Clinical disparity in rheumatoid arthritis patients with history of spontaneous abortion: Potential link to metabolic syndrome and under treatment

Abstract

Objective: The aim of the work was to describe the characteristics of married rheumatoid arthritis (RA) female patients with history of spontaneous abortion and compare them to those without. Patients and methods: Three hundred and four female RA with history of abortion compared with another 304 RA married patients of matched age without history of abortion. Patients were subjected to full history taking and clinical examination. The routine laboratory investigations were done in addition to rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), antinuclear antibody. Also, plain x-ray hands were performed to detect erosions. Disease activity score (DAS28) and health assessment questionnaire (HAQ) were assessed. Results: In this study 3.5 % of patients with history of abortion out of a large RA cohort (n = 8750), had a mean age of 42.8±11.4 years and disease duration of 6.2 ±5.4 years. 14 (4.6 %) were smokers. There was a significant increase in the frequency of metabolic syndrome in those with abortion (17.4%) than in those without (10.9%) (p=0.008). Methotrexate (MTX) and hydroxychloroquine (HCQ) were less frequently used among patients with a history of spontaneous abortion (67.8% and 68.8%) compared to those without (82.6% and 78%) (p =0.005 and p =0.037 respectively). Disease activity and the functional status were comparable between those with and without abortion. Conclusion: Spontaneous abortion in RA females was higher in those with metabolic syndrome. Reluctance and/or incompliance in using the basic DMARD treatment with MTX or HCQ in controlling the disease may add to the possibility of abortion.