Reproductive health care in women with rheumatoid arthritis, psoriasis and psoriatic arthritis of childbearing age in routine clinical practice

Summary

A certain number of rheumatology and dermatology patients are women of childbearing age who are diagnosed with inflammatory rheumatic diseases and psoriasis. Subsequently they are treated with disease-modifying drugs (including biological ones) while the proportion of women treated with any of the biological drugs is increasing. These patients often consider becoming pregnant and starting or expanding their families.
Aim of the study: The aim of the presented questionnaire survey was to find out how rheumatologists and dermatologists in their female patients with rheumatoid arthritis, psoriasis and psoriatic arthritis cope with the needs for family planning, pregnancy and breastfeeding as  well as their possible maternal concerns. The main task was to map the needs for communication between patients and physicians, collaboration with other medical specialists and potential impact of reproductive journey’s issues on the therapeutic requirements in real clinical practice.
Methods: It was a questionnaire survey with 55 questions (given in English language) focusing on identifying the needs related to the reproductive health of fertile female patients living with rheumatoid arthritis, psoriasis and psoriatic arthritis. A total of 82 rheumatologists from the Czech Republic, Hungary and Slovakia and 38 dermatologists from the Czech Republic and Slovakia participated in this investigation.
Results: The ratio of the fertile female patients with moderate to severe rheumatoid arthritis, psoriasis and psoriatic arthritis, i.e. between 18 and 45 years of age, represents 10 to 30%. Approximately two thirds of respondents discuss family planning with their patients when making a diagnosis. In the care a higher number of rheumatologists collaborate with a wider range of other specialists compare to dermatologists who mostly consult only a gynecologist-obstetrician. Half of rheumatologists usually modify systemic treatment only 6 months before the patient would like to get pregnant while dermatologists act on average much earlier. Drugs of the first choice against flares during pregnancy are glucocorticoids for both specialties. Information on family planning was most often acquired by healthcare professionals from official guidelines and recommendations as well as from conferences and congresses. The physicians would welcome more congresses and interdisciplinary forums based on case reports as the most useful sources of information.
Conclusion: Timely initiation of discussion about family planning and ongoing dialogue with healthcare professionals are important for all women of childbearing age. The implications of medical treatment must be considered in all women with rheumatoid arthritis, psoriasis and psoriatic arthritis who are sexually active, even if they are not actively planning to start a family. The need for better and open communication, more holistic, multidisciplinary, collaborative and integrated care about these patients consistently emerged in the survey.

Keywords:

reproductive health – Psoriatic arthritis – Psoriasis – rheumatoid arthritis – inflammatory rheumatic diseases – women’s health of childbearing age – need for communication