’t get pregnant accused their impaired fertility to their DMARDs and eight women stopped their DMARDs in pregnancy for fear that it affected their baby. Only 5 women (8%) saw a rheumatologist in the preconception period.

Conclusion: The relationship between RA and fertility seems to be misunderstood in young women with RA. Clinicians must routinely discuss this issue with these young patients to preserve their fertility by learning them the mechanisms by which RA may affects their fertility: the disease itself and medication. Appropriate information about fertility can help women in productive age reach and carry a healthy pregnancy.

Disclosure of Interests: None declared