PARE0024 AWARENESS ABOUT FAMILY PLANNING AND PREGNANCY EXPECTATION AMONG PATIENTS WITH CHRONIC INFLAMMATORY DISEASE OF THE SKIN OR JOINTS
Authors: K. Schreiber, C. Johansen, U. F. Jensen, A. Egeberg, S. F. Thomsen, A. L. Hansen, T. B. Laurberg, L. Skov, L. E. Kristensen
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients affected by chronic inflammatory diseases of the skin or joints (CIDs; including psoriasis [PSO], rheumatoid arthritis [RA], juvenile idiopathic arthritis [JIA], psoriatic arthritis [PsA], non-radiographic axial spondyloarthritis [nr-axSpA; reported in the survey as ‘axSpA’], or ankylosing spondylitis [AS]) may be challenged in their attempts to have children. A multinational survey conducted in Europe and the US, including 969 patients, revealed that most patients’ concerns regarding family planning and pregnancy (FPP) were inadequately or inconsistently addressed. 1 Objectives: To investigate the general level of information on FPP and the potential concerns among Danish patients with CIDs. Methods: An online survey to identify FPP issues was designed, and CID patients aged 18–50 years (yrs) were included. Respondents were recruited through patient organisations providing their members with a link to the questionnaire. In addition to demographics, information relating to time of diagnosis, treatments received, pregnancies, and course of disease were collected along with access to and concerns regarding FPP. Descriptive statistics were applied. Results: Eligible patients included 368 with rheumatological diagnoses (RA, PsA, JIA, nr-axSpA, or AS; 304 [83%] female, mean age: 40 yrs; 64 [17%] male, mean age: 42 yrs) and 95 with dermatological diagnoses (PSO or PsA; 64 [67%] female, mean age: 37 yrs; 31 [33%] male, mean age: 42 yrs). Among the rheumatic patients, 43% of females and 53% of males were currently receiving systemic treatment and 37% of females and 22% of males had received &gt;3 different systemic treatments (other than painkillers and non-steroidal anti-inflammatory drugs [NSAIDs]). Lack of access to FPP information was consistent across age groups, but higher in those with dermatological diagnoses ( Table ). In total, 68% of patients with rheumatological and 73% with dermatological diagnoses had biological children and among these 18% and 23% of patients, respectively, indicated their disease had affected how many children they had or planned to have. The most frequent concerns among patients with rheumatological diagnoses were the potential physical impact of a pregnancy, disease worsening, heredity and being able to take care of the child (19, 16, 16 and 13%, respectively), whilst disease worsening and heredity (12 and 16%, respectively) were the most frequent concerns in those with dermatological diagnoses. Many patients experienced disease worsening during or after pregnancy (rheumatologic diagnoses: 16% and 34%; dermatologic: 20% and 59%, respectively). Conclusion: Danish CID patients of reproductive age have concerns related both to their disease and to FPP, which affect their decisions around family planning. The majority of patients responding to this survey reported limited access to information about FPP, pointing to a need for healthcare professionals to provide standardised family planning information. References: [1] Chakravarty E. BMJ Open 2014;4:e004081. Table. Thematic analysis and quotes Theme Description Quote Oral-RA links RA medications caused dry mouth The medications, really, really are awful on your mouth, in particular prednisone. I get very raw gums… it [was] painful to brush my teeth. We don’t have saliva to wash things away. We have a different mouth flora Complicated oral care Time-demanding oral care routines. Multiple oral health care tools and adaptations used depending on current oral health, and RA activity. The severe pain made it very hard to open my mouth to brush my teeth. The joint damage [makes it] really hard to handle a toothbrush. We have to have toothbrushes with a wide handle… and different attachments when we need them. Even with those [special] products, the pain sometimes was just overwhelming. I’m dedicated about brushing my teeth, but boy, it was a struggle. It took me a long time to brush my teeth. Access to professional oral care Lack of dental insurance and costs of care Logistical access: multiple dental visits. Physical access: attending appointments; prolonged sitting in a dental chair. I have a hygienist, and a dentist, and a gum dentist and a bunch of dentists with fancy names. I see them every 3 months. Dental offices have dental hygienists. And some of them are an A+, and some of them are C-…it’s important that hygienists are trained, that they really understand the tools. When I go back in the [dental] chair, it was uncomfortable [when first diagnosed]. I struggled. I couldn’t keep my mouth open. Shame due to oral health Shame relating to poor oral health. Seeking oral care possibly considered unusual for their age. I would feel ashamed. Something’s wrong. Everyone around me has these beautiful teeth. I don’t, and something is wrong. I’m getting braces. At my age, I’m getting braces. Table. Proportion of patients with rheumatological or dermatological diagnoses who reported having little or no access to FPP information, stratified by age Age Rheumatological diagnosis N (% ) Dermatological diagnosis N (% ) 18–29 yrs 19 (49) 14 (74) 30–39 yrs 61 (58) 16 (73) 40–50 yrs 134 (60) 34 (63) Acknowledgments: This study was funded by UCB Pharma. Editorial services were provided by Costello Medical. Disclosure of Interests: Karen Schreiber Consultant of: UCB Pharma (Advisory Board), Caecilie Johansen Consultant of: UCB Pharma (Advisory Board), Ulla-Fie Jensen Consultant of: UCB Pharma (Advisory Board), Employee of: UCB Pharma, Alexander Egeberg Grant/research support from: Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation and the Kgl Hofbundtmager Aage Bang Foundation, Consultant of: UCB Pharma (Advisory Board), Speakers bureau: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co. Ltd., Pfizer, Eli Lilly, Novartis, Galderma, Dermavant, UCB Pharma, Mylan, Bristol-Myers Squibb and Janssen Pharmaceuticals, Simon F. Thomsen Grant/research support from: UCB Pharma, AbbVie, Novartis, Sanofi, Leo Pharma, and Janssen Pharmaceuticals, Consultant of: UCB Pharma (Advisory Board), AbbVie, Novartis, Sanofi, Eli Lilly, Roche, Janssen Pharmaceuticals, Pfizer, Celgene, Leo Pharma, Almirall, Speakers bureau: UCB Pharma, AbbVie, Novartis, Sanofi, Eli Lilly and Leo Pharma, Asbjorn L Hansen Consultant of: UCB Pharma (Advisory Board), Employee of: UCB Pharma, Trine Bay Laurberg Consultant of: UCB Pharma (Advisory Board), Lone Skov Grant/research support from: Pfizer, AbbVie, Novartis, Sanofi, Janssen Pharmaceuticals, and LEO Pharma, Consultant of: UCB Pharma (Advisory Board), AbbVie, Janssen Pharmaceuticals, Novartis, Eli Lilly, LEO Pharma, Almirall, and Sanofi, Speakers bureau: AbbVie, Eli Lilly, Novartis, and LEO Pharma. Investigator for AbbVie, Janssen Pharmaceuticals, Boehringer Ingelheim, AstraZeneca, Eli Lilly, Novartis, Regeneron, and LEO Pharma, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma