Guidelines for managing women’s health in SLE/APS

Wednesday, 17 Jun 2015

EULAR has released preliminary recommendations on women’s health and the management of family planning in women with systemic lupus erythematosus and antiphospholipid syndrome.

Developed by the EULAR taskforce on Women’s Health and Pregnancy in SLE/APS the guidelines recommend:

  • SLE / APS patients planning a pregnancy should be counselled and managed after risk stratification by taking into consideration disease activity, serological profile and antiphospholipid antibodies, hypertension and use of drugs.
  • Women with SLE and /or APS can be candidates for contraceptive measures based on their disease activity and thrombotic risk. Fertility preservation methods, especially GnRH analogues, should be considered prior to the use of alkylating agents.
  • Assisted reproduction techniques seem to have comparable efficacy as in the general population, and can be safely used in patients with stable/inactive disease; patients with positive aPL/APS should receive appropriate anticoagulation and/or low dose aspirin.
  • Disease activity, serological markers, and renal function parameters are useful to monitor for obstetrical adverse outcomes and disease flares during pregnancy.
  • Fetal monitoring is similar to high-risk pregnancies including Doppler ultrasonography, particularly after 24-28 weeks of gestation to screen for placental insufficiency; fetal echocardiography is indicated for suspected fetal dysrhythmia, especially in patients with positive anti-Ro and/or anti-La.
  • HCQ, glucocorticoids (oral/intravenous pulse), azathioprine, cyclosporine-A, tacrolimus and intravenous immunoglobulin can be used to prevent or manage SLE flares during pregnancy.
  • If stable/inactive disease and negative aPL, hormonal replacement therapy can be used for severe vasomotor menopausal manifestations.
  • Screening for malignancies is similar to the general population, with vigilance for cervical pre-malignant lesions if exposed to immunosuppressive drugs. Similar to the general population,HPV immunization should be considered in women with stable/inactive disease.

The full set of recommendations are expected to be published in 2016.

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