Safety of contraceptive methods for women with rheumatoid arthritis: a systematic review

BackgroundWomen with rheumatoid arthritis (RA) and their clinicians may have unique concerns about certain methods of contraception.Study DesignWe conducted a systematic review of the literature in the MEDLINE database through February 2009 for peer-reviewed journal articles on use of any method of contraception, or progestins or estrogens, and progression of RA.ResultsWe identified eight articles that met the inclusion criteria: six examined oral contraceptives (OCs), one progesterone, and one estrogen. We found no studies on other methods of contraception. For OCs, no consistent pattern of improvement or worsening of disease emerged and most patients showed little change in RA symptoms. We saw little improvement in the studies examining progesterone and estrogen.ConclusionAlthough sparse and based primarily on older studies of poor quality, this information suggests that OC use is unlikely to affect RA disease progression. Research is needed on other forms of contraception, such as DMPA and IUD.