UK survey shows differences between clinicians treating rheumatology in pregnancy

Results from a UK health-care practitioner (HCP) study presented today at the EULAR 2011 Annual Congress outline a lack of uniform practice between health-care professionals (HCPs) and highlight a strong need for guidelines on the treatments prescribed to patients with rheumatic conditions during conception, pregnancy and during the breastfeeding period.

This study, which is one of the first of its kind, collated responses from rheumatologists (52% consultants) and obstetricians (94% consultants) on the subject of patient education on safe treatments for use during pregnancy, the existence of local guidelines on treating this patient population, and recorded HCP use of several individual drugs used during the pre-conception, pregnancy and breastfeeding period.

The survey results outlined variations around the use of non-steroidal anti-inflammatory medications (NSAIDs) with 32% of rheumatologists and 18% of obstetricians opting to continue treatment whilst 67% of rheumatologists and 39% of obstetricians opted to discontinue these treatments during pregnancy.

"The results of our study have shown that there are several different approaches to treating women of a childbearing age with rheumatic conditions. Whilst healthcare practitioners are aware that they should consult a specialist when unsure of a treatment decision, best practice guidelines, developed with consensus between rheumatologists, obstetricians and specialist nurses would benefit healthcare practitioners in the UK and Europe greatly" said Dr Sonia Panchal, University Hospital of Leicester NHS Trust, UK.

Only 25% of rheumatologists and 6% of obstetricians had guidelines that were locally developed for the management of this patient population. The results of the survey also showed that there were several variations in approaches to prescribing specific treatments in the group:

• The majority of rheumatologists (92%), but only half of obstetricians (54%) would discontinue anti-TNF treatment during pregnancy
  
• 95% rheumatologists compared to 52% of obstetricians would discontinue rituximab

Regarding other treatments for rheumatic conditions, there was considerable variation in practice with regard to prescribing medications including sulphasalazine (Salazopyrin), azathioprine (Imuran / Azasan) and methotrexate (Rheumatrex).

The questionnaire was distributed to 1000 HCPs across the UK, via the British Society of Rheumatology and the British Maternal Foetal Medicine Society. Responses were received from 102 rheumatologists and 33 obstetricians and responses were analysed using online software.