Disease progression in relation to pre-onset parity among women with rheumatoid arthritis

Abstract

Objective.-Rheumatoid arthritis (RA) often ameliorates during pregnancy and flares postpartum, but the relationship of pregnancy and childbirth to RA prognosis is unclear. We examined RA severity for association with parity prior to RA onset and asked whether time from birth (latency) and/or the mother's HLA genotype influenced results.Methods.-A cohort study was conducted of 222 women previously identified in a prospective study of newly diagnosed RA, who returned for follow-up evaluation a median of 8 years later. Stratified analyses using Mantel-Haenszel methods were conducted to evaluate 5 RA severity measures including hand and wrist radiographs, physical exams, and Health Assessment Questionnaires for association with parity.Results.-Overall we observed little evidence of altered risk of progression to severe RA in relation to pre-onset parity, adjusting for RA onset age and time to follow-up. Stratifying parous women who had only live births by latency (<15 years/15+ years) showed no difference in risk of severe RA compared to nulligravid women. Live birth deliveries were significantly protective for women with 0 but not for those with 1+ copies of the RA risk-associated HLA-DRB1 shared epitope sequence for erosion score (RR 0.26 95% CI 0.09-0.89) and joint count (RR 0.28 95% CI 0.09-0.87).

Work situation of rheumatologists and residents in times of COVID-19

“…This is especially important in the healthcare sector, where opportunities for competition for qualified staff are generally more hampered by the politics of comprehensive regulation of education, employment, and practice conditions. The situation is even more difficult in small highly specialized medical professions, such as rheumatology, where the long duration of training and poor representation at medical schools add further challenges to recruitment [ 22 , 27 ]. Rheumatology fishes from the same pool of internal medicine as other medical specialties with broadly similar professional and organizational conditions.…”

“…More than every fourth respondent reported sexual harassment, but female rheumatologists were affected about three times more often than their male colleagues (31% vs. 11%) [ 30 ]. Recent research conducted in the US also revealed persisting gender disparities in academic rheumatology [ 27 ]. Specific figures for German rheumatology are not available, but results from an online survey carried out in Berlin in 2015 among all physicians working in tertiary referral centers confirmed widespread discrimination and sexual harassment in medicine in Germany.…”