Introduction: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Keywords: biological DMARDs; fertility; methotrexate; real‐world data; rheumatoid arthritis; time to delivery.
© 2025 The Author(s). International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.