Reproductive health in women with ankylosing spondylitis: contraception and fertility. A narrative review
Published: September 11 2024
Abstract Views: 1029
PDF: 343
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. The knowledge of ankylosing spondylitis is rising, and more and more attention is being paid to the diagnosis of this pathology in females. The purpose of this narrative review is to emphasize the role of reproductive health in women with ankylosing spondylitis, with particular attention to contraception and fertility.
Methods. A comprehensive review of the literature was performed to evaluate the reproductive health of women with ankylosing spondylitis.
Results. Oral contraception has been shown to be safe in women with ankylosing spondylitis, with no contraceptive benefits that should be evaluated during counseling. In the literature, there is no strong data regarding fertility in women with ankylosing spondylitis. It seems that these women may have impaired fertility due to reduced ovarian reserve, pharmacological treatments, and reduced sexual activity due to the concern that offspring may contract the disease. A multidisciplinary approach is needed in these women to ensure an adequate evaluation of sexual activity as an important aspect of quality of life and to counsel regarding family planning to address patients’ concerns on contraception, fertility desire, and fertility preservation.
Conclusions. Lifestyle factors should be investigated to improve fertility and disease activity without medications. Further trials are needed to investigate the reproductive health of women with ankylosing spondylitis.
Altmetrics
Downloads
Download data is not yet available.
Citations
Chimenti MS, Perricone C, Conigliaro P, Triggianese P, D’Antonio A, de Martino E, et al. Tackling the autoimmune side in spondyloarthritis: a systematic review. Autoimmun Rev 2020; 19: 102648. DOI: https://doi.org/10.1016/j.autrev.2020.102648
Kennedy LG, Will R, Calin A. Sex ratio in the spondyloarthropathies and its relationship to phenotypic expression, mode of inheritance and age at onset. J Rheumatol 1993; 20: 1900-4.
Chimenti MS, Alten R, D’Agostino MA, Gremese E, Kiltz U, Lubrano E, et al. Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients. RMD Open 2021; 7: e001681. DOI: https://doi.org/10.1136/rmdopen-2021-001681
Emmungil H, Erdogan M, Kalfa M, Karabulut G, Kocanaogulları H, Inal V, et al. Autoimmune thyroid disease in ankylosing spondylitis. Clin Rheumatol 2014; 33: 955-61. DOI: https://doi.org/10.1007/s10067-013-2466-1
Zhang J, Qi J, Li Y, Wang J, Jiang H, Sun Q, et al. Association between type 1 diabetes mellitus and ankylosing spondylitis: a two-sample Mendelian randomization study. Front Immunol 2023; 14: 1289104. DOI: https://doi.org/10.3389/fimmu.2023.1289104
Chew CC, Chin JJ, Wan Hitam WH, Chong MF, Ahmad Tajudin LS. Diagnosis of ankylosing spondylitis: do not let the spine bites the eye. Malays Fam Physician 2021; 16: 73-7. DOI: https://doi.org/10.51866/cr1121
Marin L, Ambrosini G, Esposito F, Capobianco G, Laganà AS, Vio C, et al. Fertility preservation in girls and women: state of art and future possibilities. Clin Exp Obstet Gynecol 2022; 49: 206. DOI: https://doi.org/10.31083/j.ceog4909206
Benagiano G, Benagiano M, Bianchi P, D’Elios MM, Brosens I. Contraception in autoimmune diseases. Best Pract Res Clin Obstet Gynaecol 2019; 60: 111-23. DOI: https://doi.org/10.1016/j.bpobgyn.2019.05.003
Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017; 76: 47-85. DOI: https://doi.org/10.1136/annrheumdis-2016-209770
Sammaritano LR. Contraception and preconception counseling in women with autoimmune disease. Best Pract Res Clin Obstet Gynaecol 2020; 64: 11-23. DOI: https://doi.org/10.1016/j.bpobgyn.2019.09.003
Somers EC. Pregnancy and autoimmune diseases. Best Pract Res Clin Obstet Gynaecol 2020; 64: 3-10. DOI: https://doi.org/10.1016/j.bpobgyn.2019.11.004
Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol 2020; 72: 529-56. DOI: https://doi.org/10.1002/art.41191
Tedeschi SK, Massarotti E, Guan H, Fine A, Bermas BL, Costenbader KH. Specific systemic lupus erythematosus disease manifestations in the six months prior to conception are associated with similar disease manifestations during pregnancy. Lupus 2015; 24: 1283-92. DOI: https://doi.org/10.1177/0961203315586455
