https://doi.org/10.55788/5932c2d0
Around three-quarters of RA patients are women, and clinical onset often occurs during their childbearing years. However, RA may lower the chance of pregnancy, as infertility rates (defined as the inability to conceive within 1 year of unprotected intercourse) are up to 42% in women with RA compared with 10–15% in the general population [1]. RA-related factors associated with fertility were previously studied in the Pregnancy-induced Amelioration of RA (PARA) cohort [2]. These factors include age, nulliparity, disease activity, use of NSAIDs, and use of prednisone (>7.5 mg/day).
The results of the PARA study prompted the initiation of a new cohort, namely the Preconception Counseling in Active RA (PreCARA). The PreCARA study went on to show that in women who wish to conceive, a T2T approach aiming at remission but avoiding NSAIDs and high-dose prednisone is feasible [3]. To achieve this, sulfasalazine and hydroxychloroquine were prescribed, plus, if needed, a TNF inhibitor or low-dose prednisone.
The Dutch group, led by Prof. Radboud Dolhain (Erasmus University Medical Center, the Netherlands), evaluated whether a T2T strategy in the PreCARA cohort (2012–2023) was associated with a shorter time to pregnancy than in the historical reference cohort of the PARA study (2002–2010) [4].
The PreCARA and PARA cohorts had 215 and 245 participants, respectively. Prof. Dolhain noted that disease activity in the first trimester was significantly lower in the PreCARA cohort (DAS28 of 2.03 vs 3.48; P<0.01). In the PreCARA cohort, medication use was much more common, including the use of TNF inhibitors (53% vs 4%; P<0.01).
The median time to pregnancy in the PreCARA cohort was 84 days (range 0–298) in participants who got pregnant, compared with 196 days (77–464) in the PARA study (P<0.01). In the PreCARA cohort, 23% was not pregnant within 1 year; in the PARA cohort, this was 42% (P<0.01). A Kaplan-Meier survival curve depicting pregnancy within 5 years also showed a statistically significant difference in favour of the PreCARA cohort, with differences being much greater in the first 3 years (see Figure).
Figure: Time to pregnancy in the PreCARA (T2T) and PARA (historical controls) cohort: Kaplan-Meier curve for being pregnant within 5 years [4]

Factors associated with pregnancy in the PreCARA cohort included maternal age per year (HR 0.95) and nulliparity (HR 0.69). These findings suggest that the T2T approach could significantly improve fertility management in women with RA.
- De Man YA, et al. Arthritis Rheum. 2008;59(9):1241-8.
- Brouwer J, et al. Ann Rheum Dis. 2015;74(10):1836-41.
- Smeele HTW, et al. Ann Rheum Dis. 2021;80(7):859-64.
- Quaak CH, et al. Improved fertility in women with rheumatoid arthritis and a wish to conceive when treated according to a treat-to-target approach aimed at remission. Abstract 1647, ACR Convergence 2024, 14–19 November, Washington DC, USA.
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Table of Contents: ACR 2024
Featured articles
Registry participation can enhance quality of rheumatology care
Meet the Trialist: Prof. Philip J. Mease on the bimekizumab clinical trial program in psoriatic arthritis
Rheumatoid Arthritis
T2T approach in women with RA associated with increased fertility
Positive results for vagus nerve stimulation in RA
Machine learning to aid evaluation of ANA pattern and titer
Systemic Lupus Erythematosus
ACR presents new 2024 Guideline for lupus nephritis
Dapirolizumab pegol associated with less SLE activity and corticosteroid use
Allogeneic CD19-targeting CAR NK-cell therapy for SLE
Osteoarthritis and Osteoporosis
XG005 relieves knee osteoarthritis symptoms in phase 2b study
NT-3 inhibitor relieves pain caused by osteoarthritis
Therapeutic equivalence between denosumab and biosimilar Bmab-1000
Psoriatic Arthritis
Post-hoc analysis of 3 large trials maps sex differences in PsA
Global recruitment associated with higher placebo responses in PsA trials
Gout
Prolonged plasma urate-lowering with a novel pegylated uricase
SGLT2 inhibitor therapy could be beneficial for gout patients
Vasculitis
Fully tapering glucocorticosteroids may be a viable option for GPA
Favourable benefit-risk profile of upadacitinib in giant cell arteritis
Mycophenolate mofetil plus methotrexate is effective in Takayasu’s arteritis
Miscellaneous
Emapalumab rapidly controls MAS in patients with Still’s disease
FcRn blocker nipocalimab improves disease activity in Sjögren’s disease
Inebilizumab associated with reduced flare risk in IgG4-related disease
General Rheumatology
ICI therapy does not increase mortality risk in patients with pre-existing autoimmune disease
Registry participation can enhance quality of rheumatology care
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