Weill Cornell Medicine, Hospital for Special Surgery, New York, New York.
University of Texas Southwestern Medical Center, Dallas.
Arthritis Rheumatol. 2020 Apr;72(4):529-556. doi: 10.1002/art.41191. Epub 2020 Feb 23.
To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD).
We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary.
This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti-Ro/SSA and/or anti-La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre-pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy-compatible medications, and ongoing physician-patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD.
This guideline provides evidence-based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low-level data. We intend that this guideline be used to inform a shared decision-making process between patients and their physicians on issues related to reproductive health that incorporates patients' values, preferences, and comorbidities.
制定关于避孕、辅助生殖技术 (ART)、性腺毒性治疗的生育力保存、绝经激素治疗 (HRT)、妊娠评估和管理以及风湿和肌肉骨骼疾病 (RMD) 患者药物使用的循证指南。
我们使用推荐评估、制定和评估方法对避孕、ART、生育力保存、HRT、妊娠和哺乳以及 RMD 人群药物使用的相关证据进行了系统评价，以评估证据质量，并通过小组共识过程确定最终建议并对其强度（有条件或强）进行分级。当间接证据足够有说服力，不需要正式投票时，就会达成良好实践声明。
本美国风湿病学会指南为 RMD 患者的生殖健康护理提供了 12 条未分级的良好实践声明和 131 条分级建议。这些建议旨在指导所有 RMD 患者的护理，除非明确指出适用于系统性红斑狼疮患者、抗磷脂抗体阳性患者和/或抗 Ro/SSA 和/或抗 La/SSB 抗体阳性患者。建议和良好实践声明支持以下几个指导原则：使用安全有效的避孕方法来防止意外怀孕、在疾病缓解期和接受妊娠兼容药物时进行孕前咨询，鼓励怀孕，并在所有生殖健康问题上与妇产科医生进行持续的医患讨论，鉴于与 RMD 具体相关的可用证据总体水平较低。
本指南提供了由专家小组和 RMD 患者制定和审查的循证建议。许多建议是有条件的，反映了数据缺乏或数据水平低的情况。我们希望本指南能够用于告知患者及其医生在与生殖健康相关的问题上的共同决策过程，其中包括患者的价值观、偏好和合并症。
