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Background: Juvenile idiopathic arthritis (JIA) most commonly affects joints; however, it can also affect extra-articular structures [1]. Moreover, the treatment used for JIA can cause long-lasting adverse effects in multiple systems, including the reproductive system.
Objectives: To investigate the fertility status, pregnancy outcomes, and disease activity during and after pregnancy in patients with JIA. To determine the effects of drugs used in the treatment of JIA on these outcomes.
Methods: In this study, we interviewed 141 adult patients with JIA (65 male and 76 female) diagnosed using the International League of Associations for Rheumatology criteria. Relevant data were collected from archives and interviews. Infertility was defined as failure to conceive after one year of unprotected intercourse. Pregnancy complications investigated included preterm birth, gestational hypertensive disorders, births with fetal anomalies, miscarriage, non-elective cesarean section, fetal growth restriction, gestational diabetes, and fetal asphyxia.
Results: Nineteen female and six male patients attempted pregnancy. There were eight polyarticular (32%), six enthesitis-related (24%), five systemic (20%), three oligoarticular (12%), two undifferentiated (8%), and one psoriatic (4%) JIA patients. The average age was 29.2 years and the average age at disease diagnosis was 10.4 years. Twenty-four (96%) patients achieved conception, and only one patient (4%) was infertile.
All six male patients managed to have children without in vitro fertilization (IVF). Out of the nineteen female patients, sixteen managed to have healthy children. None of them used IVF. Of the three female patients who do not have children, two are currently pregnant. The patient who does not have children nor is pregnant has polycystic ovary syndrome (PCOS).
Eighteen female patients had a total of twenty-three pregnancies excluding the two ongoing pregnancies. Four pregnancies were complicated by miscarriage (17.4%) and nineteen resulted in healthy births. Pregnancy complications and disease activity during and after pregnancy in female JIA patients and their relationship with DMARD or biological agent exposure during conception or second and third trimesters are shown in Table 1. The mean visual analogue scale (VAS) score for the JIA disease activity during pregnancy was 2.6.
Conclusion: According to our findings, JIA does not seem to affect fertility. In addition, it did not have a significant effect on pregnancy outcomes or complications. Pregnancy did not have a remarkable effect on disease activity and most patients did not have a disease flare in the month following birth. There were no significant differences regarding pregnancy complications and disease activity between patients who were exposed to DMARDs or biological agents during conception or second and third trimesters and patients who were not exposed. Additional precautions do not seem to be necessary in managing patients with JIA during or after birth.
Pregnancy complications and disease activity during and after pregnancy in female JIA patients
| DMARD or biological agent exposure during conception or second and third trimester, n=5 | No DMARD or biological agent exposure during conception or second and third trimester, n=14 | p-value | |
|---|---|---|---|
| Preterm birth, n (%) | 0 (0) | 1 (7.1) | 1.00 |
| Preeclampsia, n (%) | 0 (0) | 1 (7.1) | 1.00 |
| Maternal diabetes, n (%) | 0 (0) | 1 (7.1) | 1.00 |
| Non-elective c-section, n (%) | 2 (40.0) | 8 (57.1) | 1.00 |
| VAS score during pregnancy
| 4.2 | 2.1 | 0.15 |
| Change in JIA flare frequency during pregnancy, n (% ) | |||
| Increase | 2 (40.0) | 3 (21.4) | 0.57 |
| Decrease | 1 (20.0) | 6 (42.9) | 0.60 |
| No change
| 2 (40.0) | 5 (35.7) | 1.00 |
| First post-partum JIA flare onset, n (% ) | |||
| During labour | 0 (0) | 1 (7.1) | 1.00 |
| During first week | 2 (40) | 2 (14.3) | 0.27 |
| Between first week and first month | 1 (20) | 2 (14.3) | 1.00 |
| No flare in first month | 2 (40) | 9 (64.3) | 0.60 |
REFERENCES: [1] Zaripova LN, Midgley A, Christmas SE, et al. Juvenile idiopathic arthritis: from aetiopathogenesis to therapeutic approaches. Pediatr Rheumatol Online J. 2021;19(1):135.
Acknowledgements: NIL.
Disclosure of Interests: None declared.