Influence of reproductive health concerns on treatment decisions for women with rheumatoid arthritis: real-world data insights from the Kuwait rheumatoid arthritis registry

Background: Rheumatoid arthritis (RA) predominantly affects women, particularly during their reproductive years, necessitating careful consideration of treatment choices. Objectives: To assess if the age of female RA patients influences the prescribing patterns of non-pregnancy-compatible versus pregnancy-compatible Disease-Modifying Anti-Rheumatic Drugs (DMARDs) by analyzing treatment trends in a national registry. Methods: We conducted a retrospective analysis of prospectively collected data from the Kuwait Registry for Rheumatic Diseases (KRRD) between January 1, 2013, and May 30, 2024. The analysis included 1001 female patients, stratified into two age groups: ≤45 years and >45 years. We examined demographic data, disease activity (DAS28), and initial (at first visit) treatment regimens. Statistical analyses included chi-square tests, t-tests to compare differences between age groups and logistic regression (univariate and multivariate) were performed to determine the association between age, nationality, disease activity, seropositivity, and anti-rheumatic medications, reporting odds ratios (OR) with 95% confidence intervals (CI). Adjustments were made for potential confounders, including baseline DAS28 and rheumatoid factor (RF)/anti-cyclic citrullinated peptide (anti-CCP) status. Results: Among the patients, younger women (≤45 years) represented 22.4%, while older patients (>45 years) comprised 77.6%. No difference in the prescription of methotrexate was found between the groups, younger women received leflunomide more often (12.1% vs. 7.6%, p=0.036). Notably, biologics, including TNF inhibitors, were prescribed significantly less to younger women (9.8% vs. 18.4%, p=0.002), possibly reflecting concerns regarding reproductive safety. Conclusion: This study reveals that age and reproductive health considerations did not factor into the treatment decision-making process for female RA patients in Kuwait, highlighting a gap between the international treatment guidelines and real-world prescribing patterns. Rheumatologists face challenges in balancing disease control with reproductive safety, emphasizing the need for further research to explore underlying reasons for this approach and develop strategies that optimize treatment while considering reproductive health.