E002 cs-DMARDs during pregnancy: knowledge and practices of rheumatologists

Abstract Background/Aims Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) remain a cornerstone in managing chronic inflammatory rheumatic diseases by slowing disease progression and improving patients’ quality of life. These drugs are often prescribed to women of childbearing age, raising concerns about their safety and management during pregnancy. Although guidelines exist regarding the use of csDMARDs in pregnancy, they are sometimes insufficient, and clinical practices among rheumatologists may vary. This study aims to assess the knowledge and practices of rheumatologists concerning the use of csDMARDs during pregnancy. Methods We conducted a cross-sectional observational study among rheumatologists using an anonymous, self-administered online questionnaire via Google Forms. The questionnaire addressed demographic characteristics of the participants, as well as their knowledge and practices regarding the management of csDMARDs during pregnancy. Results A total of 65 rheumatologists (60 women and 5 men) responded, with an average age of 38.55 ± 11.2 years [25-60]. Among them, 22 were trainees, 27 worked in the public sector, and 16 in the private sector. The average duration of practice was 11.2 ± 9.8 years [1-36]. Regarding fertility, 43.8% of rheumatologists considered the fertility of patients with chronic inflammatory rheumatic diseases comparable to that of the general population. Additionally, 87.5% observed an improvement in rheumatoid arthritis (RA) activity during pregnancy. In terms of contraception, 58.5% of practitioners discussed it systematically, 26.2% frequently, and 15.4% occasionally. Regarding fertility, 29.2% of patients rarely raised the topic, 43.1% occasionally, and 26.2% often. Furthermore, 79.9% of rheumatologists had encountered situations requiring therapeutic adjustments during pregnancy. Methotrexate discontinuation three months before conception was recommended by 81.5% of respondents, while 18.5% discontinued it once pregnancy was confirmed. The csDMARDs considered the safest during pregnancy included sulfasalazine (n = 49), hydroxychloroquine (n = 49), and azathioprine (n = 10). Nearly half of the participants (51.6%) felt that current recommendations on the use of csDMARDs during pregnancy were insufficient or ambiguous. The main sources of information used to manage these treatments included CRI (Club Rhumatismes et Inflammations) guidelines (n = 35), recommendations from scientific societies (EULAR, ACR) (n = 37), the Reference Center for Teratogenic Agents (CRAT) website (n = 31), scientific journals (n = 19), and peer discussions or professional networks (n = 18). Conclusion This study highlights the variability in the practices of Tunisian rheumatologists regarding the use of csDMARDs during pregnancy. While medications such as sulfasalazine and hydroxychloroquine are considered relatively safe, many practitioners believe current guidelines are inadequate. This underscores the need for clearer and more accessible guidelines to improve the management of pregnant patients with inflammatory rheumatic diseases. Disclosure M. Dhifallah: None. L. Rouached: None. S. Bouden: None. A. Ben Tekaya: None. S. Ben Dhia: None. I. Mahmoud: None. R. Tekaya: None. O. Saidane: None. L. Abdelmoula: None.