2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases
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 mu...
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| Veröffentlicht in: | Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2020-04, Vol.72 (4), p.529-556 |
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| creator | Sammaritano, Lisa R. Bermas, Bonnie L. Chakravarty, Eliza E. Chambers, Christina Clowse, Megan E. B. Lockshin, Michael D. Marder, Wendy Guyatt, Gordon Branch, D. Ware Buyon, Jill Christopher‐Stine, Lisa Crow‐Hercher, Rachelle Cush, John Druzin, Maurice Kavanaugh, Arthur Laskin, Carl A. Plante, Lauren Salmon, Jane Simard, Julia Somers, Emily C. Steen, Virginia Tedeschi, Sara K. Vinet, Evelyne White, C. Whitney Yazdany, Jinoos Barbhaiya, Medha Bettendorf, Brittany Eudy, Amanda Jayatilleke, Arundathi Shah, Amit Aakash Sullivan, Nancy Tarter, Laura L. Birru Talabi, Mehret Turgunbaev, Marat Turner, Amy D'Anci, Kristen E. |
| description | 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. |
| doi_str_mv | 10.1002/art.41191 |
| format | Article |
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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.</description><identifier>ISSN: 2326-5191</identifier><identifier>EISSN: 2326-5205</identifier><identifier>DOI: 10.1002/art.41191</identifier><identifier>PMID: 32090480</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Antibodies ; Antiphospholipid antibodies ; Autoimmune diseases ; Birth control ; Chronic conditions ; Contraception ; Decision making ; Fertility ; Gynecology ; Health care ; Hormone replacement therapy ; Lactation ; Low level ; Menopause ; Musculoskeletal diseases ; Obstetrics ; Patients ; Physicians ; Pregnancy ; Preservation ; Reproduction ; Reproductive health ; Reproductive technologies ; Rheumatology ; Ro(SSA) antigen ; Systemic lupus erythematosus</subject><ispartof>Arthritis & rheumatology (Hoboken, N.J.), 2020-04, Vol.72 (4), p.529-556</ispartof><rights>2019, American College of Rheumatology</rights><rights>2019, American College of Rheumatology.</rights><rights>2020, American College of Rheumatology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4541-36367da549a41b7261d10638d22bd82047f696b6f9e1bc5b770aff796d94dd8c3</citedby><cites>FETCH-LOGICAL-c4541-36367da549a41b7261d10638d22bd82047f696b6f9e1bc5b770aff796d94dd8c3</cites><orcidid>0000-0001-5234-3978 ; 0000-0001-9475-1363 ; 0000-0002-3508-4094 ; 0000-0001-5735-9856 ; 0000-0002-8579-3470 ; 0000-0001-7727-5879 ; 0000-0002-7150-7306 ; 0000-0002-6670-7696 ; 0000-0001-9113-7122 ; 0000-0001-5049-4932</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fart.41191$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fart.41191$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32090480$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sammaritano, Lisa R.</creatorcontrib><creatorcontrib>Bermas, Bonnie L.</creatorcontrib><creatorcontrib>Chakravarty, Eliza E.</creatorcontrib><creatorcontrib>Chambers, Christina</creatorcontrib><creatorcontrib>Clowse, Megan E. B.</creatorcontrib><creatorcontrib>Lockshin, Michael D.</creatorcontrib><creatorcontrib>Marder, Wendy</creatorcontrib><creatorcontrib>Guyatt, Gordon</creatorcontrib><creatorcontrib>Branch, D. Ware</creatorcontrib><creatorcontrib>Buyon, Jill</creatorcontrib><creatorcontrib>Christopher‐Stine, Lisa</creatorcontrib><creatorcontrib>Crow‐Hercher, Rachelle</creatorcontrib><creatorcontrib>Cush, John</creatorcontrib><creatorcontrib>Druzin, Maurice</creatorcontrib><creatorcontrib>Kavanaugh, Arthur</creatorcontrib><creatorcontrib>Laskin, Carl A.</creatorcontrib><creatorcontrib>Plante, Lauren</creatorcontrib><creatorcontrib>Salmon, Jane</creatorcontrib><creatorcontrib>Simard, Julia</creatorcontrib><creatorcontrib>Somers, Emily C.