Shao-Hsien LiuShridharmurthy, Divya2022-11-292022-11-292022-11-1510.13028/245x-c569https://hdl.handle.net/20.500.14038/51347Background: Axial spondyloarthritis (axSpA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) are the most prevalent forms of chronic immune-mediated inflammatory arthritis, affecting approximately 0.3-1.4% of adults in the US. These rheumatic diseases (RD) have an early age of onset and may have a significant impact on women and men of reproductive ages, particularly during pregnancy and the postpartum period. Methods: Using the IBM® MarketScan® Commercial Claims and Encounters Database (2013-2018), this dissertation first described sex differences in time to non-steroidal anti-inflammatory drugs (NSAIDs) or biologic disease modifying antirheumatic drugs (bDMARDs) initiation among patients with axSpA. We then evaluated co-management with rheumatology and bDMARD prescriptions filled during pregnancy among pregnant women with axSpA, RA, and PsA. Finally, we evaluated postpartum depression (PPD) rates among reproductive-age women with axSpA, RA or PsA compared to those without RD. Results: Overall, women experienced a delay in biologic treatment initiation compared with men. Dispensations for bDMARDs during pregnancy were low in the RA/PsA subgroup, and extremely uncommon among those with axSpA, and did not align with recommendations from clinical practice guidelines. While the receipt of rheumatologic care during and after pregnancy among RD patients was low, the prevalence of PPD in women with RD was higher compared to those without any RD. Conclusions: Findings from this dissertation emphasize the need for additional research to improve and prioritize care for reproductive-age women with rheumatic disease, particularly before, during, and after pregnancy. This could be accomplished through patient education, counseling, increased access, screening, and timely referrals to rheumatologists and mental health care specialists through enhanced care coordination of providers.en-USCopyright © 2022 ShridharmurthyAll Rights Reservedrheumatoid arthritispsoriatic arthritisaxial spondyloarthritistime to treatment initiationpregnancyrheumatic diseaseDoctoral Dissertation0000-0002-0234-4611