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Background: The importance of safe and effective contraception for women with rheumatic diseases has been increasing. 1 Several studies have demostrated that carefully planned pregnancies are related with better outcomes making the use of contraceptive methods (CM) more significant.
Objectives: To describe the use of methods of contraception among Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE).
Methods: A Cross-sectional study where women aged 18-45 followed in our CEER outpatient clinic, at Monterrey, Mexico, were questioned about the use of CM. Sociodemographic data was collected from the medical record.
CM were classified as Ineffective (10-25% pregnant each year), effective (6-9% pregnant each year) and highly effective (<1% pregnant each year). Methotrexate, Mycophenolate, Cyclophosphamide, Thalidomide and Leflunomide were considered as teratogenic drugs.
The statistical analysis was performed using SPSS 24.0. A p < 0.05 was taken to indicate statistical significance.
Results: A total of 91 patients were included, 35 (38.5%) SLE patients with a median age of 30 years (22-39) and 56 (61.5%) RA patients with a median age of 34.5 years (27.25-40). From the total population, 58 (63.7%) reported the use of teratogenic drugs, with a higher use in RA patients (p <.001). Socio-demographic characteristics are listed in
Socio-demographic characteristics.
|
RA
|
SLE
| p | |
|---|---|---|---|
| Age , years, median (IQR ) | 34.5 (27.25-40) | 30
| |
| Disease duration, years, median (IQR ) | 3.5 (1.25-7.75) | 4 (1-7) | |
| Onset of Sexual activity,n (% ) | 46 (82.1) | 24 (68.6) | .135 |
| Onset of Sexual activity age, median (IQR ) | 18 (17-20) | 14 (17-20) | |
| Sexually Active, n (%)* | 34 (60.7) | 18 (51.4) | .384 |
| Use of teratogenic drugs, n (% ) | 44 (78.6%) | 14 (40%) | <.001 |
RA, Rheumatoid Arthritis; SLE, Systemic Lupus Erythematosus. *Sexual activity in the last month.
Among the patients that had started sexual activity (SLE=24, RA=46), the most common CM was tubal ligation 26 (28.6%)
Graphic 1
. In this group, 49 (70%) patients received contraceptive counseling, however, 21 (42%) patients were using innefective CM.
According to effectiveness, highly efective were the most frequent method used in patients that had started sexual activity (n=39, 55.7%) Graphic 2 .
Conclusion: Despite highly effective CM were more frequent in patients that had started sexual activity, 42% of patients that received contraceptive counseling reported the use of inneffective methods. It is neccesary to promote the counseling and use of contraception and provide a multidisciplinary support among rheumatoid patients.
Methods according to effectiveness in patients that received contraception counseling.
| GRADE OF EFFECTIVENESS | ||||
|---|---|---|---|---|
| n (% ) |
Patients
| Inneffective | Effective | Higly effective |
| RA= 46 | 30 (65.21) | 12 (40) | 1(3.3) | 17 (56.6) |
| SLE= 24 | 19 (79.16) | 9 (47.3) | 1 (5.2) | 9 (47.36) |
| Total = 70 * | 49 (70) | 21 (42) | 2 (4.08) | 26 (53.06) |
RA= Rheumatoid Arthritis; SLE= Systemic Lupus Erythematosus. * Total of patients that have started sexual activity.
REFERENCES:
[1]Sammaritano, L. R. (2014). Contraception in Rheumatic Disease Patients. In Contraception and Pregnancy in Patients with Rheumatic Disease (pp. 201-227). Springer, New York, NY.
Graphic 1. This graphic shows the frequence in percentage % of contraceptive methods used by Rheumatoid Arthritis (RA) n=56 and Systemic Lupus Erythematosus (SLE) n=35 patients, which are categorized by the grade of effectiveness. Only were included patients that had started sexual activity.
Graphic 2. This graphic shows the percentage of use according to the effectiveness of contracetive methods. RA, Rheumatoid Arthritis; SLE, Systemic Lupus Erythematosus. Only were included patients that had started sexual activity.
Disclosure of Interests: None declared