Is rheumatoid arthritis an innocent bystander in female reproductive problems? A comparative study of fertility in Nigerian women with and without rheumatoid arthritis

Abstract

Objective: Contrary to the old belief that rheumatoid arthritis (RA) is rare in sub-Saharan Africa, re-cent reports have increasingly recognized that the burden of the disease has probably been longunder-appreciated in West Africa. Thus, fertility and other attributes of the reproductive lives amongwomen with RA have not received research attention in Africa. We aimed to compare the fertilitybetween married Nigerian women with and without RA.Methods: A comparative study of 50 women with RA and 50 women without RA was conducted via thespecialist rheumatology clinics at two teaching hospitals in Nigeria. The participants were aged 18 yearsor older. Patients with RA were recruited on the basis of the fulfillment of the 1987 American College ofRheumatology classification criteria for RA, whereas the control participants were age-matched to thepatients. Using an interviewer-administered questionnaire, demographic and clinical information wascollected from each participant. Clinical details at the time of diagnosis of RA were extracted from thehospital records of the patients. The patients were tested for rheumatoid factor and anti-cyclic citrulli-nated peptide antibody, and the disease activity was assessed using the Clinical Disease Activity Index.The functional status was determined using the Steinbrocker functional classification. Statistical analysiswas performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp.; Armonk, NY,USA). The proportions of individuals with history of infertility, irregular menstruation, and menopausalstates were compared between the two groups using χ 2 and Fisher’s exact tests, whereas the durationsof infertility and parities were compared using Mann-Whitney U and independent t-tests, respectively.Results: A positive history of infertility was found in 22 (44%) patients and 14 (28%) controls (p=0.096),while 17 (34%) patients and 23 (46%) controls were found to be postmenopausal (p=0.221). Historyof irregular menstruation was present in 15 (30%) patients and 4 (8%) controls (p=0.005). The medianduration of infertility was 60 (range: 16-132) months among the patients and 36 (range: 12-72) monthsamong the controls (p=0.036), while the mean parity was 2.85±1.8 among the patients and 3.77±2.2among the controls (p=0.027). A significant association was found between infertility and functionalclass as well as methotrexate treatment.Conclusion: Infertility is not uncommon among patients with RA, and like many aspects of rheumaticdiseases, it may have been under-recognized in the Nigerian patients.