Table 3 summarizes recommendations for maternal medication use. November 12-17, 2005, San Diego, … There has been little attention to aspects of reproductive health care other than pregnancy in patients with RMD, and the American College of Rheumatology (ACR) recognizes the imperative for guidance in reproductive health issues for these patients. Pregnancy‐induced hypercoagulability increases RMD‐associated thrombosis risk. 642: increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy, U.S. medical eligibility criteria for contraceptive use, 2016, Combined oral contraceptives in women with systemic lupus erythematosus, A trial of contraceptive methods in women with systemic lupus erythematosus, Contraceptive practice in women with systemic lupus erythematosus, Transdermal delivery of combined hormonal contraception: a review of the current literature, Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive, Contraceptive and hormonal treatment options for women with history of venous thromboembolism, ACOG Committee on Practice Bulletins‐Gynecology, ACOG practice bulletin no. Other independent risk factors in aPL‐positive women were younger age, history of thrombosis, and SLE. Chambers has received research support from Amgen, AstraZeneca, Bristol‐Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Pfizer, Regeneron, Hoffmann La‐Roche‐Genentech, Genzyme‐Sanofi‐Aventis, Seqirus, Takeda Pharmaceuticals, UCB, Sun Pharma Global FZE, and the Gerber Foundation. SLE = systemic lupus erythematosus; HCQ = hydroxychloroquine; NLE = neonatal lupus erythematosus; aPL = antiphospholipid antibody (persistent moderate‐to‐high–titer anticardiolipin or anti–β, orcid.org/https://orcid.org/0000-0002-8579-3470, orcid.org/https://orcid.org/0000-0002-7150-7306, orcid.org/https://orcid.org/0000-0001-9113-7122, orcid.org/https://orcid.org/0000-0001-5735-9856, orcid.org/https://orcid.org/0000-0001-5234-3978, orcid.org/https://orcid.org/0000-0001-9475-1363, orcid.org/https://orcid.org/0000-0001-7727-5879, orcid.org/https://orcid.org/0000-0002-3508-4094, orcid.org/https://orcid.org/0000-0002-6670-7696, orcid.org/https://orcid.org/0000-0001-5049-4932, I have read and accept the Wiley Online Library Terms and Conditions of Use, A systematic review and meta‐analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis, Factors associated with preterm delivery among women with rheumatoid arthritis and women with juvenile idiopathic arthritis, High rate of preterm birth in pregnancies complicated by rheumatoid arthritis, Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis, Disease severity and pregnancy outcomes in women with rheumatoid arthritis: results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project, Predictors of maternal and fetal complications in SLE patients: a prospective study, Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies, Does rheumatoid arthritis remit during pregnancy and relapse postpartum? View abstracts about a certain topic by visiting the keyword index. A novel coronavirus from patients with pneumonia in China, 2019. ). Pregnancy in systemic lupus erythematosus. American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 3. Condoms, fertility‐based methods (e.g., “rhythm”), and spermicide are less effective and yield pregnancy rates of 18–28% per year 17. We conditionally recommend treatment with CYC for life‐threatening conditions in the second or third trimester ( Supplementary Appendix 7, Table H (http://onlin​elibr​ary.wiley.com/doi/10.1002/art.41191/​abstract) presents best practice statements and recommendations regarding paternal medication use in men with RMD, with strength of supporting evidence. Most information regarding pregnancy management in RMD comes from observational studies, primarily in patients with SLE and APS. Schramm MA, Venhoff N, Wagner D, Thiel J, Huzly D, Craig-Mueller N, Panning M, Hengel H, Kern WV, Voll RE. Progestin IUDs may decrease these symptoms 30, a potential benefit for patients receiving anticoagulation therapy. Treatment should begin early in pregnancy (before 16 weeks) and continue through delivery. Management of OB APS is one area with moderately strong evidence, but treatment for women with recurring adverse outcomes despite standard therapy is needed. 