Abstract
BackgroundWith improved therapies and management, more women with inflammatory arthritides (IA) are considering pregnancy. Our objective was to survey rheumatologists across Canada about their IA management in pregnancy to identify practice patterns and knowledge gaps.MethodsWe administered an online survey with questions regarding medications for IA treatment including conventional synthetic disease modifying antirheumatic drugs (csDMARDs) and biologics/small molecules in planned and unplanned pregnancies. Email invitations were sent to members of the Canadian Rheumatology Association. We calculated responses frequencies and a priori set a cut-off of ≥75% to define consensus.ResultsNinety rheumatologists participated in the survey (20% participation rate); 57% have been practicing for > 10 years, 32% for ≤10 years, and 11% in training. There was consensus on discontinuation of 4 csDMARDs – cyclophosphamide (100%), leflunomide (98%), methotrexate (96%), and mycophenolate mofetil (89%) – in planned pregnancies but varied responses on when to discontinue them or what to do in unplanned pregnancies. Respondents agreed that 3 csDMARDs – azathioprine (84%), hydroxychloroquine (95%), and sulfasalazine (77%) – were safe to continue in planned and unplanned pregnancies. There was consensus with use of 4 biologics – adalimumab (81%), certolizumab (80%), etanercept (83%), and infliximab (76%) – in planned pregnancies but uncertainty on when they should be discontinued and their use in unplanned pregnancies.ConclusionsThis national survey shows consensus among rheumatologists on the use of some csDMARDs and biologics/small molecules in IA patients planning pregnancy but varied knowledge on when to discontinue and what to do in unplanned pregnancies.
Highlights
With improved therapies and management, more women with inflammatory arthritides (IA) are considering pregnancy
The survey consisted of 23 general and specific questions focusing on the use of csDMARDs (n = 12; azathioprine, chloroquine, cyclophosphamide, cyclosporine, doxycycline, gold salts, hydroxychloroquine, leflunomide, methotrexate, minocycline, mycophenolate mofetil, and sulfasalazine), biologics/ targeted small molecules (n = 12; abatacept, adalimumab, anakinra, apremilast, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, tofacitinib, and ustekinumab), non-steroidal anti-inflammatory drugs (NSAIDs; celecoxib, ibuprofen, and naproxen) and prednisone
43% and 8% of respondents reported that the majority (26–50% and over 50%, respectively) of their IA patients were women of childbearing years, and 87% of respondents reported they continue to care these patients for during pregnancy
Summary
With improved therapies and management, more women with inflammatory arthritides (IA) are considering pregnancy. Our objective was to survey rheumatologists across Canada about their IA management in pregnancy to identify practice patterns and knowledge gaps. Inflammatory arthritides (IA), which include rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), are chronic autoimmune diseases that disproportionately affect females more than males [1], often with peak incidences during reproductive years [2]. A 2013 UK survey of rheumatologists and obstetricians showed no uniform practice for using IA medications during pregnancy. No cut-off was used to define response consensus, 80% of respondents indicated continuation of hydroxychloroquine and over 98% advised discontinuation of methotrexate and leflunomide [7]. We surveyed rheumatologists across Canada about their management of IA pregnancy to achieve objectives of identifying consensus among respondents and establishing practice patterns
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