Contraception Recommendations for Rheumatoid Arthritis and Spondyloarthritis
General Recommendations
- The American College of Rheumatology recommends highly effective contraception for women with rheumatic musculoskeletal diseases to prevent unplanned pregnancies during periods of high disease activity or while on teratogenic medications 1, 3
- Long-acting reversible contraceptives, such as IUDs and subdermal progestin implants, are preferred due to their high efficacy and safety profile in rheumatic diseases 4, 5
- Progestin-only methods are generally safe for most patients with RA and spondyloarthritis, with minimal impact on disease activity 1, 6
Contraceptive Recommendations Based on Disease Status
- For patients with stable/low disease activity, IUDs, progestin implants, and progestin-only pills are safe options, while combined estrogen-progestin contraceptives may be used in patients with stable disease who are antiphospholipid antibody negative 1, 4, 6
- For patients with moderate/high disease activity, progestin-only or IUD contraceptives are strongly recommended over combined estrogen-progestin methods 1, 7
- For patients with positive antiphospholipid antibodies, combined estrogen-progestin contraceptives should be avoided due to increased thromboembolism risk, and IUDs or progestin-only pills are recommended 1, 9
Special Considerations
- Depot medroxyprogesterone acetate should be avoided in patients at risk for osteoporosis, and in patients on mycophenolate medications, an IUD or combination of two other contraceptive forms is required due to teratogenicity concerns 4, 8
- Emergency contraception can be safely used by patients with rheumatic diseases, including those with SLE or positive aPL 1, 6