2020 American College of Rheumatology Guideline for the Mana
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Today, the American College of Rheumatology (ACR) published the 2020 Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases (RMD). This is the first, evidence-based, official clinical practice guideline related to the management of reproductive health issues for all patients with rheumatic diseases.

The guideline provides 12 ungraded good practice statements and 131 graded recommendations that are intended to guide care for rheumatology patients except where indicated as being for patients with specific conditions or antibodies present.

Good practice statements from the guideline are:

-In women with RMD who are of childbearing age, we suggest discussing contraception and plans for pregnancy at an initial or early visit and when initiating treatment with potentially teratogenic medications.

-Counseling regarding contraceptive methods for each particular patient should be based on efficacy, safety, and individual values and preferences

-In women with RMD for whom use of other, more effective forms of birth control are contraindicated, we suggest using barrier methods of contraception as birth control over other less effective options or no contraception

-In men with RMD receiving cyclophosphamide therapy who have no immediate plans to father a child we suggest - where possible and when future conception is desired - proceeding with sperm cryopreservation, ideally prior to initiating cyclophosphamide therapy.

-In women with RMD without SLE and without positive aPL we suggest treating with HRT according to the guidelines for the general postmenopausal population.

-In women with RMD considering pregnancy or who are pregnant we strongly suggest: o Counseling patients that maternal and pregnancy outcomes are better when illness is quiescent / low activity before pregnancy. Co-management by a rheumatologist or other physician with relevant expertise throughout pregnancy is preferred.

-In women with SLE who are currently pregnant: We strongly suggest monitoring laboratory tests for disease activity at least once per trimester during pregnancy.

-In men with RMD who are planning to father a child, we suggest discussing the use of medications prior to attempting to conceive a pregnancy.

-In men with RMD who are initiating treatment with medications that may affect fertility (e.g. cyclophosphamide), we suggest discussing future pregnancy plans.

-We suggest discussing the use of medications prior to attempting to conceive; we also suggest discussing future pregnancy plans when initiating treatment with medications that may affect fertility such as cyclophosphamide.

-In women with inadvertent exposure to teratogenic medications during pregnancy, we strongly suggest immediate medication discontinuation and referral to a maternal-fetal-medicine specialist or genetics counselor.

-Women should be encouraged to breastfeed if desired and possible. Disease control should be maintained with medications compatible with lactation and risks/benefits reviewed with each patient for her particular situation

Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice. The paper containing the full list of recommendations and supporting evidence is available at https://www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines/Reproductive-Health-in-Rheumatic-Diseases.

About the American College of Rheumatology:
The American College of Rheumatology (ACR) is an international medical society representing over 8,500 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty.
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