Changes to expert opinion in the use of antirheumatic drugs before and during pregnancy five years after EULAR: points to consider

Abstract

Extract DEAR EDITOR, Counselling women with inflammatory rheumatic diseases (RDs) before and during pregnancy poses challenges since the well-being of two individuals, the mother and her unborn child, has to be considered. Untreated maternal RDs are likely to result in a disease flare, which in turn can lead to an adverse pregnancy outcome [1, 2]. Therefore, the modern management of women with RDs planning a family comprises a treat-to-target concept. Evidence-based international guidelines and recommendations from EULAR 2016 and ACR 2020 help when choosing a pregnancy-compatible treatment option [1, 2]. The aim of this study was to analyse changes between the current experts’ view on the use of antirheumatic drugs in pregnancy and the experts’ view five years ago. We report the results of a web-based survey evaluating the use of each medication in daily practice. The survey was sent to the previous EULAR group and attendees of the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases in 2021. The same question and answer options were used as for the EULAR consensus in 2016 [1]. For each drug the respondent had to decide whether she/he would (1, blue) recommend the drug in the same way as if the patient was not pregnant, (2, yellow) only recommend the drug if she/he feared at least moderate or (3, red) severe disease activity in its absence, or (4, black) never recommend the drug in pregnancy.