Background/Purpose: Males account for about one third of all cases of juvenile idiopathic arthritis (JIA). During the course of the disease and often into adulthood, they are exposed to various disease-modifying antirheumatic drugs (DMARDs). If men with JIA wish to have a child, they have to weigh the risk of disease flare on drug withdrawal against a not yet clearly defined impact of drugs on offspring.

The study objective was to investigate the outcomes of pregnancies in partners of male JIA patients who were exposed to DMARDs.

Methods: In the JIA biologic registry JuMBO (Juvenile arthritis MTX/Biologics long-term Observation), male patients with pregnancies in partners were identified. Standardized patient interviews were conducted and the outcome of pregnancies inquired. In addition, prospectively collected physician-reported data on treatment and disease activity of JIA patients were considered in the analysis.

Results: Out of the 1,397 patients enrolled in JuMBO, a total of 243 pregnancies in 125 women and in partners of 26 men with JIA were reported. Until February 2018, detailed information was available for 39 pregnancies of partners of 21 men with JIA. Most male patients (43%) had polyarticular JIA, 24% enthesitis-related arthritis, 10% psoriatic arthritis. At first pregnancy, the mean paternal age was 23.2±4.2 years, the mean disease duration was 13.3±6.0 years and the mean disease activity according to cJADAS-10 4.8±4.5.

All men had been exposed to 2.5±1.0 DMARDs for a mean of 7.1±3.1 years until 1st pregnancy, 90.5% had received biological DMARDs. Of the 39 pregnancies, there were 26 (66.7%) with paternal DMARD exposure during time of conception. Exposures included etanercept in 12, adalimumab in 3, infliximab in 3, certolizumab in 2, anakinra in 1, methotrexate in 9 and leflunomide in 2 pregnancies. Pregnancy outcomes with paternal exposure (n=26) and without (n=13) were as follows: 22 and 10 live births, 1 and 1 elective pregnancy termination, 2 and 2 spontaneous abortions, 1 and 0 stillbirth, respectively. Of the 9 pregnancies with paternal MTX exposure, 6 (66.7%) resulted in a live birth, one (11.1%) was terminated electively and 2 (22.2%) resulted in an early miscarriage.

In the 32 pregnancies with live births, pregnancy complications were reported in 22% of the cases (in exposed pregnancies in 18%, in unexposed pregnancies in 30%). Adverse neonatal outcomes like preterm delivery and neonatal hospitalizations were reported in 3 (13.6%) and 3 (30.0%) and 5 (22.7%) and 3 (30.0%) cases, respectively. No children were born small for gestational age or with low APGAR score at 5 minutes, no child died in the neonatal period. Two children were born with major congenital anomalies (club foot, agenesis of the corpus callosum) according to the EUROCAT classification, both fathers were exposed (leflunomide, corticosteroids, NSAIDs, and MTX, certolizumab, corticosteroids, NSAIDs, respectively).

Conclusion: Men with JIA who are still undergoing treatment in young adulthood often procreate children under medication, why more information on the effect of medication on male reproduction is needed. For this, more patient data must be carefully evaluated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-in-partners-of-dmard-exposed-men-with-juvenile-idiopathic-arthritis-an-observational-study/