It has been a delight to organize and edit this compilation of articles summarizing the current knowledge and future directions of reproductive health in women with systemic rheumatic diseases. We are indebted to all of the authors worldwide who have contributed such outstanding articles to this issue of Rheumatic Disease Clinics of North America .
Women make up the majority of patients with systemic rheumatic diseases. With advances in the diagnosis and treatment of underlying rheumatic disease, patients have both improved life expectancy and quality of life: many now feel healthy enough to consider and desire pregnancy and childrearing. Rheumatologists caring for these women must now consider contraception, pregnancy, lactation, reproductive health care screening, and menopause when providing longitudinal care. The interrelationships between female sex hormones and underlying rheumatic disease are complex and remain incompletely understood. However, the last few decades have provided a foundation of clinical data to guide the clinician regarding medical management of rheumatic disease through the female reproductive lifespan with particular emphasis on balancing risks of untreated or undertreated disease on pregnancy outcomes with the potential risks of immunosuppressive therapy as well as hormonal therapy. Reproductive health care for women with rheumatic diseases goes well beyond risk stratification and medical management throughout pregnancy and includes issues such as safe and effective contraception, infertility and fertility therapies, human papilloma virus, menopause, and developing fields of study, such as monitoring offspring of women with rheumatic diseases beyond the immediate neonatal period into childhood and beyond.
We have been fortunate to assemble a group of contributors whose work over the past few decades has significantly contributed to the growing field of reproductive rheumatology and makes up the basis for many of the recommendations discussed in this issue. Much of the data, particularly on use of medications to treat rheumatic diseases during pregnancy, remains somewhat controversial; therefore, some recommendations will vary slightly between different authors. This is a reflection of differing expert opinions based on the relatively limited clinical data that are currently available. We anticipate and hope that, given the complex immunology involved as well as the need for more definitive clinical data, research on reproductive issues within rheumatology will continue to expand and attract young investigators.
We would like to thank all of the authors for their outstanding contributions and hope that readers will find this information valuable in guiding truly comprehensive care for women with rheumatic diseases.