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Female patients are particularly impacted by chronic rheumatic diseases, with a lower quality of life and a higher burden of disease.1–6 Women are increasingly choosing to start a family later in life; however, treatments to control rheumatic diseases are often started at a younger age.7
It is therefore critical that disease remission is achieved to prevent disease progression, maintain quality of life and aid optimal foetal outcomes.8–14 Despite this importance, many patients do not feel accurately informed about their treatment options during their childbearing years.7,15
Timely shared decision-making discussions enable women of childbearing age to make informed choices regarding treatment options, taking into account potential disease outcomes and future plans.7,16–19 Find out more about how you can address these unmet needs to help improve treatment outcomes for your female patients.
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HEAR FROM THE EXPERTS
Achieving clinical remission for your female patients of childbearing age
with Prof. Andreoli
Achieving and maintaining clinical remission for women of reproductive age accommodates diverse reproductive goals and timelines.7
Prof. Laura Andreoli discusses the increased burden of disease for women of childbearing age with chronic rheumatic diseases, including the implications of not achieving clinical remission in these patients. Prof. Andreoli explores strategies to help these patients achieve clinical remission, highlighting the importance of proactive family planning discussions which can facilitate a treat-to-target treatment strategy.
“It's important to plan today for tomorrow, so it means that achieving remission as early as possible.”
Prof. Laura Andreoli
University of Brescia, Brescia, Italy
Knowing future plans of your female patients could improve their treatment outcomes
Understanding the future plans of female patients is important for improving treatment outcomes, especially as diagnosis and treatment for axSpA, RA and PsA tend to overlap with their reproductive years.7,16,19
However, there exists a notable gap in patient education, as many women report feeling inadequately informed about their treatment options.7,15 Engaging in timely discussions can inform patients about their treatment options and facilitate a shared decision-making process that aligns with their current health needs, as well as their future plans.7,16–19
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HEAR FROM EXPERTS
The importance of future planning with female patients with chronic rheumatic diseases
with Dr Oseme Etomi
Watch the interview video below, as Dr Oseme Etomi examines the importance of discussing future plans with female patients who have chronic rheumatic diseases. In her answers, Dr Etomi:
Elaborates on the key stages in the female patient journey where conversations regarding treatment management should take place
Explains the importance of early dialogue to ensure patients have all the required, and accurate, information to help make an informed treatment decision
Emphasises the importance of clinical data in helping guide these vital conversations and facilitate a shared decision-making process between the clinician and patient, ensuring patient choices are informed and compatible with future pregnancies
“It's really important for us to tell these patients the right information at the beginning and then checking at various time points within that treatment journey.”
Dr Oseme Etomi
Guy's and St Thomas' Hospital, London, United Kingdom
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Bridging the information gap for your female patients
Women aged 18–45 with chronic rheumatic diseases often have limited information on how to best manage their condition throughout their lives.20
Early shared decision-making is crucial for women with chronic rheumatic diseases, including identifying the risks and benefits of treatment. By initially guiding informed choices, future interventions can be minimised. Without these conversations, women may potentially delay pregnancy, face treatment concerns or avoid treatment altogether during pregnancy.12,17,19,20
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Greater awareness of family planning in disease management could improve shared decision-making conversations, ensuring a more integrated approach that better meets the needs and priorities of your female patients during their reproductive years.18,21,22
FREE E-LEARNING COURSE
Clinical communication strategies with GRAPPA to improve patient outcomes
Guidelines recommend shared decision-making across rheumatology, which is proven to improve patient satisfaction and adherence to treatment.9,17,22–24 Communicating with patients is key to the patient-clinician collaboration, yet this can be challenging in an increasingly complex treatment landscape.9,17,22–24
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) have developed a skills-based e-learning course for healthcare professionals working in rheumatology to improve consultation skills.27
Gain valuable insights into effective clinical dialogue that can positively impact your daily practice. The 60-minute course delves into the importance of active listening, offers techniques to master clinical communication and presents a clinical case to apply these skills in practice.27 Hear from fellow healthcare professionals as they share their experiences and takeaways from the course.
This course was funded by an unrestricted education grant from UCB
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GRAPPA course
The e-learning course is available to GRAPPA and non-GRAPPA members alike, so please share with your colleagues and others in patient care roles.
Learn about the collaborative, multidisciplinary team approach for the management of patients with psoriasis, the specialists involved and the clinical care...
Learn about progression from psoriasis to psoriatic arthritis, including the signs and symptoms of psoriatic arthritis, the people who are likely to be affected,...
a) A multinational survey of 969 female patients of childbearing age with chronic inflammatory disease (axial spondyloarthritis [axSpA], Crohn's Disease [CD], psoriatic arthritis [PsA], RA, systemic lupus erythematosus [SLE], ulcerative colitis [UC]) across Europe and the USA.7
b) A multinational online survey of 1,052 women of childbearing age, where 622/1,052 participants had a chronic rheumatic disease (RA, axSpA, PsA). Data reported are from a subset of patients with moderate-severe chronic rheumatic diseases who were pregnant or had been pregnant in the past 2–5 years from Germany, France, the UK, Italy, Spain, the USA and Japan.20
c) A multinational mixed-methods study (semi-structured interviews and a survey) of 173 rheumatologists across Germany, the UK and the USA.21
References
Lee W, Reveille JD, Davis JC Jr, et al. Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis. 2007;66(5):633–638.
