Rheumatic diseases affect many younger people but until now there has been little evidence-based guidance on reproductive issues, particularly for specific diagnoses that such as SLE and antiphospholipid syndrome (APS).
But now the first clinical practice guideline on the management of reproductive health issues for all patients with rheumatic diseases has been developed by the American College of Rheumatology.
The guideline covers contraception, pregnancy, fertility treatment and preservation and menopause.
And with a comprehensive 12 good practice ‘suggestions’ and 131 graded recommendations, the guidelines go beyond the limited advice provided to date by groups such as EULAR and British rheumatology organisations, according to the guideline developers.
“Other organisations have addressed important aspects of reproductive health in rheumatology patients, but this is the first project to cover all common reproductive health issues for all rheumatology patients and the first ACR guideline on this topic,” said lead author Dr Lisa Sammaritano, Director, Rheumatology Reproductive Health Center at the Hospital for Special Surgery, New York.
The recommendations highlighted that the rheumatologist had an important role in helping their patients manage their reproductive health as the person who “best understands their underlying disease”, Dr Sammaritano explained.
“We urge rheumatologists to discuss these issues with their patients, and in our patient focus group, this was an important theme.
“For example, our patients need to understand the importance of effective contraception and yet numerous studies show that rheumatology patients are less likely than the general population to utilise the most effective forms of contraception.”
Advice on medication use in pregnancy or when trying for a baby – for mother and father – have categorised into a colour-coded chart for easy referral, she said.
But she said there were many areas where they found more research is needed.
“Contraceptive studies are not routinely done in rheumatology patients although studies in patients at risk for thrombosis do exist and we used these data in making our recommendations.
“Very few studies have looked at use of ART (assisted reproductive technology) in our patients but this area of medicine continues to expand –now including oocyte cryopreservation.”
And she added that information on medication use before, during, and after pregnancy is limited since pregnant patients are excluded from drug trials.”