Innovative Approaches to Rheumatic Disease and Reproductive Health

Advances in Rheumatic Disease at ACR Convergence 2024

At this year's American College of Rheumatology (ACR) annual meeting, Hospital for Special Surgery (HSS) showcased pivotal research that aims to improve patient outcomes in the realms of rheumatic disease and reproductive health. Among the studies presented, three notably focused on critical aspects of reproductive health for women dealing with systemic rheumatic diseases. These included evaluating infant feeding behaviors, predicting adverse pregnancy outcomes, and proposing enhancements in contraception counseling.

Understanding Infant Feeding Choices

Factors Associated with Infant Feeding Behaviors

A key study explored the various factors that influence infant feeding choices among women with systemic rheumatic diseases. Despite some existing guidelines regarding safe medications during breastfeeding, the specifics surrounding the choices mothers make remain less understood. Researchers at HSS took a comprehensive look at this issue by analyzing data from the Rheumatology Women’s Reproductive Health and Wellness Cohort.

This cohort consisted of 158 participants, 56% of whom lived with systemic rheumatic diseases. Findings revealed that about two-thirds of these mothers breastfed at some point, whereas one-third opted exclusively for formula feeding. While many expressed satisfaction with their infant feeding choices, factors like breast discomfort and insufficient milk production negatively influenced their experiences.

Dr. Sarah B. Lieber, a leading rheumatologist at HSS, emphasized the importance of understanding these influences. “Rheumatologists have long-term relationships with their patients, offering them support not just for their rheumatic conditions but also for broader health issues,” Dr. Lieber noted. Such studies are essential for enhancing the support offered to women during and after pregnancy.

Predicting Pregnancy Complications in Lupus Patients

Validation of the PROMISSE Model

Another noteworthy study focused on the adverse pregnancy outcomes associated with systemic lupus erythematosus (SLE). Lupus can lead to severe complications during pregnancy, including pre-eclampsia and preterm births. Given that most lupus patients—over 80%—experience uncomplicated pregnancies, early identification of those at higher risk is crucial.

Researchers from HSS examined data from over 400 pregnant patients within the PROMISSE Study, aiming to validate predictive models to identify complications based on various clinical factors. Using insights gathered from 966 lupus patients across multiple independent cohorts, they developed algorithms that reliably forecast pregnancy outcomes by analyzing data points such as blood pressure, specific autoantibodies, and ethnic backgrounds.

“This study demonstrates that our prediction model can effectively translate across diverse populations, offering peace of mind to many lupus patients,” said Dr. Jane E. Salmon, co-principal investigator of the study. The next phase involves creating a publicly accessible online risk calculator to assist healthcare providers in managing at-risk pregnancies.

Enhancing Contraception Screening Practices

Quality Improvement Initiative for Contraception Counseling

HSS has also identified a significant need to improve contraception counseling among patients prescribed potentially teratogenic medications. Low contraception use and inadequate counseling could lead to serious health risks for patients with rheumatologic diseases. McLeod and her team at HSS initiated a quality improvement initiative, implementing electronic health record prompts to enhance documentation regarding sexual activity and contraceptive methods used by patients aged 18 to 50 on high-risk medications.

Over a 24-week period, these prompts encouraged clinical staff to inquire about and document contraceptive use, aiming to foster better communication about sexual health. However, results showed limited improvements in documentation rates, highlighting the need for ongoing efforts in education and training within clinical settings.

“Counseling on contraception remains crucial, especially as patients’ circumstances can evolve,” Dr. Nancy Pan, a rheumatologist at HSS, stated. “Improving our documentation practices is a fundamental step toward enhancing the overall care of these patients.”

About Hospital for Special Surgery

HSS stands as a leader in musculoskeletal health, acclaimed for its commitment to research, innovation, and education. With its main campus in New York, HSS operates numerous facilities across the region. It boasts of national rankings in orthopedics and rheumatology, a testament to its focus on delivering exceptional patient care. Founded over 150 years ago, the institution continues to promote advancements in treatments and care standards for patients experiencing musculoskeletal disorders. The HSS Research Institute plays a pivotal role in developing new methodologies that enhance patient outcomes.

Frequently Asked Questions

1. What significant studies were presented at ACR Convergence 2024?

The studies focused on infant feeding behaviors among women with systemic diseases, predicting pregnancy complications in lupus patients, and improving contraception counseling practices.

2. Who led the research on infant feeding behaviors?

The research was led by Dr. Sarah B. Lieber and her team at the Rheumatology Women's Reproductive Health and Wellness Cohort.

3. What is the PROMISSE model?

The PROMISSE model is a predictive tool developed to identify women with lupus at high risk for pregnancy complications based on clinical features.

4. How can healthcare providers benefit from the new online risk calculator?

This calculator will help obstetricians and rheumatologists better tailor their approaches to patient care based on individual risk factors.

5. What challenges did HSS face in improving contraception documentation?

Despite efforts to enhance documentation through alerts in electronic health records, significant improvements were not observed, indicating a need for ongoing education and staff engagement.

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