EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome
ObjectivesDevelop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).MethodsSystematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.R...
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| Vydáno v: | Annals of the rheumatic diseases Ročník 76; číslo 3; s. 476 - 485 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
England
Elsevier Limited
01.03.2017
BMJ Publishing Group |
| Edice: | Extended report |
| Témata: | |
| ISSN: | 0003-4967, 1468-2060, 1468-2060 |
| On-line přístup: | Získat plný text |
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| Abstract | ObjectivesDevelop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).MethodsSystematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.ResultsFamily planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.ConclusionsRecommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus. |
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| AbstractList | ObjectivesDevelop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).MethodsSystematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.ResultsFamily planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.ConclusionsRecommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus. Objectives Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Methods Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. Results Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. Conclusions Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus. Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).OBJECTIVESDevelop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.METHODSSystematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.RESULTSFamily planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.CONCLUSIONSRecommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus. Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus. |
| Author | Ostensen, M Forger, F Mosca, M Moraes-Fontes, M F Svenungsson, E Tincani, A Yavuz, S Boumpas, D Doria, A Khamashta, M Fischer-Betz, R Andreoli, L Motta, M Marchiori, F Pamfil, C King, J Meroni, P L Agmon-Levin, N Brown, S Schneider, M Bertsias, G K Cervera, R Tektonidou, M Raio, L Costedoat-Chalumeau, N Lojacono, A |
| AuthorAffiliation | 23 Department of Rheumatology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania 29 Joint Academic Rheumatology Program , National and Kapodestrian University of Athens , Athens , Greece 16 EULAR PARE Patient Research Partner , London , UK 1 Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy 25 Rheumatology Unit, Department of Medicine , Solna, Karolinska Institutet , Karolinska University Hospital , Stockholm , Sweden 20 Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy 7 Department of Autoimmune Diseases , Hospital Clínic , Barcelona, Catalonia , Spain 10 Rheumatology Unit, Department of Medicine , University of Padua , Italy 14 Lupus Research Unit , The Rayne Institute, St. Thomas Hospital , London , UK 4 The Zabludowicz Center for Autoimmune Diseases , Sheba Medical Center, Tel Hashomer , Israel 24 Department of Obstetrics and Gynaecology , University Hospital of Bern , In |
| AuthorAffiliation_xml | – name: 2 Unit of Rheumatology and Clinical Immunology , Spedali Civili , Brescia , Italy – name: 8 AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares , Paris , France – name: 9 Université Paris Descartes-Sorbonne Paris Cité , Paris , France – name: 25 Rheumatology Unit, Department of Medicine , Solna, Karolinska Institutet , Karolinska University Hospital , Stockholm , Sweden – name: 5 The Faculty of Medicine , Tel Aviv University , Israel – name: 15 Department of Rheumatology , Dubai Hospital , Dubai , United Arab Emirates – name: 27 Department of Rheumatology , Istanbul Bilim University, Istanbul Florence Nightingale Hospital , Esentepe-Istanbul , Turkey – name: 23 Department of Rheumatology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania – name: 29 Joint Academic Rheumatology Program , National and Kapodestrian University of Athens , Athens , Greece – name: 10 Rheumatology Unit, Department of Medicine , University of Padua , Italy – name: 3 Department of Rheumatology, Clinical Immunology and Allergy , University of Crete Medical School , Heraklion , Greece – name: 28 4th Department of Internal Medicine , ‘Attikon’ University Hospital, Medical School, University of Athens , Athens , Greece – name: 24 Department of Obstetrics and Gynaecology , University Hospital of Bern , Inselspital , Switzerland – name: 14 Lupus Research Unit , The Rayne Institute, St. Thomas Hospital , London , UK – name: 12 Department of Rheumatology, Immunology and Allergology , University Hospital of Bern , Bern , Switzerland – name: 6 Royal National Hospital For Rheumatic Diseases , Bath , UK – name: 26 Rheumatology Unit, Joint Academic Rheumatology Programme, 1st Department of Propaedeutic Internal Medicine Athens , National and Kapodistrian University of Athens , Athens , Greece – name: 1 Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy – name: 7 Department of Autoimmune Diseases , Hospital Clínic , Barcelona, Catalonia , Spain – name: 4 The Zabludowicz Center for Autoimmune Diseases , Sheba Medical Center, Tel Hashomer , Israel – name: 18 EULAR PARE Patient Research Partner , Rome , Italy – name: 16 EULAR PARE Patient Research Partner , London , UK – name: 13 Unidade de Doenças Auto-imunes—Serviço Medicina Interna 7.2, Hospital Curry Cabral/Centro Hospitalar Lisboa Central, NEDAI/SPMI , Lisboa , Portugal – name: 11 Policlinic of Rheumatology, Hiller Research Unit , University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf , Duesseldorf , Germany – name: 17 Unit of Obstetrics and Gynaecology , Spedali Civili, Brescia , Italy – name: 20 Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy – name: 22 Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway – name: 19 Department of Clinical Sciences and Community Health , University of Milan, Istituto Auxologico Italiano , Milan , Italy – name: 21 Neonatology and Neonatal Intensive Care Unit , Spedali Civili , Brescia , Italy |