</creatorcontrib><creatorcontrib>Steen, Virginia</creatorcontrib><creatorcontrib>Tedeschi, Sara K.</creatorcontrib><creatorcontrib>Vinet, Evelyne</creatorcontrib><creatorcontrib>White, C. Whitney</creatorcontrib><creatorcontrib>Yazdany, Jinoos</creatorcontrib><creatorcontrib>Barbhaiya, Medha</creatorcontrib><creatorcontrib>Bettendorf, Brittany</creatorcontrib><creatorcontrib>Eudy, Amanda</creatorcontrib><creatorcontrib>Jayatilleke, Arundathi</creatorcontrib><creatorcontrib>Shah, Amit Aakash</creatorcontrib><creatorcontrib>Sullivan, Nancy</creatorcontrib><creatorcontrib>Tarter, Laura L.</creatorcontrib><creatorcontrib>Birru Talabi, Mehret</creatorcontrib><creatorcontrib>Turgunbaev, Marat</creatorcontrib><creatorcontrib>Turner, Amy</creatorcontrib><creatorcontrib>D'Anci, Kristen E.</creatorcontrib><title>2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases</title><title>Arthritis & rheumatology (Hoboken, N.J.)</title><addtitle>Arthritis Rheumatol</addtitle><description>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.</description><subject>Antibodies</subject><subject>Antiphospholipid antibodies</subject><subject>Autoimmune diseases</subject><subject>Birth control</subject><subject>Chronic conditions</subject><subject>Contraception</subject><subject>Decision making</subject><subject>Fertility</subject><subject>Gynecology</subject><subject>Health care</subject><subject>Hormone replacement therapy</subject><subject>Lactation</subject><subject>Low level</subject><subject>Menopause</subject><subject>Musculoskeletal diseases</subject><subject>Obstetrics</subject><subject>Patients</subject><subject>Physicians</subject><subject>Pregnancy</subject><subject>Preservation</subject><subject>Reproduction</subject><subject>Reproductive health</subject><subject>Reproductive technologies</subject><subject>Rheumatology</subject><subject>Ro(SSA) antigen</subject><subject>Systemic lupus erythematosus</subject><issn>2326-5191</issn><issn>2326-5205</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp10UFLHDEYBuBQKlWsB_-ABLzUw2qSySSZ47KtWlAE0fOQSb7ZjWYmmkxa9uwfN3VdD0JzSfh4ePPBi9AhJaeUEHam43TKKW3oF7THKiZmNSP11-27zHfRQUoPpJxGEkHqb2i3YqQhXJE99MIII3g-QHRGj3gRvIcl4NDj2xXkQU_Bh-UaX2RnwbsRcB8inlaAr_WolzDAOL1heIrBZjO5P4AvQftphd24zXAG69Hi65xM9iE9godJe_zTJdAJ0ne002uf4OD93kf357_uFpezq5uL34v51czwmtNZJSohra55ozntJBPUUiIqZRnrrGKEy140ohN9A7QzdScl0X0vG2Ebbq0y1T76scktuz5nSFM7uGTAez1CyKll5QeiaiZVocef6EPIcSzbFaU4VUwxWdTJRpkYUorQt0_RDTquW0raf-W0pZz2rZxij94TczeA_ZDbKgo424C_zsP6_0nt_PZuE_kKEPqX4w</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Sammaritano, Lisa R.</creator><creator>Bermas, Bonnie L.</creator><creator>Chakravarty, Eliza E.</creator><creator>Chambers, Christina</creator><creator>Clowse, Megan E. B.</creator><creator>Lockshin, Michael D.</creator><creator>Marder, Wendy</creator><creator>Guyatt, Gordon</creator><creator>Branch, D. Ware</creator><creator>Buyon, Jill</creator><creator>Christopher‐Stine, Lisa</creator><creator>Crow‐Hercher, Rachelle</creator><creator>Cush, John</creator><creator>Druzin, Maurice</creator><creator>Kavanaugh, Arthur</creator><creator>Laskin, Carl A.</creator><creator>Plante, Lauren</creator><creator>Salmon, Jane</creator><creator>Simard, Julia</creator><creator>Somers, Emily C.</creator><creator>Steen, Virginia</creator><creator>Tedeschi, Sara K.</creator><creator>Vinet, Evelyne</creator><creator>White, C. Whitney</creator><creator>Yazdany, Jinoos</creator><creator>Barbhaiya, Medha</creator><creator>Bettendorf, Brittany</creator><creator>Eudy, Amanda</creator><creator>Jayatilleke, Arundathi</creator><creator>Shah, Amit Aakash</creator><creator>Sullivan, Nancy</creator><creator>Tarter, Laura L.</creator><creator>Birru Talabi, Mehret</creator><creator>Turgunbaev, Marat</creator><creator>Turner, Amy</creator><creator>D'Anci, Kristen E.