- I dati sulle raccomandazioni terapeutiche nelle donne in trattamento con biologici che stanno valutando una gravidanza sono limitati.
- La presente survey ha valutato le indicazioni dei reumatologi e dei dermatologi in merito alle esigenze delle donne sulla pianificazione familiare, la gravidanza e l’allattamento, nonché sulle preoccupazioni per la concomitante patologia infiammatoria reumatologica o la psoriasi.
- C’è la necessità di una comunicazione olistica, multidisciplinare, collaborativa e integrata tra i clinici e le donne in età fertile. I clinici dovrebbero tenere in considerazione le implicazioni delle condizioni personali sul trattamento delle donne con artrite reumatoide e psoriasi. Un programma di cure incentrato sul paziente che includa le decisioni riproduttive dovrebbe rientrare nella normale pratica clinica.
Abstract
Introduction
The proportion of women being treated with biologics is growing. However, data on treatment recommendation awareness among treating physicians and women who are considering pregnancy and family planning are limited. In this study, we used a questionnaire survey to learn how rheumatologists and dermatologists address women’s needs for family planning, pregnancy, and breastfeeding, as well as their possible concerns with concurrent inflammatory rheumatic disease or psoriasis.
Methods
A 55-question (in English) survey aimed at identifying surveyed physicians’ current practices regarding the reproductive health needs of women with rheumatoid arthritis, psoriasis, or psoriatic arthritis. This survey included 82 rheumatologists and 38 dermatologists from the Czech Republic, Hungary, and Slovakia.
Results
The proportion of female patients of reproductive age with the moderate-to-severe disease was 10-30% of all patients treated by the respondents. At the time of diagnosis, approximately two-thirds of the respondents discussed family planning with their patients. Rheumatologists collaborated with other specialists more frequently than dermatologists and gynecologist-obstetricians. Half of the rheumatologists revised systemic treatment 6 months before the patient planned to become pregnant, whereas dermatologists appear to act much sooner. Rheumatologists chose systemic glucocorticoids as the first-line treatment for pregnancy flares, whereas dermatologists chose topical corticosteroids. Congresses and interdisciplinary forums were rated the most valuable sources of information by physicians.
Conclusions
There is a need for more holistic, multidisciplinary, collaborative, and integrated communication between clinicians and women of childbearing age. Physicians should consider the implications of these conditions and medical treatment for women of childbearing age and family planning for those with rheumatoid arthritis and psoriatic disease. Patient-centered care that includes patients’ reproductive choices should be a routine clinical practice.