A clinical care pathway for managing pregnancy in patients with inflammatory arthritis
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By
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Neda Amiri
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Maeve Gamble
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Carl Laskin
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Viktoria Pavlova
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Sarah Troster
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December 1, 2025
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Clinical Scorecard: A Structured Approach to Managing Pregnancy in Individuals with Inflammatory Arthritis
At a Glance
| Category | Detail |
|---|
| Condition | Inflammatory arthritis including rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis |
| Key Mechanisms | Autoimmune inflammation affecting joints, influenced by sex hormones, epigenetics, and gut microbiome |
| Target Population | Women of reproductive age with inflammatory arthritis considering pregnancy |
| Care Setting | Rheumatology and obstetrics clinics managing peri-pregnancy care |
Key Highlights
- Inflammatory arthritis disproportionately affects women, impacting family planning decisions.
- Many patients lack adequate preconception counselling on pregnancy risks and medication safety.
- Long-acting reversible contraception is recommended until pregnancy is planned and disease is controlled.
Guideline-Based Recommendations
Diagnosis
- Identify inflammatory arthritis subtype (RA, PsA, SpA) in women of reproductive age.
- Assess disease activity and medication regimen prior to conception.
Management
- Provide ongoing reproductive counselling early and at medication changes.
- Discuss contraception options tailored to disease status and comorbidities.
- Aim for low disease activity or remission on pregnancy-compatible medications before conception.
- Refer to allied health providers as needed for multidisciplinary care.
Monitoring & Follow-up
- Regularly review disease activity during preconception, pregnancy, and postpartum periods.
- Monitor medication safety and adjust treatment to minimize fetal risks.
Risks
- Unplanned pregnancy risks include disease flare, teratogenic medication exposure, and adverse pregnancy outcomes (loss, prematurity, growth restriction).
- Contraceptive failure risks mitigated by recommending long-acting reversible methods.
Patient & Prescribing Data
Women with inflammatory arthritis of reproductive age in Canada
Only 46% receive preconception counselling; contraception is underutilized; pregnancy-compatible medications and disease control improve outcomes.
Clinical Best Practices
- Engage in high-quality discussions to assess patient knowledge and beliefs about pregnancy and IA.
- Incorporate shared decision-making to empower patients in family planning.
- Use evidence-based guidelines from BSR, ACR, and EULAR adapted to Canadian clinical practice.
- Recommend long-acting reversible contraception as first-line for women not planning pregnancy.
- Address contraception and pregnancy planning routinely in rheumatology visits.
References
