2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases
2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases
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DOI：
10.1002/acr.24130
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发表时间：
2020-02-26
影响因子：
4.7
通讯作者：
D'Anci, Kristen E.
中科院分区：
文献类型：
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作者：
Sammaritano, Lisa R.;Bermas, Bonnie L.;D'Anci, Kristen E.
目的 制定关于避孕、辅助生殖技术 (ART)、性腺毒性疗法保留生育力、绝经期激素替代疗法 (HRT) 的使用、妊娠评估和管理以及风湿性和肌肉骨骼疾病 (RMD) 患者药物使用的循证指南。 方法 我们对与避孕、ART、生育力相关的证据进行了系统回顾。 RMD 人群中的保存、HRT、怀孕和哺乳期以及药物使用，使用建议分级评估、制定和评估方法来评估证据质量，并采用小组共识流程来确定最终建议并对其强度进行分级（有条件或强）。当间接证据足以令人信服，无需进行正式投票时，就良好实践声明达成一致。结果 美国风湿病学会指南为 RMD 患者的生殖保健提供了 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，除非特别针对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几项指导原则：考虑到与 RMD 相关的可用证据总体水平较低，使用安全有效的避孕措施预防意外怀孕；在疾病静止期和接受妊娠相容药物的同时进行孕前咨询以鼓励受孕；以及与妇产科就所有生殖健康问题进行持续的医患讨论。 结论 本指南 提供由专家小组和 RMD 患者制定和审查的基于证据的建议。许多建议都是有条件的，反映出缺乏数据或低水平数据。我们希望该指南能够为患者和医生之间关于生殖健康相关问题的共同决策过程提供信息，其中包括患者的价值观、偏好和合并症。
Objective 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).Methods 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.Results 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.Conclusion 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.