Her most recent research focuses on how rheumatologists can help patients build the families they want as safely as possible.
“While we’ve known for a long time that patients with lupus have poorer pregnancy outcomes when their disease was active or they were taking dangerous medications, my work now focuses on how rheumatologists can help their patients turn this knowledge into a plan for a safe pregnancy,” she says. Without this approach, Dr. Clowse says a lot of patients begin their pregnancy without a plan from a rheumatology standpoint. Data show these pregnancies more often lead to pregnancy loss, preeclampsia, early deliveries, and sick babies and moms.
“We’re spending a lot of time working on ways to make pregnancy planning a regular part of rheumatology care,” Dr. Clowse says. “We’ve developed tools and educational programs to help providers feel comfortable discussing a pregnancy plan with their patients.”
Taking a proactive approach to pregnancy planning is critical, Dr. Clowse says, because many of the complications (e.g., pregnancy loss, preterm birth and preeclampsia) that occur in patients with lupus are avoidable. “We can cut the risk of poor outcomes in half if the patient conceives while her disease is well controlled or when she’s not taking medicines that cause major birth defects,” Dr. Clowse says. “If we can help patients plan for pregnancy long before they become pregnant, we see much better outcomes.”
A healthy pregnancy with lupus is possible without taking patients off all medicine, Dr. Clowse says. She recommends rheumatologists prescribe pregnancy-compatible medicines while their patients are trying to get pregnant, as well as after they’ve conceived. “There are a few medicines we can’t use safely in pregnancy, including methotrexate, mycophenolate and cyclophosphamide,” Dr. Clowse says. “Although there’s a risk–benefit ratio with all medications, the other drugs we prescribe, such as hydroxychloroquine, lead to better pregnancy outcomes.”
With funding from the Rheumatology Research Foundation, Dr. Clowse and her team at Duke are currently working with some private clinics, as well as academic clinics to build the question “Are you thinking about getting pregnant in the next year?” into appointments and to document current contraception choices so doctors can have accurate, timely conversations about pregnancy planning with their patients.
Classifying Lupus
Along with her colleagues Jennifer Rogers, MD, David Pisetsky, MD, PhD, and Amanda Eudy, PhD, MSPH, Dr. Clowse has classified systemic lupus erythematosus (SLE) symptoms into two categories: type 1, which includes autoimmune inflammation of tissues (e.g., arthritis, cutaneous lupus, lupus nephritis) and type 2, which encompasses the features of systemic lupus erythematosus that are nearly ubiquitous but have unknown causes (e.g., brain fog, myalgia and fatigue).
