A clinical care pathway for managing pregnancy in patients with inflammatory arthritis
By
Neda Amiri
Maeve Gamble
Carl Laskin
Viktoria Pavlova
Sarah Troster
December 1, 2025
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
