The American College of Rheumatology (ACR) has published its first-ever Reproductive Health in Rheumatic and Musculoskeletal Disease guideline, which aims to provide valuable guidance for the evaluation and management of reproductive health challenges for women across the spectrum of rheumatic diseases.

Autoimmune and inflammatory diseases are especially prevalent among women, particularly those in their childbearing years. For example, systemic lupus erythematosus (SLE) is approximately nine times more common in women, and three times as many women as men are diagnosed with rheumatoid arthritis.

Even though an increasing number of patients are having successful pregnancies, certain complications are more common in patients with rheumatologic disorders, and certain interactions between the diseases and pregnancy can be problematic. One such concern is preeclampsia, which occurs in some mothers with SLE or antiphospholipid syndrome and can be life-threatening. Another is increased risk of fetal death or low birth weight. All of these medical challenges require expert knowledge and vigilance by rheumatologists, in collaboration with obstetricians and gynecologists. Yet until now, no formal guidance had been available to support the management of the spectrum of reproductive health issues encountered by women with rheumatic diseases.

The guideline was created by a group of experts, including members of the HSS faculty, who conducted a systematic review and evaluation of the literature in the area of reproductive health and rheumatic and musculoskeletal diseases. The group voted on hundreds of specific recommendations. Pregnancy is a major focus of the guideline, which also addresses contraception, assisted reproductive therapies, fertility preservation therapies and use of hormone replacement therapy. The recommendations also include conditional guidance for clinical situations that have not yet been sufficiently addressed in research studies.

An important message from the guideline is that patients with rheumatic diseases should plan for pregnancy accordingly, which means using safe and effective contraception during periods of active disease flares. Planning a pregnancy should be done when rheumatic disease, especially lupus, is quiet and has been quiet for six months.

Like with other ACR guidelines, this new guideline will be revised and updated as future studies provide more information.