‘Bad for patients’: Rheumatologists express dismay over Roe v. Wade reversal

In the wake of the Supreme Court’s decision overturning Roe v. Wade, rheumatologists and rheumatology associations are voicing concern over what the loss of federal abortion protections could mean for patients.

Pregnancy can sometimes be life-threatening for patients with rheumatic diseases, according to the American College of Rheumatology. In a statement posted to its website following the Supreme Court’s ruling, the organization advocated for “evidence-based medicine” and decried actions that disrupt the patient-physician relationship.

“The ACR opposes any action which interferes with the practice of evidence-based medicine or intrudes upon the doctor-patient relationship,” read the statement. “Pregnancy often complicates the management of women with rheumatic diseases and may threaten the life of the mother. Rheumatologists and other rheumatology professionals must be able to provide the best evidence-based care and guidance for all of their patients.”

According to Kristen Young, DO, a rheumatologist at the University of Arizona College of Medicine, the rollback of federal abortion protections has left rheumatology patients and providers “wondering and worried” about the safe management of pregnancy in this population.

“Rheumatologists and patients with rheumatic diseases in Arizona are wondering and worried how overturning Roe will impact our day to day and opportunities to have children safely,” Young told Healio. “Many people do not realize how often we discuss pregnancy and family planning with patients.”

Current Arizona law allows for pregnancies to be terminated in the event of a mortal risk for the mother. However, conditions that can be considered a danger to a mother’s life are not concrete, Young said.

“The current — and future — Arizona abortion law allows access to termination for mothers whose lives are in danger, but what is considered danger?” Young said. “Does lupus nephritis count? Pulmonary hypertension?”

In addition to questions surrounding pregnancy and abortion in vulnerable patients, Arizona faces a shortage of rheumatologists, rendering any prospect of leaving for another state a nonstarter for many providers.

“My group is one of three hospitals in the entire state that sees in-patient rheumatology consults — some of these sickest rheumatic disease patients in my state,” Young said. “If we all leave and go to places that are probably safer to practice medicolegally, who will take care of these patients?”

Added Young: “Ultimately, laws like this are bad for patients and may dissuade physicians from moving here to practice.”

Rheumatologists also took to Twitter to speak out about the importance of access to contraception and abortion in daily practice.

“As a rheumatologist I care for teens and young women for whom pregnancy could be life threatening, and whose quality of life is ensured by therapies that are highly teratogenic,” Grant Schulert, MD, PhD, tweeted. “Access to safe contraception and abortion is absolutely essential to the practice of rheumatology.”

Schulert added, “I hold a medical license in two states, and in one of them such care is now illegal, and in the other functional illegal. I don’t know where we go from here, but abandoning my patients for a ‘safe’ state isn’t the answer. It’s time to fight.”

Cuoghi Edens, MD, tweeted about maintaining patient access to important drugs, such as methotrexate, which anecdotal reports suggest is already being restricted by some pharmacies in impacted states.

Meanwhile, Iris Navarro-Millan, MD, tweeted about the potential implications of the ruling on patients with rheumatic diseases.

“The ruling of the Supreme Court to make abortion illegal has serious implications on the care that we can give to patients with rheumatic diseases,” Navarro-Millan tweeted. “Pregnancy can increase disease activity of lupus, increase the risk of clots, pulmonary embolism, preeclampsia, eclampsia or seizures while having high blood pressure during pregnancy. An abortion can be a treatment.”

References:

Access to care – ACR and Roe v. Wade Decision. https://www.rheumatology.org/. Accessed June 29.

@GrantSchulert. https://twitter.com/GrantSchulert/status/1540698722694090754. June 25, 2022. Accessed June 29, 2022.

@KristenYoung. https://twitter.com/kristenyoung/status/1541103081609342976. June 26, 2022. Accessed June 29, 2022.

@CuoghiE. https://twitter.com/CuoghiE/status/1542145563562573825. June 29, 2022. Accessed June 29, 2022.

@NavarroMillanMD. https://twitter.com/NavarroMillanMD/status/1540897479549505541. June 25, 2022. Accessed June 29, 2022.