Mahendira D, Thavaneswaran A, Carty A, Haroon N, Anton A, Passalent L, et al. Analysis of the effect of the oral contraceptive pill on clinical outcomes in women with ankylosing spondylitis. J Rheumatol 2014; 4: 1344-8. DOI: https://doi.org/10.3899/jrheum.130996
Ramírez J, Nieto-González JC, Curbelo Rodríguez R, Castañeda S, Carmona L. Prevalence and risk factors for osteoporosis and fractures in axial spondyloarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48: 44-52. DOI: https://doi.org/10.1016/j.semarthrit.2017.12.001
Haroon NN, Sriganthan J, Al Ghanim N, Inman RD, Cheung AM. Effect of TNF-alpha inhibitor treatment on bone mineral density in patients with ankylosing spondylitis: a systematic review and meta-analysis. Semin Arthritis Rheum 2014; 44: 155-61. DOI: https://doi.org/10.1016/j.semarthrit.2014.05.008
FSRH guideline (January 2019) combined hormonal contraception (revision due by January 2024). BMJ Sex Reprod Health 2019; 45: 1-93. DOI: https://doi.org/10.1136/bmjsrh-2018-CHC
Ozkan Y. Cardiac involvement in ankylosing spondylitis. J Clin Med Res 2016; 8: 427-30. DOI: https://doi.org/10.14740/jocmr2488w
Koken Avsar A, Yuce Inel T, Kocaer SB, Can G. Pulmonary apical fibrosis as the initial symptom of ankylosing spondylitis. Rheumatology (Oxford) 2021; 60: 4444-5. DOI: https://doi.org/10.1093/rheumatology/keab012
Lin A, Tan Y, Chen J, Liu X, Wu J. Development of ankylosing spondylitis in patients with ulcerative colitis: a systematic meta-analysis. PLoS One 2023; 18: e0289021. DOI: https://doi.org/10.1371/journal.pone.0289021
Ostensen M, Ostensen H. Ankylosing spondylitis--the female aspect. J Rheumatol 1998; 25: 120-4.
Ferreira GRV, Tomioka RB, Aikawa NE, Leon EP, Maciel GAR, Serafini PC, et al. Ovarian reserve in young juvenile idiopathic arthritis patients. Mod Rheumatol 2019; 29: 447-51. DOI: https://doi.org/10.1080/14397595.2018.1465646
Alexander VM, Ashley-Martin J, Riley JK, Cooper AR, Ratts VS, Jungheim ES. Association between arthritis treatments and ovarian reserve: a prospective study. Reprod Biomed Online 2021; 42: 1203-10. DOI: https://doi.org/10.1016/j.rbmo.2021.03.018
Aslanidis S, Pyrpasopoulou A, Douma S, Poulakos P, Triantafyllou A. Restoration of menstruation in premature ovarian failure after initiation of adalimumab. Scand J Rheumatol 2008; 37: 488-90. DOI: https://doi.org/10.1080/03009740802241733
Gaytán M, Morales C, Bellido C, Sánchez-Criado JE, Gaytán F. Non-steroidal anti-inflammatory drugs (NSAIDs) and ovulation: lessons from morphology. Histol Histopathol 2006; 21: 541-56.
Ciurea A, Finckh A. Smoking and spondyloarthritis. Joint Bone Spine 2013; 80: 234-5. DOI: https://doi.org/10.1016/j.jbspin.2012.10.017
Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, et al. Fertility in women with chronic inflammatory arthritides. Rheumatology (Oxford) 2011; 50: 1162-7. DOI: https://doi.org/10.1093/rheumatology/keq458
El Hasbani G, E Nassar J, Elsayed Ali A, Uthman I, Jawad A. The impact of nicotine smoking on spondyloarthritis and rheumatoid arthritis. Reumatismo 2024; 76: 1572. DOI: https://doi.org/10.4081/reumatismo.2024.1572
Zhang XH, Zhang YA, Chen X, Qiao PY, Zhang LY. Assessment of the ovarian reserve by serum anti-müllerian hormone in rheumatoid arthritis patients: a systematic review and meta-analysis. Int Arch Allergy Immunol 2022; 183: 462-9. DOI: https://doi.org/10.1159/000520133
Ying XH, Bao DN, Jiang HY, Shi YD. Maternal non-steroidal anti-inflammatory drug exposure during pregnancy and risk of miscarriage: a systematic review and meta-analysis. Eur J Clin Pharmacol 2022; 78: 171-80. DOI: https://doi.org/10.1007/s00228-021-03222-w
Sammaritano LR, Bermas BL. Management of pregnancy and lactation. Best Pract Res Clin Rheumatol 2018; 32: 750-66. DOI: https://doi.org/10.1016/j.berh.2019.03.007
Verlinsky Y, Rechitsky S, Sharapova T, Morris R, Taranissi M, Kuliev A. Preimplantation HLA testing. JAMA 2004; 291: 2079-85. DOI: https://doi.org/10.1001/jama.291.17.2079
De Rycke M, De Vos A, Belva F, Berckmoes V, Bonduelle M, Buysse A, et al. Preimplantation genetic testing with HLA matching: from counseling to birth and beyond. J Hum Genet 2020; 65: 445-54. DOI: https://doi.org/10.1038/s10038-020-0732-z
Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility: a committee opinion. Fertil Steril 2018; 110: 611-8.
