December 15, 2014
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Panel: Women’s health, reproductive issues overlooked in rheumatic patients

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During a 2013 meeting in Athens, Greece, researchers convened a panel of experts to analyze women’s health and fertility issues in patients with rheumatic diseases that may not be adequately addressed.

The research panel assessed published literature on women’s health and reproductive issues for treating physicians to consider, including evidence-based and eminence-based information, and disclosed their findings in a review recently published in Clinical and Experimental Rheumatology.

According to the researchers, up to 50% of women with rheumatic diseases reported that the disease negatively affected their pregnancy decisions and choice of family size, and that 40% to 50% of pregnancies will have measurable activity of the rheumatic disease.

The researchers also found patients with systemic lupus erythematosus have higher risk of pregnancy and birth complications and experienced a 5% to 10% increased risk for mild-to-moderate flares during pregnancy. Conversely, 50% to 68% of women with rheumatoid arthritis were likely to show improvement of symptoms during pregnancy, with 25% reaching remission during the third trimester. However, many relapsed within 3 months after birth, according to the researchers.

The fertility of patients with ankylosing spondylitis was mostly unaffected by the disease unless severe hip arthritis caused changes to the pelvic resulting mechanical issues, according to the researchers, and flares were common for 3 months after birth.

Female, adult patients with juvenile idiopathic arthritis were found to be more likely to be less fertile due to chronic inflammation and side effects of medications. In addition, nontraditional birth and higher rates of preeclampsia, postpartum hemorrhage and premature birth were observed.

Patients with systemic sclerosis were found to be at higher risk for preterm delivery and low birth weight. Little information was available about the impact of inflammatory myopathies on fertility, according to the researchers. Additionally, limited data on the use of methotrexate during pregnancy were available. One systematic review of 100 women taking 5 mg to 25 mg of methotrexate from conception through the first trimester associated a higher rate of miscarriage and birth defects.

Patients taking leflunomide experienced complications similar to the general population, but anti-TNF therapies were associated in one study with a decrease in live births in patients taking rituximab. However, the severity of the underlying disease and other factors may confound the data. The researchers described data on other biologics as scarce.

Disclosure: The meeting was supported by an unrestricted grant from the “Family Planning and Pregnancy in Immunologic Diseases” initiative of UCB Pharma and the researchers declared no competing interests.