Background Achieving low disease activity and remission in patients (pts) is a key recommendation in the latest EULAR guidelines for the treatment of rheumatoid arthritis (RA).1 Disease control is also critical for successful pregnancy outcomes among pts with RA who are pregnant or are planning to conceive.2 In addition to understanding how these pts are managed by healthcare professionals, pt beliefs likely also play a role in determining treatment approaches and goals.3
Objectives To evaluate pt and physician attitudes towards the treatment of rheumatological disease prior to and during pregnancy.
Methods Two online surveys were undertaken, one in pts, and one in rheumatologists and obstetrics/gynecology physicians (OBGYN). Surveys were conducted in the UK, Germany, US and Mexico. The pt survey included women with RA who had been pregnant in the past 2 years. Rheumatologists and OBGYN were questioned on the last 3 RA pts they have consulted who were pregnant or considering pregnancy. Questions were aimed at identifying the goals that drive pt and physician decisions regarding treatment.
Results 57 RA pts completed the pt survey. 89% of pts said the ability to have a healthy baby is the most important factor for them in the treatment of their disease. 91% of pts believe that their rheumatologist is capable of helping them make decisions during their pregnancy. 46% of pts reported that they rely on advice from friends and family regarding their pregnancy. 44% of pts reported that their cultural and/or religious beliefs played a large role in influencing their choice of treatment plan. 30 rheumatologists and 21 OBGYN completed the physician survey. 83% of rheumatologists and 86% of OBGYN considered the most important goal in the treatment of pregnant or conceiving women to be ensuring a healthy pregnancy and outcome for the child. 77% of rheumatologists and 76% of OBGYN felt confident in treating pregnant pts with RA. 53% of rheumatologists and 33% of OBGYN were not willing to take any risks in determining treatment options even if the pt's disease was active. 67% of both rheumatologists and OBGYN reported having the information necessary to treat their pregnant pts.
Conclusions The pt's personal beliefs should be taken into account when making their treatment plan, as this may influence medication options. For both the pt and physician, the main goal was to have a healthy pregnancy and baby. Although disease activity needs to be controlled in order to ensure an optimum outcome, most rheumatologists but not OBGYN were unwilling to take any risks in order to achieve disease control. The importance of controlling disease activity needs to be emphasized and continuous education of both physicians and pts could help to achieve this.
Smolen J. Ann Rheum Dis 2014;73(3):492–509.
Østensen M. Autoimmun Rev 2014 [Epub ahead of print].
Nota I. Arthritis Care Res 2014 [Epub ahead of print]
Acknowledgements The authors acknowledge Costello Medical Consulting for writing and editorial assistance which was funded by UCB Pharma.
Disclosure of Interest M. Khamashta Consultant for: AstraZeneca, INOVA, GSK, Medimmune, UCB Pharma, D. Pushparajah Employee of: UCB Pharma, E. Chakravarty Consultant for: UCB Pharma
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