Background: Rheumatoid arthritis (RA) is one of the most common autoimmune diseases of connective tissue. Women are affected by RA 3 times more than men, and because most of them are in the reproductive age and they have to be on a teratogenic drugs (disease modifying antirheumatic drugs DMARDs as methotrexate, leflunamide) for a long periods, so there is a big need to clarify the contraceptive method that should be used by those women.
Aim of the Work: we aimed to explore the association of the RA activity and the commonly used female contraceptive methods in a sample of Egyptian females.
Patients and Methods: Fifty female RA patients were enrolled and divided into two groups; contraceptive methods users(40 patients), which was further subdivided into intra uterine cupper device (IUCD) users(15 patients),oral contraceptive pills(OC) users(13pateints) and injectables users(12 patients), and non-contraceptive methods users(control group) (10 patients). All patients underwent thorough history taking with special emphasis on contraception history, clinical examination, and assessment by routine laboratory tests, rheumatoid factor (RF) and antibodies to citrullinated protein antigens (ACPA). Rheumatoid arthritis disease activity was assessed using Disease Activity Score 28 using CRP (DAS28/ CRP), while RA disease severity was assessed using Rheumatoid Arthritis Severity Scale (RASS).
Results: The RASS was significantly higher in injectables-users in comparison to other methods-users followed by the IUCD-users with the highest significant difference between the injectables and OCs (P=0.002), and the DAS28\CRP was significantly higher in IUCD users followed by the injectables users with the highest significant difference between the IUCD and OCs (P=0.009). the highest CRP and ACPA was among the IUCD users with the highest significant difference in CRP level between the IUCD users and the control group (P=0.030) and the highest significant difference in ACPA level between the IUCD users and the OCs users (P=0.004). About 64 % of all patients used IUCD prior to the onset of RA, The RA patients who used IUCD prior to the onset of RA had a higher ACPA titers than those with disease onset preceding IUCD use with high statistical significance(P=0.004), Also, on performing a correlation between the duration passed since first use of IUCD and the disease duration, There was a significant positive correlation between them (i.e. the earlier the first exposure to IUCD the longer the disease duration) (r=0.425)  Conclusion: There's a relation between RA activity and the currently used contraceptive methods. the IUCD could increase the severity and activity of RA.OCs could decrease the disease activity and severity.