Tournadre A, Pereira B, Lhoste A, et al. Differences between women and men with recent-onset axial spondyloarthritis: Results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken). 2013;65(9):1482–1489.
Slobodin G, Reyhan I, Avshovich N, et al. Recently diagnosed axial spondyloarthritis: gender differences and factors related to delay in diagnosis. Clin Rheumatol. 2011;30(8):1075–1080.
Eder L, Thavaneswaran A, Chandran V, et al. Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. Ann Rheum Dis. 2013;72(4): 578–582.
Nas K, Kiliç E, Tekeoğlu İ, et al. The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis. Mod Rheumatol. 2021;31(4):869–874.
Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender differences in axial spondyloarthritis: Women are not so Lucky. Curr Rheumatol Rep. 2018;20(6):35.
Chakravarty E, Clowse ME, Pushparajah DS, et al. Family planning and pregnancy issues for women with systemic inflammatory diseases: patient and physician perspectives. BMJ Open. 2014;4(2):e004081.
Clowse MEB, Scheuerle AE, Chambers C, et al. Pregnancy outcomes after exposure to certolizumab pegol: Updated results from a pharmacovigilance safety database. Arthritis Rheumatol. 2018;70(9):1399–1407.
Coates LC, Soriano ER, Corp N, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): Updated treatment recommendations for psoriatic arthritis 2021. Nature Rev Rheumatol. 2022;18(8):465–479.
Landewé RBM, van der Heijde D, Dougados M, et al. Maintenance of clinical remission in early axial spondyloarthritis following certolizumab pegol dose reduction. Ann Rheum Dis. 2020;79(7):920–928.
Ostor AJ, Sawant R, Qi CZ, et al. Value of remission in patients with rheumatoid arthritis: A targeted review. Adv Ther. 2022;39(1):75–93.
Russell MD, Dey M, Flint J, et al. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: Immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2023;62(4):e48–e88.
Brouwer J, Hazes JM, Laven JS, et al. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis. 2015;74(10):1836–1841.
Smeele HTW, Dolhain RJEM. Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Semin Arthritis Rheum. 2019;49(3s):S32–S35.
Tanaka Y, Barrett C, Hirano Y, et al. Management of chronic rheumatic diseases in women 18-45 years of age in Asia Pacific: Insights from patient and clinician surveys. Rheumatol Int. 2023;43(4):721–733.
Kavanaugh A, Cush JJ, Ahmed MS, et al. Proceedings from the American College of Rheumatology Reproductive Health Summit: The management of fertility, pregnancy, and lactation in women with autoimmune and systemic inflammatory diseases. Arthritis Care Res (Hoboken). 2015;67(3):313–325.
Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol. 2020;72(4):529–556.
Wolgemuth T, Stransky OM, Chodoff A, et al. Exploring the preferences of women regarding sexual and reproductive health care in the context of rheumatology: A qualitative study. Arthritis Care Res (Hoboken). 2021;73(8):1194–1200.
Gottlieb AB, Ryan C, Murase JE. Clinical considerations for the management of psoriasis in women. Int J Womens Dermatol. 2019;5(3):141–150.
Tincani A, Taylor P, Fischer-Betz R, et al. Fears and misconceptions of women with chronic rheumatic diseases on their journey to motherhood [abstract]. Annals of the Rheumatic Diseases. 2018;77(Suppl 2):866. Abstract FRI0693.
Murray S, Augustyniak M, Murase JE, et al. Barriers to shared decision-making with women of reproductive age affected by a chronic inflammatory disease: a mixed-methods needs assessment of dermatologists and rheumatologists. BMJ Open. 2021;11(6):e043960.
Förger F, Pluma Sanjurjo A, Rüegg L, et al. Update of the EULAR points to consider for use of antirheumatic drugs in reproduction, pregnancy and lactation [abstract]. Ann Rheum Dis. 2024;83(Suppl 1):2075–2076. EULAR 2024. Abstract AB1439.
Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheum. 2021;73(7):1108–1123.
Morrison T, Foster E, Dougherty J, et al. Shared decision making in rheumatology: A scoping review. Semin Arthritis Rheum. 2022;56:152041.
Asan O, Yu Z, Crotty BH. How clinician-patient communication affects trust in health information sources: Temporal trends from a national cross-sectional survey. PLoS One. 2021;16(2):e0247583.
Smolen JS, Landewé RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
AI: Artificial intelligence; axSpA: Axial spondyloarthritis; CD: Crohn’s Disease; GRAPPA: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus; UC: Ulcerative colitis; UK: United Kingdom; USA: United States of America.