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5234-3978</orcidid><orcidid>https://orcid.org/0000-0001-9475-1363</orcidid><orcidid>https://orcid.org/0000-0002-3508-4094</orcidid><orcidid>https://orcid.org/0000-0001-5735-9856</orcidid><orcidid>https://orcid.org/0000-0002-8579-3470</orcidid><orcidid>https://orcid.org/0000-0001-7727-5879</orcidid><orcidid>https://orcid.org/0000-0002-7150-7306</orcidid><orcidid>https://orcid.org/0000-0002-6670-7696</orcidid><orcidid>https://orcid.org/0000-0001-9113-7122</orcidid><orcidid>https://orcid.org/0000-0001-5049-4932</orcidid></search><sort><creationdate>202004</creationdate><title>2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases</title><author>Sammaritano, Lisa R. ; Bermas, Bonnie L. ; Chakravarty, Eliza E. ; Chambers, Christina ; Clowse, Megan E. B. ; Lockshin, Michael D. ; Marder, Wendy ; Guyatt, Gordon ; Branch, D. Ware ; Buyon, Jill ; Christopher‐Stine, Lisa ; Crow‐Hercher, Rachelle ; Cush, John ; Druzin, Maurice ; Kavanaugh, Arthur ; Laskin, Carl A. ; Plante, Lauren ; Salmon, Jane ; Simard, Julia ; Somers, Emily C. ; Steen, Virginia ; Tedeschi, Sara K. ; Vinet, Evelyne ; White, C. Whitney ; Yazdany, Jinoos ; Barbhaiya, Medha ; Bettendorf, Brittany ; Eudy, Amanda ; Jayatilleke, Arundathi ; Shah, Amit Aakash ; Sullivan, Nancy ; Tarter, Laura L. ; Birru Talabi, Mehret ; Turgunbaev, Marat ; Turner, Amy ; D'Anci, Kristen E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4541-36367da549a41b7261d10638d22bd82047f696b6f9e1bc5b770aff796d94dd8c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antibodies</topic><topic>Antiphospholipid antibodies</topic><topic>Autoimmune diseases</topic><topic>Birth control</topic><topic>Chronic conditions</topic><topic>Contraception</topic><topic>Decision making</topic><topic>Fertility</topic><topic>Gynecology</topic><topic>Health care</topic><topic>Hormone replacement therapy</topic><topic>Lactation</topic><topic>Low level</topic><topic>Menopause</topic><topic>Musculoskeletal diseases</topic><topic>Obstetrics</topic><topic>Patients</topic><topic>Physicians</topic><topic>Pregnancy</topic><topic>Preservation</topic><topic>Reproduction</topic><topic>Reproductive health</topic><topic>Reproductive technologies</topic><topic>Rheumatology</topic><topic>Ro(SSA) antigen</topic><topic>Systemic lupus erythematosus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sammaritano, Lisa R.</creatorcontrib><creatorcontrib>Bermas, Bonnie L.</creatorcontrib><creatorcontrib>Chakravarty, Eliza E.</creatorcontrib><creatorcontrib>Chambers, Christina</creatorcontrib><creatorcontrib>Clowse, Megan E. B.</creatorcontrib><creatorcontrib>Lockshin, Michael D.</creatorcontrib><creatorcontrib>Marder, Wendy</creatorcontrib><creatorcontrib>Guyatt, Gordon</creatorcontrib><creatorcontrib>Branch, D. Ware</creatorcontrib><creatorcontrib>Buyon, Jill</creatorcontrib><creatorcontrib>Christopher‐Stine, Lisa</creatorcontrib><creatorcontrib>Crow‐Hercher, Rachelle</creatorcontrib><creatorcontrib>Cush, John</creatorcontrib><creatorcontrib>Druzin, Maurice</creatorcontrib><creatorcontrib>Kavanaugh, Arthur</creatorcontrib><creatorcontrib>Laskin, Carl A.</creatorcontrib><creatorcontrib>Plante, Lauren</creatorcontrib><creatorcontrib>Salmon, Jane</creatorcontrib><creatorcontrib>Simard, Julia</creatorcontrib><creatorcontrib>Somers, Emily C.</creatorcontrib><creatorcontrib>Steen, Virginia</creatorcontrib><creatorcontrib>Tedeschi, Sara K.</creatorcontrib><creatorcontrib>Vinet, Evelyne</creatorcontrib><creatorcontrib>White, C. Whitney</creatorcontrib><creatorcontrib>Yazdany, Jinoos</creatorcontrib><creatorcontrib>Barbhaiya, Medha</creatorcontrib><creatorcontrib>Bettendorf, Brittany</creatorcontrib><creatorcontrib>Eudy, Amanda</creatorcontrib><creatorcontrib>Jayatilleke, Arundathi</creatorcontrib><creatorcontrib>Shah, Amit Aakash</creatorcontrib><creatorcontrib>Sullivan, Nancy</creatorcontrib><creatorcontrib>Tarter, Laura L.