The great improvement in the quality of life prompts a number of patients suffering from rheumatic diseases to desire to have a normal family.
This particular period need to be skillfully guided by the physicians that have to be prepared to face a number of different situations according to the different diseases of the patients, the different drugs they are taking and according to the different gender of individuals desiring to become parents.
Problems of men are mainly related to drugs uptake. In fact some drugs like salazopyrin can cause oligospermia linked to transient infertility, other one such as cyclophosphamide can irreversibly damage the gonads in unpredictable way (not dependent by the cumulative dosage) causing irreversible infertility. Sperma cryopreservation should be proposed to patients that need cyclophosphamide. Recently it was also observed an high rate of erectile dysfunctions in man suffering from systemic sclerosis, to underline that this severe disease can affect life expectances.
Women that suffer from rheumatic diseases and desire to become mothers have a number of different problems related first to disease modifications in pregnancy: in this respect it is known that certain diseases, like rheumatoid arthritis, usually improve during pregnancy while others, like systemic lupus erythemetosus, seem to suffer from an increased rate of flares. A second problem is the treatment needed to keep the disease in remission: obviously it needs to be tailored respecting the safety of the fetus. In addition, some rheumatic diseases carry risk factors for the normal development of the pregnancy with a consequent increase of complications and losses.
Puerperium, even after a successful pregnancy, has to be regarded as particularly challenging in patients with rheumatic disease. In fact, complications and flares are often reported and in particular the increased thromboembolic risk linked to the period can act as “second hit” for thrombosis in women with antiphospholipid syndrome with or without SLE.
To be a mother and grow the child is also difficult for women with musculoskeletal problems. When mothers have a chronic disease, fatigue and pain can impair their parenting activity and can cause psychological distress if they do not feel adequate for the task.
All these issues need to be discussed and clarified with patients to prevent with medical, psychological and familiar help the occurrence of problems that could spoil the satisfaction of a having a family.
Disclosure of Interest None Declared