Peer-reviewed article

Systematic review of the treatment of rheumatoid arthritis patients of reproductive age: informing the 2024 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis-secondary publication.

Goto M, Kohno C, Takai C, Miyagawa E, Yanai R et al. · 1 Mar 2026

Abstract

Objectives To inform the 2024 updates of the Japanese College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis of the safety of maternal and paternal exposure to disease-modifying antirheumatic drugs (DMARDs). Methods We searched the databases of PubMed, the Cochrane Library, and the Japana Centra Revuo Medicina for articles published between 2019 and 2022 and combined them with our previous systematic review. Two independent reviewers screened articles, evaluated core outcomes, and performed meta-analyses for each clinical question. Results The relative effects (odds ratio (OR) [95% confidence interval (95% CI)]) of tumour necrosis factor inhibitor (TNFi) exposure on the infants of pregnant women with rheumatoid arthritis were as follows: major birth defects, 1.51 [0.89, 2.58]; and serious neonatal infections, 1.20 [0.84, 1.71]. The relative effects (OR [95% CI]) of paternal antirheumatic drugs exposure on major birth defect in infants were 1.30 [0.28, 6.14] for TNFi and 0.94 [0.38, 2.33] for methotrexate. Conclusions This systematic review provided the latest evidence on effects of maternal and paternal exposure to DMARDs on their infants for the 2024 update of the clinical practice guidelines.