de Angelis C, Nardone A, Garifalos F, Pivonello C, Sansone A, Conforti A, et al. Smoke, alcohol and drug addiction and female fertility. Reprod Biol Endocrinol 2020; 18: 21. DOI: https://doi.org/10.1186/s12958-020-0567-7
Zhao SS, Goodson NJ, Robertson S, Gaffney K. Smoking in spondyloarthritis: unravelling the complexities. Rheumatology (Oxford) 2020; 59: 1472-81. DOI: https://doi.org/10.1093/rheumatology/keaa093
Exarchou S, Turesson C, Lindström U, Ramonda R, Landewé RB, Dagfinrud H, et al. Lifestyle factors and disease activity over time in early axial spondyloarthritis: the SPondyloArthritis Caught Early (SPACE) cohort. J Rheumatol 2022; 49: 365-72. DOI: https://doi.org/10.3899/jrheum.210046
Barbieri C, Amato O, Cattelan AC, Marin L, Andrisani A, Saccardi C, et al. Fertility counseling pattern over time in young patients with breast cancer: a retrospective analysis at a large comprehensive cancer center. Clin Exp Obstet Gynecol 2023; 50: 114. DOI: https://doi.org/10.31083/j.ceog5006114
Oktay KH, Marin L, Titus S. Impact of chemotherapy on the ovarian reserve: are all primordial follicles created equal?. Fertil Steril 2022; 117: 396-8. DOI: https://doi.org/10.1016/j.fertnstert.2021.12.007
Park SU, Walsh L, Berkowitz KM. Mechanisms of ovarian aging. Reproduction 2021; 162: 19-33. DOI: https://doi.org/10.1530/REP-21-0022
Marin L, Turan V, Oktay K. Fertility Preservation in breast cancer patients. In: Grynberg M, Patrizio P, editors. Female and male fertility preservation. Cham: Springer, 2022; 185-98. DOI: https://doi.org/10.1007/978-3-030-47767-7_14
van den Brandt S, Zbinden A, Baeten D, Villiger PM, Østensen M, Förger F. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther 2017; 19: 64. DOI: https://doi.org/10.1186/s13075-017-1269-1
Oktay KH, Marin L. Comparison of orthotopic and heterotopic autologous ovarian tissue transplantation outcomes. Fertil Steril 2024; 121: 72-9. DOI: https://doi.org/10.1016/j.fertnstert.2023.10.015
Oktay K, Marin L, Bedoschi G, Pacheco F, Sugishita Y, Kawahara T, et al. Ovarian transplantation with robotic surgery and a neovascularizing human extracellular matrix scaffold: a case series in comparison to meta-analytic data. Fertil Steril 2022; 117: 181-92. DOI: https://doi.org/10.1016/j.fertnstert.2021.08.034
Practice Committee of the American Society for Reproductive Medicine. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril 2019; 112: 1022-33. DOI: https://doi.org/10.1016/j.fertnstert.2019.09.013
Szeliga A, Calik-Ksepka A, Maciejewska-Jeske M, Grymowicz M, Smolarczyk K, Kostrzak A, et al. Autoimmune diseases in patients with premature ovarian insufficiency - our current state of knowledge. Int J Mol Sci 2021; 22: 2594. DOI: https://doi.org/10.3390/ijms22052594
Marin L, Bedoschi G, Kawahara T, Oktay KH. History, evolution and current state of ovarian tissue auto-transplantation with cryopreserved tissue: a successful translational research journey from 1999 to 2020. Reprod Sci 2020; 27: 955-62. DOI: https://doi.org/10.1007/s43032-019-00066-9
Oktay KH, Marin L, Petrikovsky B, Terrani M, Babayev SN. Delaying reproductive aging by ovarian tissue cryopreservation and transplantation: is it prime time?. Trends Mol Med 2021; 27: 753-61. DOI: https://doi.org/10.1016/j.molmed.2021.01.005
