Ohtsu Hiroshi, Fujioka Izumi, Goto Mikako, Takai Chinatsu, Yonemoto Naohiro, Sase Kazuhiro, Murashima Atsuko
Faculty of Health Data Science, Juntendo University, Tokyo, Japan.
Department of Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Int J Rheum Dis. 2025 Jun;28(6):e70296. doi: 10.1111/1756-185X.70296.
Rheumatoid arthritis (RA) frequently affects women of reproductive age; its treatment requires disease-modifying antirheumatic drugs (DMARDs). Despite the widespread use of biologics and the expected improvement in fertility, real-world studies evaluating reproductive outcomes in women with RA are limited. We aimed to compare reproductive outcomes in women with and without RA using a nationwide claims database in Japan.
This retrospective cohort study analyzed 231 427 women (aged 20-38 years) from the JMDC Claims Database. After propensity score matching, we compared 262 women with RA (defined by diagnosis and DMARDs prescription) to 1310 matched controls without RA.
During the 5-year follow-up, women with RA showed significantly lower delivery rates than the matched controls (19.0% vs. 28.2%, p < 0.001). Kaplan-Meier analysis demonstrated a significantly longer time to delivery in the RA group than in the non-RA group (log-rank p = 0.0014). In the subgroup analysis, the mean time to delivery was longer in patients with RA and methotrexate use (38.1 months) than in those without methotrexate use (33.7 months) and in non-RA controls (32.2 months). Despite modern RA treatments, including biologics, women with RA have significantly lower delivery rates and longer delivery times than those without RA. This study was limited by potentially unmeasured confounding factors and the lack of certain data.
These findings highlight the need for proactive reproductive health management in women with RA and emphasize the importance of collaboration between rheumatologists and obstetricians to provide optimal care for these patients.
类风湿关节炎（RA）常影响育龄女性；其治疗需要使用改善病情抗风湿药（DMARDs）。尽管生物制剂广泛应用且预期生育能力会有所改善，但评估RA女性生殖结局的真实世界研究有限。我们旨在利用日本全国性理赔数据库比较患RA和未患RA女性的生殖结局。
这项回顾性队列研究分析了来自JMDC理赔数据库的231427名年龄在20至38岁之间的女性。在进行倾向得分匹配后，我们将262名患RA的女性（根据诊断和DMARDs处方定义）与1310名匹配的未患RA的对照进行了比较。
在5年随访期间，患RA的女性分娩率显著低于匹配的对照组（19.0%对28.2%，p<0.001）。Kaplan-Meier分析表明，RA组的分娩时间显著长于非RA组（对数秩检验p=0.0014）。在亚组分析中，使用甲氨蝶呤的RA患者的平均分娩时间（38.1个月）长于未使用甲氨蝶呤的患者（33.7个月）和非RA对照组（32.2个月）。尽管有包括生物制剂在内的现代RA治疗方法，但患RA的女性分娩率显著低于未患RA的女性，且分娩时间更长。本研究受到潜在未测量的混杂因素和某些数据缺乏的限制。
这些发现凸显了对RA女性进行积极生殖健康管理的必要性，并强调了风湿病学家和产科医生合作以为这些患者提供最佳护理的重要性。
