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2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases.

Publication ,  Journal Article
Sammaritano, LR; Bermas, BL; Chakravarty, EE; Chambers, C; Clowse, MEB; Lockshin, MD; Marder, W; Guyatt, G; Branch, DW; Buyon, J; Cush, J ...
Published in: Arthritis Rheumatol
April 2020

OBJECTIVE: To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD). METHODS: We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary. RESULTS: This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. 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. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre-pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy-compatible medications, and ongoing physician-patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD. CONCLUSION: This guideline provides evidence-based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low-level data. We intend that this guideline be used to inform a shared decision-making process between patients and their physicians on issues related to reproductive health that incorporates patients' values, preferences, and comorbidities.

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Published In

Arthritis Rheumatol

DOI

EISSN

2326-5205

Publication Date

April 2020

Volume

72

Issue

4

Start / End Page

529 / 556

Location

United States

Related Subject Headings

  • Rheumatology
  • Rheumatic Diseases
  • Reproductive Health
  • Musculoskeletal Diseases
  • Humans
  • Fertility Preservation
  • Disease Management
  • Contraception
  • 3204 Immunology
  • 3202 Clinical sciences
 

Citation

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Sammaritano, L. R., Bermas, B. L., Chakravarty, E. E., Chambers, C., Clowse, M. E. B., Lockshin, M. D., … D’Anci, K. E. (2020). 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol, 72(4), 529–556. https://doi.org/10.1002/art.41191
Sammaritano, Lisa R., Bonnie L. Bermas, Eliza E. Chakravarty, Christina Chambers, Megan E. B. Clowse, Michael D. Lockshin, Wendy Marder, et al. “2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases.Arthritis Rheumatol 72, no. 4 (April 2020): 529–56. https://doi.org/10.1002/art.41191.
Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020 Apr;72(4):529–56.
Sammaritano, Lisa R., et al. “2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases.Arthritis Rheumatol, vol. 72, no. 4, Apr. 2020, pp. 529–56. Pubmed, doi:10.1002/art.41191.
Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, Marder W, Guyatt G, Branch DW, Buyon J, Christopher-Stine L, Crow-Hercher R, Cush J, Druzin M, Kavanaugh A, Laskin CA, Plante L, Salmon J, Simard J, Somers EC, Steen V, Tedeschi SK, Vinet E, White CW, Yazdany J, Barbhaiya M, Bettendorf B, Eudy A, Jayatilleke A, Shah AA, Sullivan N, Tarter LL, Birru Talabi M, Turgunbaev M, Turner A, D’Anci KE. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020 Apr;72(4):529–556.
Journal cover image

Published In

Arthritis Rheumatol

DOI

EISSN

2326-5205

Publication Date

April 2020

Volume

72

Issue

4

Start / End Page

529 / 556

Location

United States

Related Subject Headings

  • Rheumatology
  • Rheumatic Diseases
  • Reproductive Health
  • Musculoskeletal Diseases
  • Humans
  • Fertility Preservation
  • Disease Management
  • Contraception
  • 3204 Immunology
  • 3202 Clinical sciences