2020 Nov;35(6):1317-1332. doi: 10.3904/kjim.2020.417. It should be noted, however, that small molecules are likely to pass through the placenta. We conditionally recommend that women with RMD taking mycophenolate mofetil/mycophenolic acid (MMF) use an IUD alone or 2 other methods of contraception together, because MMF may reduce serum estrogen and progesterone levels (in turn reducing the efficacy of oral contraceptives). Reports of thrombosis in aPL‐positive patients undergoing IVF are uncommon, but most reported patients received empiric anticoagulation 41, 42. For patients undergoing CYC therapy, the greatest challenge is to consider preservation of gonadal function and to initiate protective treatment protocols. There are several ways to explore this site: Browse 2020 abstracts in numerical order. When the man's partner is pregnant, the concern is whether his medication is present in seminal fluid and can transfer through vaginal mucosa, cross the placenta, and be teratogenic. Prospective studies (evidence level moderate) in patients with stable SLE showed no increased risk of flare related to estrogen‐progestin pills 19, 20, and there are no data suggesting increased SLE flare risk with progestin‐only pills or copper IUDs 20, 21. Many studies support maternal and pregnancy benefit of HCQ and low risk for mother and fetus 84, 102-111. We strongly recommend discussing use of emergency contraception with all patients, including those with SLE or positive aPL, because risks of emergency contraception are low compared to those of unplanned pregnancy. Underlying thrombophilia increases the risk of severe ovarian hyperstimulation syndrome 44. Abstract Number: 542 ‘BENEFIT’ Pan-European Observational Study to Evaluate the Real-world Effectiveness of SB4 Transition from Originator Etanercept (ETN) in Patients with Rheumatoid Arthritis … American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID-19 Pandemic: Version 1. Detailed definitions of aPL and antiphospholipid syndrome (APS) are presented in Supplementary Appendix 8 (available on the Arthritis & Rheumatology web site at http://onlin​elibr​ary.wiley.com/doi/10.1002/art.41191/abstract). All discussions should acknowledge the limited data and consider the patient's values and preferences. Online ahead of print. We strongly recommend against use of HRT in women with obstetric and/or thrombotic APS. Aspirin is not commonly used prior to oocyte retrieval (it will be started after retrieval if indicated) given concern that its prolonged action may increase bleeding risk at the time of the retrieval. We strongly recommend treatment with HCQ, colchicine, sulfasalazine, rituximab, and all TNF inhibitors as compatible with breastfeeding ( Sammaritano, Bermas, Chakravarty, Chambers, Clowse, Lockshin, Marder, Guyatt, Branch, Buyon, Christopher‐Stine, Crow‐Hercher, Cush, Druzin, Kavanaugh, Laskin, Plante, Salmon, Simard, Somers, Steen, Tedeschi, Vinet, White, Barbhaiya, Bettendorf, Eudy, Jayatilleke, Shah, Sullivan, Tarter, Birru Talabi, Turgunbaev, D'Anci. RMD patients typically underutilize effective contraception 11-13. One aspect of disease in systemic sclerosis, however, is of particular importance during pregnancy: the development of scleroderma renal crisis. This site needs JavaScript to work properly. Figure 1 details the contraception decision‐making process, and Table 1 provides efficacy data and comments on available contraceptives. We conditionally recommend continuing treatment with rituximab while a woman is trying to conceive, and we conditionally recommend continuing rituximab during pregnancy if severe life‐ or organ‐threatening maternal disease so warrants. Although the drug label suggests discontinuation of MTX before attempting pregnancy, data show no evidence for mutagenesis or teratogenicity 143-145. During 24 months of follow‐up 3 thrombotic events occurred in the HRT group and 1 in the placebo group, a nonsignificant difference. Patients who meet criteria for APS—whether obstetric or thrombotic—should receive therapy with heparin (usually LMWH) to improve pregnancy outcome and/or reduce risk of thrombosis. Effectiveness of reproductive health counseling of women with systemic lupus