Women Express Concern Over Arthritis Therapy Continuation During Pregnancy

In a collaborative study with patient-powered research network Arthritis Power and their partner online community CreakyJoints, a team of investigators explored female patient’s trepidation with health care providers and how concerns with drug safety impact the use of arthritis medications within that group.

The study, headed by Mehret Birru Talabi, MD, indicated that 31-62% of women with inflammatory arthritic disease such as rheumatoid arthritis (RA), spondylarthritis (SPA), and juvenile idiopathic arthritis (JIA) discontinue disease-modifying antirheumatic drugs (DMARDs) while pregnant or breastfeeding.

While the discontinuation is appropriate in some circumstances, the team highlighted some of the concerning health consequences in some female patients when their arthritis is not properly treated.

“Poorly controlled inflammatory arthritis among mothers with RA and JIA has been associated with adverse fetal outcomes, including prematurity and low birth weight,” the team wrote.

Active arthritis has also been associated with subfertility and impaired physical functioning, investigators wrote.

The team noted that discontinuation of arthritis medication is often a choice rather than a necessity. As such, they chose to gather information regarding the risks and benefits of treatment in order to better inform female patients with inflammatory arthritis.

The study population consisted of 66 female patients with arthritis, all of whom were members of Arthritis Power and CreakyJoints. Questionnaires were sent regarding the age of the participants (ages 18-50 were accepted), as well as their post-pregnancy diagnosis.

In addition to the questionnaires, a qualitative analysis was conducted by MBT, a rheumatologist and women’s health specialist with formal qualitative training; in coordination with MEBC a rheumatologist with expertise in the reproductive health of women with rheumatic diseases; and AME, an investigator in rheumatology and women’s health.

Most of the participants in the study were White, diagnosed with RA, and college educated. However, the team noted that each type of arthritis was represented. An average of 1.7 pregnancies per diagnosis were recorded, and 95% of all participants indicated a historical or current use of a DMARD or prednisone.

Despite the overwhelming number of participants stating they used medications for their arthritis, many of them admitted concerns involving their pregnancies.

“A central theme that emerged from surveys and free-text responses was that respondents were worried about the safety of their traditional or biologic DMARDs during pregnancy and lactation,” the team wrote.

According to the study, 40% of all women felt that no medications were safe to use during pregnancy. The remaining participants chose prednisone (41%); tumor necrosis factor α (TNF) inhibitors (15%); nonsteroidal anti-inflammatory drugs (NSAIDs; 11%); hydroxychloroquine (HCQ; 9%); and acetaminophen (2%) as safe medications.

However, in a sample taken from the study, nearly 80% of all participants discontinued their use of prescribed medication, and 78% of all participants had concerns of the effect of medication on breastfeeding.

Despite a significant portion of participants admitting to having discussions with rheumatologists (80%), obstetricians (73%), and/or primary care providers (P

CPs; 33%) about the safety of the antirheumatic drugs during pregnancy, an overwhelming number of participants felt they should discontinue use.

The team contributed these decisions to a variety of factors. They noted about one-fourth (24%) of participants reported differing opinions among health care providers. Another 95% reported discrepancies and misinformation in online health searches.

The team went on to suggest that greater care be put into informing pregnant patients with arthritis of the benefits and possible side effects of medications.

“Our findings underscore the importance of care coordination between health care providers so that messaging about medication safety is consistent and evidence based,” the team wrote. “High-quality information is needed for patients and providers alike to support informed, up-to-date medication decision-making that preserves women’s physical functioning and well-being through all phases of their reproductive lives.”

The study, “Tough Choices: Exploring Medication Decision-Making During Pregnancy and Lactation Among Women With Inflammatory Arthritis,” was published online in ACR Open Rheumatology.