Rheumatology and prescribing

Last month, the research round-up provided you with an overview of articles looking at issues around opioid prescribing. This month, we will be looking at research published in the areas of rheumatology. The first article looks at the newly published update to the 2016 British Society for Rheumatology guidelines on prescribing antirheumatic drugs in pregnancy and breastfeeding. The second looks at prescribing in rheumatology with renal problems and, finally, we look at an article reviewing health literacy and the impact of this on medication management in the patient with rheumatoid arthritis.

This article, published in the journal Rheumatology, looked at the newly published guidance by the British Society for Rheumatology. The article outlines the need for the guidance and discusses the rationale that led up to the update, including the existence of other evidence-based guidelines.

Within the objectives of the guidance, it outlines medications that should be avoided or stopped in pregnancy, or even in those of reproductive age unless contraception is used. The guideline target audience is all healthcare practitioners in the UK who are involved in managing patients with rheumatic diseases who are or are planning to become pregnant. It is acknowledged that chronic disease itself can have an impact on pregnancy, but that patients with rheumatological conditions can be safely managed during pregnancy, and how to avoid poor disease control while balancing the risks to the developing foetus. The guideline suggests preconception counselling where at all possible and referral to professionals with appropriate expertise is recommended. Risks and benefits of medications should be clearly discussed and documented, and pregnancy incompatible drugs replaced.