Τίτλος:
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
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Methods: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. Results: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. Conclusions: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus. © Published by the BMJ Publishing Group Limited.
Συγγραφείς:
Andreoli, L.
Bertsias, G.K.
Agmon-Levin, N.
Brown, S.
Cervera, R.
Costedoat-Chalumeau, N.
Doria, A.
Fischer-Betz, R.
Forger, F.
Moraes-Fontes, M.F.
Khamashta, M.
King, J.
Lojacono, A.
Marchiori, F.
Meroni, P.L.
Mosca, M.
Motta, M.
Ostensen, M.
Pamfil, C.
Raio, L.
Schneider, M.
Svenungsson, E.
Tektonidou, M.
Yavuz, S.
Boumpas, D.
Tincani, A.
Περιοδικό:
Annals of the Rheumatic Diseases
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
acetylsalicylic acid; anticoagulant agent; azathioprine; cyclosporin A; glucocorticoid; gonadorelin derivative; hydroxychloroquine; immunoglobulin; phospholipid antibody; rubella vaccine; tacrolimus; oral contraceptive agent, antiphospholipid syndrome; Article; biometry; congenital heart block; disease activity; Doppler ultrasonography; drug megadose; evidence based medicine; family planning; fertility preservation; fetus monitoring; fetus outcome; health care planning; hormonal contraception; hormone substitution; human; hypertension; infertility therapy; kidney function test; low drug dose; maternal morbidity; menopause; placenta insufficiency; plasmapheresis; pregnancy; risk assessment; small for date infant; systematic review; systemic lupus erythematosus; third trimester pregnancy; vaccination; women's health; antiphospholipid syndrome; consensus development; Delphi study; early cancer diagnosis; estrogen therapy; family planning; female; Genital Neoplasms, Female; infertility therapy; Lupus Erythematosus, Systemic; menopause; practice guideline; pregnancy; Pregnancy Complications; prepregnancy care, Antiphospholipid Syndrome; Contraceptives, Oral, Hormonal; Delphi Technique; Early Detection of Cancer; Estrogen Replacement Therapy; Family Planning Services; Female; Fertility Preservation; Fetal Monitoring; Genital Neoplasms, Female; Humans; Lupus Erythematosus, Systemic; Menopause; Preconception Care; Pregnancy; Pregnancy Complications; Reproductive Techniques, Assisted; Risk Assessment
DOI:
10.1136/annrheumdis-2016-209770