erythematosus: observational cross-sectional study at an academic lupus clinic. PMID: 32734689 DOI: 10.1002/art.41437 Abstract Objective: To provide guidance to rheumatology providers on the management of adult … Vasomotor symptoms, as defined by the North American Menopause Society, include hot flashes and night sweats. Low‐dose aspirin is not thought to complicate anesthesia or delivery 112; however, a decision regarding discontinuation prior to delivery should be made by the obstetrician‐gynecologist and anesthesiologist according to the patient's specific clinical situation. Levonorgestrel, the over‐the‐counter option, is widely available and has no medical contraindications to use, including thrombophilia 18. We strongly recommend use of angiotensin‐converting enzyme inhibitor or angiotensin receptor blockade therapy to treat active scleroderma renal crisis in pregnancy, because the risk of maternal or fetal death with untreated disease is higher than the risk associated with use of these medications during pregnancy. Oocyte freezing is now widely available 197. 1990 Feb;33 ... Abstract To develop criteria for the … Online ahead of print. Thus far, studies have addressed gonadotropin‐releasing hormone agonist co‐therapy only in CYC‐treated RMD patients who receive CYC monthly by intravenous administration. Frequency of laboratory monitoring and rheumatology follow‐up may vary with an individual patient's clinical status and medications. ART techniques include ovarian stimulation, which elevates estrogen levels, IVF, and embryo transfer. Pregnancies in patients with positive aPL or APS present specific challenges and may require additional monitoring and therapy. Issues regarding contraception, fertility, pregnancy, lactation, and the offspring's health affect almost every patient across all RMD diagnoses. We conditionally recommend against use of MTX while breastfeeding. The expected 50% increase in glomerular filtration rate during pregnancy may worsen preexisting stable proteinuria. Dr. Chakravarty has received consulting fees, speaking fees, and/or honoraria from UCB (less than $10,000). “Hormonal contraceptives” refers to any contraception containing a hormone, including estrogen‐progestin contraceptives and progestin‐only contraceptives. The Voting Panel elected not to offer recommendations regarding these drugs. ). Abstract. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, Behrens EM, Ferris A, Kernan KF, Schulert GS, Seo P, F Son MB, Tremoulet AH, Yeung RSM, Mudano AS, Turner AS, Karp DR, Mehta JJ. Very limited data on non‐RMD patients suggest that injectable DMPA imparts a higher VTE risk than do other progestin‐only contraceptives (RR 2.67 [95% CI1.29–5.53]), similar to that with oral estrogen‐progestin contraceptives 27. The increased risk of organ‐ or life‐threatening thrombosis due to high estrogen levels greatly outweighs the low risk of bleeding or other complications of unfractionated heparin or low molecular weight heparin (LMWH). Concise recommendations within this appendix and throughout the article are grouped into categories of contraception, ART, fertility preservation with gonadotoxic therapy, use of menopausal HRT, pregnancy assessment and management, and medication use (compatibilities for paternal, maternal, and breastfeeding use are reported). The American College of Rheumatology is an independent, professional, medical and scientific society that does not guarantee, warrant, or endorse any commercial product or service. While isolated anti‐La/SSB rarely imposes risk, when combined with anti‐Ro/SSA, La/SSB antibodies may increase fetal risk 128. ). Prophylactic‐dose heparin and aspirin therapy for OB APS improves likelihood of live birth, but not necessarily full‐term birth. USA.gov. 99 Supplementary Appendix 10 (http://onlin​elibr​ary.wiley.com/doi/10.1002/art.41191/​abstract) provides assessment and management suggestions for specific RMDs. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti‐Ro/SSA and/or anti‐La/SSB antibodies. Provides 12 ungraded good practice statements are those for which indirect evidence is american college of rheumatology abstract compelling that a formal is! 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