European Rheumatism Organization Publishes Recommendations for Women with Lupus

Researchers from the European League Against Rheumatism (EULAR) have published a list of recommendations that women with lupus or antiphospholipid syndrome (APS) can use to deal with health issues or do family planning.

The article, “EULAR Recommendations For Women’s Health And The Management Of Family Planning, Assisted Reproduction, Pregnancy And Menopause In Patients With Systemic Lupus Erythematosus And/Or Antiphospholipid Syndrome,” was published in the journal Annals of the Rheumatic Diseases.

APS is an autoimmune disease that mostly affects young women. It can cause frequent clotting in arteries and veins, and miscarriages.

The clotting results from anti-phospholipid autoantibodies in the blood, which the immune system generates against a person’s own tissues. The autoantibodies interfere with coagulation.

People with APS may otherwise be healthy, or they also may have an underlying disease, most frequently lupus.

“These recommendations have been devised with the intention of helping physicians involved in the care of patients with [lupus] and/or APS and facilitating physician–patient communication,” the researchers wrote. “They recognise an implicit need for change in the mindset of health professionals, shifting from caution against pregnancy towards embracement of pregnancy.”

“Accordingly, family planning should be discussed from the first physician–patient encounter and reinforced thereafter.” the researchers added. “Health professionals should support the patient and her family in their decisions regarding family planning by discussing individual pregnancy risks.”

Researchers made these recommendations and observations:

• family planning be discussed as early as possible after a lupus diagnosis.
• most patients can have successful pregnancies, and measures can be taken to reduce the risks of health problems to the mother and child.
• women’s risk should be assessed according to disease activity, autoantibody profile, previous vascular disease or pregnancy issue, hypertension, and use of drugs, especially hydroxychloroquine and anti-platelets or anticoagulants.
• hormonal contraception and menopause replacement therapy can be used in women with stable or inactive disease and with a low risk of thrombosis.
• fertility preservation with gonadotropin-releasing hormone analogues should be considered before using alkylating agents.
• assisted-reproduction techniques can be safely used in patients with stable or inactive disease.
• patients with positive antiphospholipid antibodies or APS should receive anticoagulation therapies and/or low-dose aspirin.
• evaluation of disease activity, kidney function and blood markers is important for diagnosing disease flares and monitoring for adverse outcomes to a mother and a newborn.
• fetal monitoring should include Doppler ultrasonography and fetal biometry — especially in the third trimester — to screen for placental anomalies and fetuses that are small for their gestational age.
• screening for gynecological malignancies should be similar to that in other women, but with increased vigilance for cervical premalignant lesions if a patient is treated with immunosuppressive drugs.
• the vaccine against the human papillomavirus can be given to women with stable and inactive disease.

The research team based their recommendations on a review of information about women’s health issues connected with SLE or APS, and opinions from a multidisciplinary team of experts.