ACR CONVERGENCE 2021—A comprehensive reproductive guideline published by the ACR in 2020 addresses making reproductive health and family planning issues in people with rheumatologic diseases an integral part of their care.1 During a session titled Reproductive Health & Psoriatic Arthritis: Enhancing Provider Education, experts described the educational training program developed by the ACR that focuses specifically on educating rheumatologists and other clinicians on reproductive health issues for women with psoriatic arthritis (PsA). Arthur Kavanaugh, MD, professor of medicine at the University of California, San Diego, who has led the Reproductive Health Initiative effort to develop educational materials on PsA and pregnancy, moderated the session.
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Called PsA-RESPECT, the program is intended to educate clinicians on, and provide resources for, communicating with women on issues of fertility, pregnancy and lactation within the context of their disease and its management. The program also includes training on how to talk to men with PsA who have concerns about the impact of their disease on family planning.
Interactive cases were used to illustrate different scenarios of a provider-patient conversation around such important issues as contraception and medication safety. Key learning points were presented at the end of each case.
“The goal of this talk is to enhance education for providers and give them a toolkit so they are better prepared to start these conversations, even if patients themselves are not sure of what they want,” said Vagishwari Murugesan, MBBS, FRCPC, a clinical fellow in psoriatic arthritis at the University of Toronto, who was one of the presenters.
Sonam Kiwalkar, MD, a rheumatologist at the Vancouver Clinic, Washington, presented a case that illustrated the important conversation providers need to have with their patients around medication safety and family planning. She walked participants through a four-step process—available in a handbook that can be given to female patients—providers can use when talking to patients about ensuring the safest pregnancy possible. The steps include a color-coded description of which drugs are the safest during pregnancy (green list), which drugs can be taken during pregnancy but should be discussed with a rheumatologist (grey list), and which drugs need to be stopped to ensure a safe pregnancy (red list).
Mehret Birru Talabi, MD, PhD, assistant professor of medicine and associate program director of the University of Pittsburgh Medical Center Rheumatology Fellowship Training Program, the third presenter in the session, emphasized during the question-and-answer (Q&A) session the need for clinicians to keep in mind that patients often hear a lot about potential toxicities of medications in general and are therefore concerned about the toxic potential of their medications when considering pregnancy planning. Providers, she said, need to remember to talk to patients about the benefits of these medications as well, both in general and in the context of reproductive health. She underscored the importance for women to understand the need for, and benefits of, adequately and safely treating their disease and the potential positive benefits this has on a future child.