Men with psoriatic arthritis, rheumatoid arthritis and axial spondylarthritis have more children and at an earlier age than matched controls: results from a nationwide cohort.

Objectives: The reproductive health of men with inflammatory joint disease (IJD) has been a topic of debate in recent years, due to conflicting findings in existing research. In this study, we investigated childlessness and number of children per man, according to the joint diseases psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondylarthritis (axSpA). Furthermore, we studied the timing of fathering and risk factors associated with childlessness.

Methods: This is a nationwide, population-based cohort study. Male patients aged 25-65 years with PsA (n=2649), RA (n=1716) and axSpA (n=2766) from the Norwegian Arthritis Registry were individually matched 1:5 with men without IJDs obtained from the National Population Register (n=35 655). Information on children was obtained from the Medical Birth Registry of Norway. Fertility rates were compared between the patient/IJD groups and matched controls.

Results: In all IJD groups, fewer men were childless compared with the control groups (p<0.001). Similarly, the mean number of children per man was higher in all diagnostic groups, and this difference was evident before the IJD diagnosis (p<0.001). AxSpA patients had a slightly higher proportion of childless men compared with patients with PsA (p<0.001). Also, men with IJD were younger than the respective controls when fathering for the first time (p<0.001).

Conclusion: This large nationwide study revealed that men with PsA, RA and axSpA were less childless compared with the general population, a difference that occurred before the onset of the IJD. These findings are novel, suggesting a notable difference in fertility patterns between those with and without IJDs.