Division of Rheumatology, Duke University, Durham, NC, USA.
Nat Rev Rheumatol. 2022 Dec;18(12):711-723. doi: 10.1038/s41584-022-00842-z. Epub 2022 Oct 3.
Vasculitides and their therapies affect all areas of the reproductive life cycle. The ACR, EULAR and the Drugs and Lactation database offer guidance on the management of the reproductive health of patients with rheumatic diseases; however, these guidelines do not address patients with vasculitis specifically. This Review discusses the guidance from multiple expert panels and how these recommendations might apply to men and women with vasculitis, including the safety of contraception, use of assisted reproductive technology, preservation of fertility during cyclophosphamide therapy, disease management in pregnancy and the use of medications compatible with pregnancy and lactation. These discussions are augmented by the existing literature on vasculitis in pregnancy to enable physicians to provide comprehensive, precise and high quality care to patients with vasculitis. The contents of this Review, in conjunction with educational tools, serve to empower patients and physicians to participate in shared decision-making regarding pregnancy prevention, planning and management.
血管炎及其治疗会影响生殖生命周期的所有方面。美国风湿病学会、欧洲抗风湿病联盟和药物与哺乳数据库为风湿性疾病患者生殖健康管理提供了指导;然而,这些指南并未专门针对血管炎患者。本综述讨论了多个专家小组的指导意见,以及这些建议如何适用于患有血管炎的男性和女性,包括避孕的安全性、辅助生殖技术的使用、在环磷酰胺治疗期间保存生育能力、妊娠期间的疾病管理以及使用与妊娠和哺乳期兼容的药物。这些讨论通过现有的妊娠血管炎文献得到补充,使医生能够为血管炎患者提供全面、准确和高质量的护理。本综述的内容与教育工具相结合,使患者和医生能够参与关于妊娠预防、计划和管理的共同决策。