Reproductive Health, Beyond the Guidelines: Rheumatologists Must Think About Patients’ Psychosocial Needs

According to Dr. Wells, these data suggest appropriate patient counseling and wraparound services from an interdisciplinary team could mitigate many of these challenges, and providing accurate information early in the family planning process as well as adequate psychosocial support from healthcare providers may help patients feel less overwhelmed by decisions they must make about their reproductive health.

Cheryl Crow

Postpartum Needs
Cheryl Crow, OTR/L, an occupation therapist and founder of Arthritis Life, an educational and support site for people living with arthritis, followed with a talk on the postpartum needs of women with rheumatic disease, underscoring the biopsychosocial demands new motherhood places on women with rheumatic disease.

She emphasized the need for more guidance to help these women navigate the physical, cognitive and social demands that can overwhelm a new mother, as recommended by research.^2,3

Citing a 2015 study by Ackerman et al. showing that women with rheumatoid arthritis prefer pragmatic information to help them cope with day-to-day challenges, she urged rheumatologists to look at the full biopsychosocial picture of their patients and refer them to appropriate specialists.⁴ Such specialists include occupational and physical therapists to help with essential activities of daily living (e.g., protecting joints, conserving energy, modifying daily living materials (e.g., baby carriers and carseats), using hand splints, etc.), and psychosocial services, including psychologists and licensed social workers, to help with emotional and social challenges.

“A multidisciplinary approach is most likely to address the totality of the patient’s needs and to also result in the patient feeling less alone and overwhelmed,” said Crow, who spoke from experience as someone who has lived with rheumatoid arthritis for many years.

Mariah Z. Leach

Resources
Along with referring patients to the appropriate specialists, rheumatologists can also refer them to patient-focused educational and support sites, such as Arthritis Life, and Mamas Facing Forward, another online community that provides reproductive and parenting support for mothers with chronic illness. Launched in 2018 by Mariah Z. Leach, JD, MS, a writer, patient advocate and mother with rheumatoid arthritis, the website offers resources on a range of issues, including family planning, pregnancy, kids and living with chronic illness such as rheumatologic conditions.

Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.

References

1. 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. [online first].
2. Carandang K, Pyatak EA, Vigen CLP. Systemic review of educational interventions for rheumatoid arthritis. Am J Occup Ther. 2016 Nov/Dec;70(6): 7006290020p1-7006290020p12.
3. Combe B, Landewe R, Daien CI, et al. 2016 Update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis. 2017 Jun;76(6):948–959.
4. Ackerman IN, Jordan JE, Van Doornum S, et al. Understanding the information needs of women with rheumatoid arthritis concerning pregnancy, post-natal care, and early parenting: A mixed-methods study. BMC Musculoskelet Disord. 2015 Aug 19;16:194.