What keywords and improvements to the key points should be suggested for a manuscript on medication exposure and pregnancy outcomes in rheumatoid arthritis among 89 Indian women (2012‑2024) submitted to a clinical rheumatology journal?

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Last updated: October 21, 2026 • View editorial policy

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Suggested Keywords for Manuscript Submission

For optimal indexing in Clinical Rheumatology, I recommend the following keywords organized by priority:

Primary Keywords (Essential - Select 5-6):

  • Rheumatoid arthritis
  • Pregnancy outcomes
  • Disease-modifying antirheumatic drugs (DMARDs)
  • Hydroxychloroquine
  • Sulfasalazine
  • Preconception counseling

Secondary Keywords (Supplementary - Select 2-3):

  • Teratogenicity
  • Pregnancy-compatible medications
  • Indian cohort
  • Maternal outcomes
  • Live birth
  • Adverse pregnancy outcomes

Recommended Improvements to Key Points

Your current key points are adequate but lack specificity and impact. Here are substantially improved versions that align with current EULAR 2025 guidelines 1 and emphasize clinically actionable findings:

Revised Key Points:

Key Point 1 (Strengthen with specific outcomes):

Original: "This retrospective two-centre Indian cohort describes pregnancy outcomes and antirheumatic drug exposure in 89 women with rheumatoid arthritis."

IMPROVED: "In this two-center North Indian cohort of 89 pregnancies in women with rheumatoid arthritis (2012-2024), 86.5% resulted in live births with low exposure to teratogenic medications (methotrexate 5.6%, leflunomide 3.4%), demonstrating real-world adherence to guideline-based pregnancy management."

Rationale: This version quantifies the success rate, specifies the teratogenic exposure rates (critical safety data), and frames the finding within guideline adherence—all priorities for Clinical Rheumatology readers.

Key Point 2 (Add clinical context and medication specifics):

Original: "Most pregnancies resulted in live birth, with the use of pregnancy compatible therapies."

IMPROVED: "Pregnancy-compatible DMARDs were predominant (hydroxychloroquine 80.9%, sulfasalazine 77.5%), with corticosteroids used in 30.3% and azathioprine in 4.5%, reflecting alignment with 2025 EULAR recommendations for maintaining disease control during pregnancy."

Rationale: This provides specific medication frequencies and explicitly connects your practice patterns to current international guidelines 1, which is essential for demonstrating clinical relevance. The 2025 EULAR guidelines specifically endorse hydroxychloroquine, sulfasalazine, and azathioprine as pregnancy-compatible 1, 2.

Key Point 3 (Emphasize the clinical imperative and knowledge gap):

Original: "The findings support preconception counselling, disease control, and use of pregnancy-compatible treatment in women with rheumatoid arthritis."

IMPROVED: "These findings underscore the critical importance of early preconception counseling and planned pregnancy on pregnancy-compatible medications to optimize maternal-fetal outcomes in resource-limited settings, addressing a significant knowledge gap in South Asian populations with rheumatoid arthritis."

Rationale: This version emphasizes the clinical imperative (early counseling prevents teratogenic exposure), acknowledges your unique contribution (South Asian data scarcity), and frames the work within the broader context of health equity and resource allocation—all priorities for Clinical Rheumatology's international readership.

Additional Structural Recommendations:

Consider Adding a Fourth Key Point:

"Despite 28.1% of patients having comorbidities (osteoarthritis and hypothyroidism most common at 10.1% each), pregnancy outcomes remained favorable, suggesting that multimorbidity in well-controlled rheumatoid arthritis does not preclude successful pregnancy when appropriate medications are used."

Rationale: This addresses the comorbidity data you collected but didn't emphasize in your key points. Comorbidity management is increasingly recognized as critical in pregnancy outcomes 3, 4.

Critical Caveats for Your Discussion Section:

Based on the evidence provided, ensure you address these points:

  1. Methotrexate exposure timing: Your 5.6% methotrexate exposure rate requires clarification—was this preconception only, or did any first-trimester exposure occur? The 2025 EULAR guidelines 2 and Korean data 5 show methotrexate within 3 months of conception increases adverse outcomes (aOR 2.14,95% CI 1.57-2.92). Specify the washout period used.

  2. Leflunomide washout: Your 3.4% leflunomide exposure must specify whether washout procedures were performed, as 49% of pregnancies in the 2025 EULAR review underwent washout 2. Without washout, leflunomide is associated with increased adverse outcomes (aOR 2.68,95% CI 1.39-5.15) 5.

  3. Disease activity data: Your manuscript lacks disease activity measures. The 2025 EULAR guidelines 1 and French national data 3 demonstrate that active disease is the primary driver of adverse outcomes (preterm birth aOR 2.02,95% CI 1.71-2.38 in active vs. inactive RA). Without disease activity data, you cannot definitively attribute your favorable outcomes to medication safety alone.

  4. Corticosteroid dosing: Specify corticosteroid doses. High-dose corticosteroids are associated with adverse outcomes 6, 7, while low-dose prednisone (≤10 mg/day) is generally safe.

Keyword Optimization Strategy:

Use MeSH (Medical Subject Headings) terms where possible:

  • "Arthritis, Rheumatoid" (MeSH)
  • "Pregnancy Outcome" (MeSH)
  • "Antirheumatic Agents" (MeSH)
  • "Hydroxychloroquine" (MeSH)
  • "Sulfasalazine" (MeSH)
  • "Preconception Care" (MeSH)

Add geographic/population specificity:

  • "India" or "South Asia"
  • "Tertiary care"
  • "Real-world evidence"

Title Consideration:

Your current title is strong but consider minor refinement:

Current: "Medication Exposure and Pregnancy Outcomes in Rheumatoid Arthritis: Real World Data From an Indian Tertiary Care Cohort"

Alternative (more specific): "Pregnancy Outcomes and Antirheumatic Drug Exposure in 89 Women With Rheumatoid Arthritis: A Retrospective Indian Tertiary Care Cohort (2012-2024)"

Rationale: Including the sample size and date range in the title increases transparency and helps readers immediately assess the study's scope and recency.

References

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