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Joint Bone Spine. 2018 Dec 21. pii: S1297-319X(18)30257-4. doi: 10.1016/j.jbspin.2018.12.002. [Epub ahead of print]

"Disease knowledge index" and perspectives on reproductive issues: A nationwide study on 398 women with autoimmune rheumatic diseases.

Author information

1
Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy; Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Piazzale Spedali Civili, 1, 25123 Brescia, Italy.
2
Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy; Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Piazzale Spedali Civili, 1, 25123 Brescia, Italy. Electronic address: laura.andreoli@unibs.it.
3
Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
4
Centro Hospitalar de Leiria (CHL), Hospital de Santo André (HSA), R. de Santo André, 2410-197 Leiria, Portugal.
5
Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy.
6
Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
7
Rheumatology Unit, Department of Medicine, University of Perugia, Piazzale Gambuli, 1, 06132 Perugia, Italy.
8
Unit of Allergology, Clinical Immunology and Rheumatology, University Campus Biomedico Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy.
9
Rheumatology Unit, Policlinico "Le Scotte" and University of Siena, Via Mario Bracci-Loc.Le Scotte, 53100 Siena, Italy.
10
Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44124 Cona, Ferrara, Italy.
11
Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Rione Biccari, 71122 Foggia, Italy.
12
Division of Rheumatology, University of Pavia and IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, 27100 Pavia, Italy.
13
Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital; BIOMETRA Department, University of Milan, Via Manzoni, 56, 20089 Rozzano (Milano), Milan, Italy.
14
Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy; Unit of Rheumatology, Istituto Auxologico Italiano, Via Mosè Bianchi, 90, 20149 Milan, Italy.
15
Rheumatology, Allergy and Clinical Immunology, University of Rome Tor Vergata, Via Oxford, 81, 00133 Rome, Italy.
16
Research Laboratory and Division of Rheumatology, Postgraduate School of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto XV, 16, 16132 Genova, Italy.
17
Rheumatology Institute of Lucania (IReL)-Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; Basilicata Ricerca Biomedica (BRB) Foundation, Via Potito Petrone, 1, 85100 Potenza, Italy.
18
Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Via Nicolò Giustiniani, 2, 35128 Padua, Italy.
19
Clinica Medica, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy 15.
20
Rheumatology Unit, A.O.U. Policlinico Vittorio Emanuele, Via S. Sofia, 78, 95123 Catania, Italy.
21
Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy; Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, Piazza Cardinale Andrea Ferrari, 1, 20122 Milan, Italy.
22
Rheumatology Outpatient Clinic, Internal Medicine Department, Hospital of Bolzano, Via Lorenz Böhler, 5, 39100 Bolzano, Italy.
23
Rheumatology Unit, Internal Medicine, Policlinico S. Orsola-Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Via Pietro Albertoni, 15, 40138 Bologna, Italy.
24
Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital; BIOMETRA Department, University of Milan, Via Manzoni, 56, 20089 Rozzano (Milano), Milan, Italy; Research Laboratory and Division of Rheumatology, Postgraduate School of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto XV, 16, 16132 Genova, Italy.
25
Unit of Rheumatology, Istituto Auxologico Italiano, Via Mosè Bianchi, 90, 20149 Milan, Italy.
26
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy.
27
Department of Rheumatology, S. Chiara Hospital, Largo Medaglie D'oro, 9, 38122 Trento, Italy.
28
Rheumatology Unit, Azienda USL-IRCCS of Reggio Emilia, University of Modena and Reggio Emilia, Viale Risorgimento, 80, 42123 Reggio-Emilia, Italy.
29
Unit of Rheumatology, S. Croce e Carle Hospital, Via Michele Coppino, 26, 12100 Cuneo, Italy.
30
Rheumatology Unit, San Camillo Hospital, Circonvallazione Gianicolense, 87, 00152 Rome, Italy.
31
Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, Piazza Cardinale Andrea Ferrari, 1, 20122 Milan, Italy.
32
Rheumatology Unit, Department of Internal Medicine and Medical Specialties, La Sapienza University, Piazzale Aldo Moro, 5, 00185 Roma, Italy.

Abstract

OBJECTIVE:

The reproductive choices of women affected by rheumatic diseases (RD) can be influenced by several factors, including the quality of physician-patient communication. We conducted a survey on reproductive issues aiming at exploring the unmet needs of women with RD during childbearing age.

METHODS:

We administered 65 multiple-choice and 12 open-answer questions about pregnancy counselling, contraception, use of drugs during pregnancy and other women reproductive issues to 477 consecutive women with RD aged 18-55 years followed-up in 24 rheumatology centres in Italy. Analysis was restricted to 398 patients who received their diagnosis of RD before the age of 45. According to the RD diagnosis, patients were subdivided into 2 groups: connective tissue diseases (n = 249) and chronic arthritis (n = 149).

RESULTS:

At the time of interview, women in both groups had a mean age of 40 years. Nearly one third of patients in each group declared not to have received any counselling about either pregnancy desire nor contraception. A smaller family size than desired was reported by nearly 37% of patients, because of concerns related to maternal disease in one fourth of the cases. A "Disease Knowledge Index" (DKI) was created to investigate the degree of patients' information about the implications of their RD on reproductive issues. Having received counselling was associated with higher DKI values and with a positive impact on family planning.

CONCLUSION:

Italian women of childbearing age affected by RD reported several unmet needs in their knowledge about reproductive issues. Strategies are needed to implement and facilitate physician-patient communication.

KEYWORDS:

Contraception; Counselling; Drugs; Pregnancy; Reproductive issues; Rheumatic diseases

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