Controlled disease, reproductive counseling ‘critical’ for both males, females with PsA
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Both men and women of reproductive age with psoriatic arthritis who are hoping to be parents should consult their medical team and adhere to medications, according to a speaker at the 2021 Rheumatology Nurses Society annual conference.
“Making sure disease is well controlled before thinking about getting pregnant is critical,” Cuoghi Edens, MD, FAAP, assistant professor of internal medicine and pediatrics in the department of pediatric rheumatology at the University of Chicago, said in her presentation.
Edens laid out the parameters of keeping disease under control. The aim should be for minimal skin and nail manifestations, minimal joint inflammation and no recent symptoms of inflammatory bowel disease (IBD).
Patients should obviously talk with their rheumatology provider, but an obstetrician should also be consulted, along with a maternal-fetal medicine specialist and, if necessary, a dermatology provider, according to Edens.
Appropriate medication use is also important. Edens suggested that there are red, gray and green lists of medications. “Those on the green list are medications that are compatible with pregnancy,” she said. These include sulfasalazine, prednisone less than 20 mg per day, non-steroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor (TNF) inhibitors.
Drugs on the gray list include janus kinase (JAK) inhibitors, apremilast (Otezla, Amgen), abatacept (Orencia, Bristol Myers Squibb), drugs in the interleukin (IL)-17 inhibitor class and IL-23 and IL-12/23 inhibitors.
On the red list are methotrexate and leflunomide (Arava, Sanofi), according to Edens.
While methotrexate is, in fact, on the red list, Edens noted that many of the concerns with the drug are “theoretical,” and based on much higher dosing levels from the days when it was used as a chemotherapeutic agent. “There are no true contraindications for males who would like to become a father for medications on the psoriatic arthritis list,” she added.
However, she did offer one caveat for men. “Sulfasalazine can lower sperm counts.”
The other chief concern frequently voiced by patients surrounding medication use pertains to breastfeeding. “The general consensus is that drugs that are safe during pregnancy are also safe during lactation,” Edens said.
Looking beyond pregnancy and lactation among women, Edens stressed that these topics should also be discussed with men. “It is really important to discuss reproductive issues with male patients and not just female patients, because they have issues and concerns as well,” Edens said.
Some of those questions may pertain to birth control. “Contraception should be discussed with all patients of child-bearing age at visits,” Edens said.
Edens acknowledged that some women may choose to stop taking medications or lower their doses through pregnancy. However, she noted that raising a newborn can be physically demanding, which is all the more reason to keep a close eye on PsA disease activity. “One of the best things to ensure a healthy baby is to have a healthy mom,” Edens said. “That means PsA is well-controlled.”
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Edens C. Exploring Psoriatic Arthritis and Reproductive Health. Presented at: Rheumatology Nurses Society annual conference; August 4-7, 2021 (virtual meeting).
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