| Author_xml | – sequence: 1 givenname: L orcidid: 0000-0002-9107-3218 surname: Andreoli fullname: Andreoli, L email: angela.tincani@unibs.it organization: Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy – sequence: 2 givenname: G K surname: Bertsias fullname: Bertsias, G K email: angela.tincani@unibs.it organization: Department of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Heraklion, Greece – sequence: 3 givenname: N surname: Agmon-Levin fullname: Agmon-Levin, N email: angela.tincani@unibs.it organization: The Faculty of Medicine, Tel Aviv University, Israel – sequence: 4 givenname: S surname: Brown fullname: Brown, S email: angela.tincani@unibs.it organization: Royal National Hospital For Rheumatic Diseases, Bath, UK – sequence: 5 givenname: R surname: Cervera fullname: Cervera, R email: angela.tincani@unibs.it organization: Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain – sequence: 6 givenname: N surname: Costedoat-Chalumeau fullname: Costedoat-Chalumeau, N email: angela.tincani@unibs.it organization: Université Paris Descartes-Sorbonne Paris Cité, Paris, France – sequence: 7 givenname: A surname: Doria fullname: Doria, A email: angela.tincani@unibs.it organization: Rheumatology Unit, Department of Medicine, University of Padua, Italy – sequence: 8 givenname: R surname: Fischer-Betz fullname: Fischer-Betz, R email: angela.tincani@unibs.it organization: Policlinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany – sequence: 9 givenname: F surname: Forger fullname: Forger, F email: angela.tincani@unibs.it organization: Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland – sequence: 10 givenname: M F surname: Moraes-Fontes fullname: Moraes-Fontes, M F email: angela.tincani@unibs.it organization: Unidade de Doenças Auto-imunes—Serviço Medicina Interna ., Hospital Curry Cabral/Centro Hospitalar Lisboa Central, NEDAI/SPMI, Lisboa, Portugal – sequence: 11 givenname: M surname: Khamashta fullname: Khamashta, M email: angela.tincani@unibs.it organization: Department of Rheumatology, Dubai Hospital, Dubai, United Arab Emirates – sequence: 12 givenname: J surname: King fullname: King, J email: angela.tincani@unibs.it organization: EULAR PARE Patient Research Partner, London, UK – sequence: 13 givenname: A surname: Lojacono fullname: Lojacono, A email: angela.tincani@unibs.it organization: Unit of Obstetrics and Gynaecology, Spedali Civili, Brescia, Italy – sequence: 14 givenname: F surname: Marchiori fullname: Marchiori, F email: angela.tincani@unibs.it organization: EULAR PARE Patient Research Partner, Rome, Italy – sequence: 15 givenname: P L surname: Meroni fullname: Meroni, P L email: angela.tincani@unibs.it organization: Department of Clinical Sciences and Community Health, University of Milan, Istituto Auxologico Italiano, Milan, Italy – sequence: 16 givenname: M surname: Mosca fullname: Mosca, M email: angela.tincani@unibs.it organization: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy – sequence: 17 givenname: M surname: Motta fullname: Motta, M email: angela.tincani@unibs.it organization: Neonatology and Neonatal Intensive Care Unit, Spedali Civili, Brescia, Italy – sequence: 18 givenname: M surname: Ostensen fullname: Ostensen, M email: angela.tincani@unibs.it organization: Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway – sequence: 19 givenname: C surname: Pamfil fullname: Pamfil, C email: angela.tincani@unibs.it organization: Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania – sequence: 20 givenname: L surname: Raio fullname: Raio, L email: angela.tincani@unibs.it organization: Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Switzerland – sequence: 21 givenname: M surname: Schneider fullname: Schneider, M email: angela.tincani@unibs.it organization: Policlinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany – sequence: 22 givenname: E surname: Svenungsson fullname: Svenungsson, E email: angela.tincani@unibs.it organization: Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden – sequence: 23 givenname: M surname: Tektonidou fullname: Tektonidou, M email: angela.tincani@unibs.it organization: Rheumatology Unit, Joint Academic Rheumatology Programme, st Department of Propaedeutic Internal Medicine Athens, National and Kapodistrian University of Athens, Athens, Greece – sequence: 24 givenname: S surname: Yavuz fullname: Yavuz, S email: angela.tincani@unibs.it organization: Department of Rheumatology, Istanbul Bilim University, Istanbul Florence Nightingale Hospital, Esentepe-Istanbul, Turkey – sequence: 25 givenname: D surname: Boumpas fullname: Boumpas, D email: angela.tincani@unibs.it organization: Joint Academic Rheumatology Program, National and Kapodestrian University of Athens, Athens, Greece – sequence: 26 givenname: A surname: Tincani fullname: Tincani, A email: angela.tincani@unibs.it organization: Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27457513$$D View this record in MEDLINE/PubMed http://kipublications.ki.se/Default.aspx?queryparsed=id:135295812$$DView record from Swedish Publication Index (Karolinska Institutet) |
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| Snippet | ObjectivesDevelop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome... Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Systematic... Objectives Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).... Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome... OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).... |
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| SubjectTerms | Anticoagulants Antiphospholipid syndrome Antiphospholipid Syndrome - drug therapy Birth control Clinical and Epidemiological Research Contraceptives, Oral, Hormonal - therapeutic use Delphi Technique Early Detection of Cancer Embaràs Estrogen Replacement Therapy Family Planning Services Female Fertility Preservation Fetal Monitoring Genital Neoplasms, Female - diagnosis Humans Lupus Lupus eritematós Lupus erythematosus Lupus Erythematosus, Systemic - drug therapy Menopausa Menopause Papillomaviridae Part Parturition Preconception Care Pregnancy Pregnancy Complications - drug therapy Reproductive Techniques, Assisted Risk Assessment Síndrome antifosfolipídica Womens health |
| Title | EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome |
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