</creatorcontrib><creatorcontrib>Birru Talabi, Mehret</creatorcontrib><creatorcontrib>Turgunbaev, Marat</creatorcontrib><creatorcontrib>Turner, Amy</creatorcontrib><creatorcontrib>D'Anci, Kristen E.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sammaritano, Lisa R.</au><au>Bermas, Bonnie L.</au><au>Chakravarty, Eliza E.</au><au>Chambers, Christina</au><au>Clowse, Megan E. B.</au><au>Lockshin, Michael D.</au><au>Marder, Wendy</au><au>Guyatt, Gordon</au><au>Branch, D. Ware</au><au>Buyon, Jill</au><au>Christopher‐Stine, Lisa</au><au>Crow‐Hercher, Rachelle</au><au>Cush, John</au><au>Druzin, Maurice</au><au>Kavanaugh, Arthur</au><au>Laskin, Carl A.</au><au>Plante, Lauren</au><au>Salmon, Jane</au><au>Simard, Julia</au><au>Somers, Emily C.</au><au>Steen, Virginia</au><au>Tedeschi, Sara K.</au><au>Vinet, Evelyne</au><au>White, C. Whitney</au><au>Yazdany, Jinoos</au><au>Barbhaiya, Medha</au><au>Bettendorf, Brittany</au><au>Eudy, Amanda</au><au>Jayatilleke, Arundathi</au><au>Shah, Amit Aakash</au><au>Sullivan, Nancy</au><au>Tarter, Laura L.</au><au>Birru Talabi, Mehret</au><au>Turgunbaev, Marat</au><au>Turner, Amy</au><au>D'Anci, Kristen E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases</atitle><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle><addtitle>Arthritis Rheumatol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>72</volume><issue>4</issue><spage>529</spage><epage>556</epage><pages>529-556</pages><issn>2326-5191</issn><eissn>2326-5205</eissn><abstract>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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32090480</pmid><doi>10.1002/art.41191</doi><tpages>29</tpages><orcidid>https://orcid.org/0000-0001-5234-3978</orcidid><orcidid>https://orcid.org/0000-0001-9475-1363</orcidid><orcidid>https://orcid.org/0000-0002-3508-4094</orcidid><orcidid>https://orcid.org/0000-0001-5735-9856</orcidid><orcidid>https://orcid.org/0000-0002-8579-3470</orcidid><orcidid>https://orcid.org/0000-0001-7727-5879</orcidid><orcidid>https://orcid.org/0000-0002-7150-7306</orcidid><orcidid>https://orcid.org/0000-0002-6670-7696</orcidid><orcidid>https://orcid.org/0000-0001-9113-7122</orcidid><orcidid>https://orcid.org/0000-0001-5049-4932</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2326-5191 |
| ispartof | Arthritis & rheumatology (Hoboken, N.J.), 2020-04, Vol.72 (4), p.529-556 |
| issn | 2326-5191 2326-5205 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2363085278 |
| source | Access via Wiley Online Library; Alma/SFX Local Collection |
| subjects | Antibodies Antiphospholipid antibodies Autoimmune diseases Birth control Chronic conditions Contraception Decision making Fertility Gynecology Health care Hormone replacement therapy Lactation Low level Menopause Musculoskeletal diseases Obstetrics Patients Physicians Pregnancy Preservation Reproduction Reproductive health Reproductive technologies Rheumatology Ro(SSA) antigen Systemic lupus erythematosus |
| title | 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-19T17%3A08%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=2020%20American%20College%20of%20Rheumatology%20Guideline%20for%20the%20Management%20of%20Reproductive%20Health%20in%20Rheumatic%20and%20Musculoskeletal%20Diseases&rft.jtitle=Arthritis%20&%20rheumatology%20(Hoboken,%20N.J.)&rft.au=Sammaritano,%20Lisa%20R.&rft.date=2020-04&rft.volume=72&rft.issue=4&rft.spage=529&rft.epage=556&rft.pages=529-556&rft.issn=2326-5191&rft.eissn=2326-5205&rft_id=info:doi/10.1002/art.41191&rft_dat=%3Cproquest_cross%3E2363085278%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2384182827&rft_id=info:pmid/32090480&rfr_iscdi=true |