Themes and elements relating to general health information for women with rheumatoid arthritis and their families
| Saying: Information that should be discussed by health professionals | Doing: Actions that should be undertaken by health professionals |
|---|---|
| General health and primary prevention practices should be discussed across health providers, inclusive of the need for appropriate physical activity, nutrition, psychological health and relevant screening practices (100%) | |
| It is important to maintain a healthy weight range through adequate and appropriate diet and physical activity | Support cessation of smoking (if smoker) |
| Alcohol intake should be minimised; eg, abide to WHO safe drinking levels and consume less alcohol than currently recommended levels for otherwise healthy women | Recommend/refer for screening procedures as appropriate including: bone mineral density, cardiovascular risk factors, pap test and breast examination |
| For some mothers and their families, it is important to consider mental well-being/stress management strategies | Review immunisation requirements (particularly if on immunosuppressive drugs) and ensure immunisation profile is up to date |
| Safe sexual health practices, including contraception and sexually transmitted disease prevention, should be adhered to | Referral to appropriate health professionals for further detailed information where required (eg, contraception counselling) |
| Specific aspects of RA management should be discussed (as appropriate to patient) relating to medication, contraception and self-management (100%) | |
| DMARDs have benefit and risk profiles across the course of the disease. Using DMARDs and other agents to manage disease activity is critical for maternal and fetal health | Adopt a holistic approach to management of RA (ie, medication is only one aspect of RA management) |
| It is important to use reliable contraception when taking medications that may affect the fetus | Review, discuss and document current medications including: side effects, interactions, contraindications, effect of medications on fertility and implantation, timing of withdrawal of medications in planning pregnancy, need for and timing related to switching medications |
| Bone health needs to be monitored and managed in people with RA | Offer pregnancy test (if any chance of pregnancy) before starting medications that may affect the fetus |
| Provide guidance in relation to obtaining relevant and trustworthy information about RA (94.1%) | |
| It is important to learn about RA and its management, but the use of websites should be limited to those that are reputable/reliable | Encourage patients to take the time to learn about RA to optimise their health literacy |
| It is important to confirm information with a specialist and to use the internet and discussion forums judiciously | |
| Information about the safety of RA medications, particularly in relation to pregnancy, may be inconsistent, overly conservative or potentially out of date (eg, manufacturer information) and therefore it is important to always check with a specialist | |
| Discuss the need for family planning and relevant considerations with respect to management of RA and involve partners, where appropriate (100%) | |
| It is important to plan for pregnancy and the postpartum period (including breast feeding) with specialists prior to conception | Establishment of an appropriate multidisciplinary team for RA management, especially as it relates to pregnancy and early parenting when required |
| Have an optimistic outlook—pregnancy and breast feeding are not contraindicated in RA and can be successful | |
| It is important to have optimal disease control prior to pregnancy and breast feeding to improve outcomes for the mother and baby. Uncontrolled disease activity is harmful to a mother and baby, so appropriate medication management is critical | |
| There are medication safety issues relating to conception, pregnancy and breast feeding | |
Four themes are listed with their supporting elements for ‘saying’ and ‘doing’. The proportion of panellists who supported or strongly supported each theme is identified in parentheses.
DMARD, disease modifying anti-rheumatic drug; WHO, World Health Organization.