ACR Releases First Ever Guideline on Reproductive Health in Rheumatic Disease
The American College of Rheumatology has issued a strong recommendation that women with rheumatic disease who do not have lupus or antiphospholipid syndrome use effective contraceptives, along with 130 other recommendations in its first clinical practice guideline for reproductive health.
According to the ACR, the 131 recommendations and 12 good practice statements — which comprise the 2020 Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases — are the first ever evidence-based, clinical practice guidelines related to the management of reproductive health issues for all patients with rheumatic diseases.
“This guideline is paramount, because it is the first official guidance addressing the intersection of rheumatology and obstetrics and gynecology,” Lisa Sammaritano, MD, lead author of the guideline, said in a press release. “Rheumatic diseases affect many younger individuals; however, little education has been provided to rheumatology professionals on current OB-GYN practices.”
“The guideline [and more detailed online appendices] presents vital background knowledge and recommendations for addressing reproductive health issues in the full spectrum of rheumatology patients, with additional focus on specific diagnoses that require more detailed recommendations such as systemic lupus erythematosus and antiphospholipid syndrome,” she added.
The practice statements and guidelines are intended to assist rheumatologists in caring for patients except where indicated as being for those with specific conditions or antibodies present, the organization said. Good practice statements are defined as those in which indirect evidence is compelling enough that a formal vote was considered unnecessary. They are ungraded and presented as suggestions rather than formal recommendations.
However, the recommendations are graded and separated into six categories: contraception, assisted reproductive technology or fertility therapies, fertility preservation with gonadotoxic therapy, menopausal hormone replacement therapy, pregnancy assessment and management, and medication.
Examples of strong recommendations include:
- Women with rheumatic disease who do not have lupus or APS should use effective contraceptives, with a conditional recommendation to preferentially use highly effective IUDs or a subdermal progestin implant;
- Do not use combined estrogen-progestin contraceptives in women who test positive for anti-phospholipid autoantibodies or APS;
- Women with uncomplicated rheumatic disease who are receiving pregnancy-compatible medications, whose disease is stable and who test negative for APL, should receive fertility therapy;
- Men should not use cyclophosphamide or thalidomide prior to attempting conception; and
- NSAIDs should not be used in the third trimester.
Experts involved in the development of the guideline included rheumatologists, obstetrician/gynecologists, reproductive medicine specialists, epidemiologists and patients with rheumatic diseases. A draft of the guideline was presented at the 2018 ACR/ARP Annual Meeting in Chicago. Since then, the original three-part draft has been condensed into a single manuscript with detailed background and discussion information available online.
The paper containing the full guideline is available here.
“This guideline should open avenues of communication between the rheumatologist and the patient, as well as between the rheumatologist and the OB-GYN,” Sammaritano said in the press release. “A better understanding of the risks and benefits of reproductive health options will enhance patient care by providing safe and effective contraception, improving pregnancy outcomes by conceiving during inactive disease periods, and allowing for continued control of rheumatic diseases during and after pregnancy with the use of well-suited medications.” – by Jason Laday