Perspective from Adrienne Hollander, MD
Disclosures: The researchers report grants from the Dutch Arthritis Foundation and Consejo Nacional de Ciencia y Tecnologia. Perez-Garcia reports consulting fees from Galapagos. Please see the study for all other authors’ relevant financial disclosures.
August 31, 2021
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Inflammatory arthritis diagnosis prior to age 30 years 'impairs' male fertility

Perspective from Adrienne Hollander, MD
Disclosures: The researchers report grants from the Dutch Arthritis Foundation and Consejo Nacional de Ciencia y Tecnologia. Perez-Garcia reports consulting fees from Galapagos. Please see the study for all other authors’ relevant financial disclosures.
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Male patients diagnosed with inflammatory arthritis at or before peak reproductive age have a lower fertility rate, a higher childlessness rate, and more fertility issues, according to data published in the Annals of the Rheumatic Diseases.

“Spondyloarthritis (SpA) and rheumatoid arthritis (RA) are frequent causes of inflammatory arthritis (IA) that can affect men before or during the peak of their reproductive age,” Luis Fernando Perez-Garcia, MD, of Erasmus Medical Center, in Rotterdam, Netherlands, and colleagues wrote. “Even though IA is associated with male infertility, erectile dysfunction and hypogonadism, the impact of IA on male fertility remains largely unexplored.”

“It is important that rheumatologists identify their male patients diagnosed with inflammatory arthritis who have a desire to become fathers and approach this topic with them,” Luis Fernando Perez-Garcia, MD, told Healio Rheumatology. Data derived from Perez-Garcia LF, et al. Ann Rheum Dis. 2021;doi: 10.1136/annrheumdis-2021-220709.

“This is even more striking if we consider that several frequently prescribed anti-rheumatic drugs have been associated with reversible or irreversible testicular toxicity,” they added. “In women diagnosed with IA, several factors related to IA have been associated with lower fertility rates. It can be expected that some of these factors could also influence the fertility rate of men diagnosed with IA, such as impaired sexual function, lower intercourse frequency, deciding not to have a family or to have smaller families due to concerns about the impact of IA or antirheumatic treatment.”

To analyze the impact of inflammatory arthritis on male fertility outcomes, including fertility rate, childlessness, fertility problems and family planning, Perez-Garcia and colleagues conducted a multicenter, cross-sectional iFAME-Fertility study. Stretching across eight Dutch hospitals, the study enrolled 628 male patients, aged 40 years or older at inclusion, who demonstrated inflammatory arthritis and indicated their current family size was complete.

Luis Fernando Perez-Garcia

The researchers defined inflammatory arthritis as a diagnosis of RA, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, reactive arthritis or enteropathic arthritis.

Participants completed a questionnaire that collected demographic, medical and fertility information. The researchers grouped the participants based on their age at diagnosis. The first group were those aged 30 years or younger at diagnosis, or “before peak reproductive age;” those between 31 and 40 years, or “peak reproductive age;” and those diagnosed at 41 years or older, or “after peak reproductive age.”

According to the researchers, participants who were diagnosed with inflammatory arthritis at age 30 years or younger had a lower mean number of number of children — 1.32 (SD = 1.14) — compared with those who were diagnosed at or after reproductive peak — 1.6 (SD = 1.35) and 1.88 (SD = 1.14), respectively (P = .0004).

“For the first time, it has been suggested that inflammatory arthritis impairs male fertility,” Perez-Garcia told Healio Rheumatology. “Our findings are of extreme value as our findings are increasing the awareness of this problematic and justify further research that corroborates this association and help us understand how inflammatory arthritis impacts male fertility.”

The rates of involuntary childlessness were 12.03% and 10.34% for those diagnosed before or at peak reproductive age, respectively, compared with 3.98% of those diagnosed at age 41 years or older. Among all three groups, 20.61%, 20.69% and 11.36%, respectively, received medical evaluations for fertility problems. Both findings were significant (P = .027), the researchers wrote.

“Rheumatologists should be aware that IA may impair male fertility,” Perez-Garcia told Healio Rheumatology. “Accordingly, it is important that rheumatologists identify their male patients diagnosed with IA who have a desire to become fathers and approach this topic with them. There are several things that can be done for this group of men, to mention a few: Adjust treatment to avoid testicular or reproductive toxicity, and give them general reproductive advice and screen for important sexual and reproductive health comorbidities that have been associated with IA, including sexual dysfunction, low sperm quality and hypogonadism.”