Anxiety and fear impact family size in women with inflammatory arthritis

Fear and disease-related anxiety may impact family sizes of women with inflammatory arthritis, says a study in ACR Open Rheumatology.

A total of 267 women aged 18–50 years completed an online survey that aimed to evaluate what impacts family size of women with inflammatory arthritis. Over 75% of the respondents had rheumatoid arthritis; the rest had juvenile arthritis, psoriatic arthritis, ankylosing spondylitis and arthritis associated with inflammatory bowel disease.

Infertility affected 40% of the volunteers, but 27% of the women became pregnant after being diagnosed with inflammatory arthritis.

As many as 58% of the women said they chose to limit their family size because of their arthritis. Some were afraid their child could inherit the arthritis, that their disease and medication could harm a foetus, that they may be incapable of physically caring for a child, or that arthritis could cause premature death.

Half of the participants reported arthritis flares around the time of menstruation. Oral contraceptive pills did not worsen disease activity for most women and for some actually prevented menstrual-associated arthritis flares.

“It was really surprising to me how many women felt they were going to die young because of their inflammatory arthritis,” Dr Mehret Birru Talabi, one of the lead authors, explained to Healio Rheumatology. “Most of these women will not die early from inflammatory arthritis, which shows a fundamental disconnect between patients’ perceptions and what epidemiologic data tell us. Some of our patients are really afraid. Some of their decisions are reflecting that fear.

“This underscores the need for better education for our patients. Our study was also novel because we discuss menstruation and oral contraceptives. These topics were of considerable interest to our patient stakeholders, and therefore, I think will be relevant to discuss with other female patients with inflammatory arthritis. We found that women have increased perceived disease activity shortly before or during the first few days of menstruation. It is unclear whether this reflects objective disease flares.

“However, we think it’s worthwhile to think about menstruation as a reason why some women may experience cyclical disease flares. Rheumatologists may wish to ask about menstrual phases when assessing the disease activity of young women with inflammatory arthritis.”

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