The Management of Rheumatic and Musculoskeletal Diseases (RMD) Involving Reproductive Health (Part 1)
There is a huge concern when it comes to managing rheumatic and musculoskeletal diseases (RMD) in patients with reproductive health problems or issues. The management of RMD in patients with reproductive health problems is different compared to RMD patients without any reproductive health issues.
This corner is starting a multi-part discussion on how doctors can manage RMD in people with reproductive health challenges.
Due to the special nature of the approach of the treatment, medical experts such as rheumatologists caring for these kinds of patients, would need to have an open line of communication to discuss the issues regarding the treatment and also give proper advise on the use of contraception, issues about pregnancy, lactation (including medications), assisted reproductive technology (ART), fertility preservation, and hormone replacement therapy (HRT).
The doctor and the patient must be in the same page and the rheumatologist should also be in close collaboration with the obstetrics and gynecology specialist and other specialists in the field of maternal-fetal medicine, and reproductive endocrinology and infertility.
Women who are pregnant, and at the same time, suffering from RMD are given special care as the condition may turn out into serious adverse maternal or fetal results.
Moreover, the modes of contraception are more often designed to the particular patient with special focus on safety and efficacy.
The doctor should discuss the issues with the patient in terms of using the appropriate contraceptives and the use of these contraceptives should be properly encouraged.
The patients with RMD need to know the risks that come with pregnancy. The complications of being pregnant and with RMD often depends on the diagnosis, the activity of the disease, the disease’s damage, medications, and the presence of anti-Ro/
(Sjogren’sSyndtome A) SSA, anti-La/ (Sjogren’s Syndrome B) SSB, and antiphospholipid (aPL) antibodies
Often, pre-pregnancy assessment is very important in educating women to manage the pregnancy, therapy, and reaching the desired results.
Also, ability to become pregnant is in itself a concern for some women who may also suffer from RMD.
For this reason, it is best to look for ways in order to minimize the risks of gonadal insufficiency.
This is a critic in women RMD patients with sub fertility value advice from their doctors regarding oocyte preservation and in vitro fertilization (IVF).
It is quite a tough challenge to avoid using drugs or medication during pregnancy. This is tougher with pregnant women with RMD.
The reality is that not all drugs are safe to take when a woman is pregnant or lactating.
The key thing here is the ability to control the systemic inflammatory disease as failure to control the problem may lead to undesirable pregnancy outcome.
Additionally, patients are at risk to disease flare postpartum.
The American Academy of Pediatrics is pushing that the babies should be exclusively breastfed for 6 months.
In several cases drug safety is not guaranteed as most data come from case reports, small series, and observational studies.
There is a scarcity of direct data from randomized controlled trials.
Due to the scarcity of data,the identification of the appropriate management and screening, which including the use of drugs that will be used for RMD management is particularly a huge challenge for the specialists.
Given the complexity of the situation and the proper management of RMD especially in patients with reproductive health issues, the clinicians need to have proper guidelines. Also, there are other aspects of reproductive health that need to be given special focus for patients with RMD.
The American College of Rheumatology (ACR) understands and takes a closer look at the need for guidelines in resolving RMD problems of patients with reproductive health issues.
In the succeeding weeks, we will discuss how clinicians should be able to manage the reproductive health challenges of people with RMD and be able to achieve the right results or outcomes.