How to Cite
Reproductive health in women with ankylosing spondylitis: contraception and fertility. A narrative review. (2024). Reumatismo, 76(3). https://doi.org/10.4081/reumatismo.2024.1778
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- R.C. Ansell, T. Shuto, N. Busquets-Perez, E.M.A. Hensor, H. Marzo-Ortega, D. McGonagle, The role of biomechanical factors in ankylosing spondylitis: the patient’s perspective , Reumatismo: Vol. 67 No. 3 (2015)
- S. Russo, T. T. Mariani, R. Migliorini, A. Marcellusi, F. S. Mennini, The economic burden of musculoskeletal disorders on the Italian social security pension system estimated by a Monte Carlo simulation , Reumatismo: Vol. 67 No. 2 (2015)
- S. Stisi, P. Sarzi-Puttini, M. Benucci, G. Biasi, S. Bellissimo, R. Talotta, F. Atzeni, RETRACTED - Pain in systemic sclerosis , Reumatismo: Vol. 66 No. 1 (2014)
- F.M. Perrotta, G. Guerra, A. De Socio, S. Scriffignano, E. Lubrano, Mesenchimal stem cells: a possible role in the pathogenesis and treatment of spondyloarthritis , Reumatismo: Vol. 69 No. 1 (2017)
- F. Salaffi, A. Stancati, A. Silvestri, M. Carotti, W. Grassi, Validation of the Italian versions of the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) in patients with ankylosing spondylitis , Reumatismo: Vol. 57 No. 3 (2005)
- I. Pantano, D. Mauro, D. Simone, L. Costa, D. Capocotta, M. Raimondo, D. Birra, G. Cuomo, T. D'Errico, M. Ferrucci, F. Comentale, G. Italiano, P. Moscato, N. Pappone, R. Russo, S. Scarpato, R. Tirri, P. Buono, A. Postiglione, R. Guida, R. Scarpa, U. Trama, E. Tirri, F. Ciccia, The data project: a shared approach between stakeholders of the healthcare system in definition of a therapeutic algorithm for inflammatory arthritis , Reumatismo: Vol. 74 No. 4 (2022)
- F. Bagcier, O.V. Yurdakul, E. Ozduran, Top 100 cited articles on ankylosing spondylitis , Reumatismo: Vol. 72 No. 4 (2020)
- N.A.G. Gaafar, M. Aslani, Z. Aghazadeh, S.S. Mortazavi-Jahromi, A. Razavi, A. Mirshafiey, Effects of mannuronic acid (M2000) on gene expression profile of signal transducer and activator of transcription proteins (STATs) in rheumatoid arthritis patients , Reumatismo: Vol. 72 No. 2 (2020)
- Chiara Crotti, Nicola Ughi, Emanuela Beretta, Antonio Luca Brucato, Greta Carrara, Maria Sole Chimenti, Paola Conigliaro, Francesca Crisafulli, Giovanna Cuomo, Emma Di Poi, Khadija El Auofy, Micaela Fredi, Maria Chiara Gerardi, Maria Gerosa, Ariela Hoxa, Aurora Ianniello, Maddalena Larosa, Danila Morano, Marta Mosca, Mario Motta, Martina Orlandi, Melissa Padovan, Davide Rozza, Savino Sciascia, Silvia Tonolo, Simona Truglia, Maria Letizia Urban, Anna Zanetti, Sonia Zatti, Angela Tincani, The Italian Society for Rheumatology guidelines on reproductive health in patients with rheumatic diseases , Reumatismo: Vol. 77 No. 1 (2025)
- B. Ristic, C. Bonetto, M. Rossini, E. Fracassi, A. Carletto, S. Tosato, Gender differences in clinical features and quality of life of patients with axial spondyloarthritis and psoriatic arthritis , Reumatismo: Vol. 76 No. 3 (2024)
1-10 of 216
Next
You may also start an advanced similarity search for this article.
