During the recent European League Against Rheumatism Annual Congress (EULAR 2015) that took place June 11-13 in Rome, Italy, new clinical recommendations for patients with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) who are trying to conceive or are currently pregnant were presented by the league. These new recommendations were based on evidence from scientific studies and input given by clinical experts, and aim to provide crucial guidance to support family planning initiatives, assisted reproduction, and pregnancy for this patient population.
In an EULAR press release, Dr. Laura Andreoli, Rheumatology and Clinical Immunology Unit, department of clinical and experimental sciences, University of Brescia, Italy, stated, “APS and SLE disproportionately affect women, typically starting when they are at their most fertile, and leaving women at risk of reduced fertility and pregnancy complications. Women often develop these conditions before they have had a chance to have children or complete their family; physicians must ensure that optimal management includes best-practice measures to reduce these risks from the onset of disease and throughout pregnancy.”
The foremost recommendation states that “SLE or APS patients planning a pregnancy should be counselled and managed after assessment of risk that takes into consideration disease activity, serological profile, hypertension and use of drugs (with emphasis on hydroxychloroquine).”
Secondary recommendations encompass clinically relevant subjects such as preservation of fertility to assisted reproduction, and include the following:
- SLE and/or APS women can be candidates for contraceptive measures based on their disease activity and thrombotic risk (particularly presence of antiphospholipid antibodies)
- Fertility preservation methods, including gonadotropin-releasing hormone (GnRH) analogues should be considered prior to the use of alkylating agents
- Assisted reproduction techniques can be safely used in patients with stable or inactive disease provided that preventative measures are offered to limit the risk of flare and/or thrombosis
- Disease activity, serological markers and renal function parameters are useful to monitor for obstetrical adverse outcomes and disease flares during pregnancy
The European League Against Rheumatism (EULAR) is the organization which represents people with arthritis/rheumatism, health professional and scientific societies of rheumatology of all the European nations.
EULAR aims to reduce the burden of rheumatic diseases on the individual and society and to improve the treatment, prevention and rehabilitation of musculoskeletal diseases.
To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with musculoskeletal diseases by the governing bodies in Europe.