0:02
Hi, I'm Sheila Reyes from the Philippines reporting here in Seoul, South Korea for APLAR 2026.
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Recently, the APLAR Special Interest Group for Women's Health and Reproductive Issues and RMDs published consensus statements for the management of reproductive issues in autoimmune rheumatic diseases.
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And joining me today is Dr. Vinendra Raindran from India, who's also the main author of the APLAR consensus statements.
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He is a consultant rheumatologist from the Center for Rheumatology at Calicut, India, and also the President-Elect of the Indian Rheumatology Association.
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Good morning, Dr. Raindran, and thank you for joining us today.
0:49
Good morning, Dr. Sheila, and very happy to be with you here. Thank you.
0:55
And first off, a huge congratulations to the team for driving this massive initiative forward.
1:04
And because of that, let's start by me asking you how the process was like — can you briefly walk us through that? How was the experience like?
1:16
Thank you. Yeah, I think it was a great collaborative effort.
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The idea of consensus statements came about from the realization that there is a lot of gap in terms of access to services — the inequality which is inherent in a huge sort of society such as APLAR, which has 33 countries with high income, middle income, and low-income countries.
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And the literature itself supporting management of reproductive issues in autoimmune diseases is sparse.
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So, as the initiative of our Special Interest Group, we thought that to develop consensus statements which are practical for countries in the APLAR region would be a great idea.
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So we started nearly about one and a half years ago, and several members of the APLAR nations contributed — 13 countries, 16 members.
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And as you know, the consensus statements process involves several different things: generating the PICO-based questions and then formulating the draft questions, signing it, doing the systematic review of literature.
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But the most important point I want to highlight was that we never wanted to reinvent the wheel, because we have robust guidelines from EULAR and ACR on these aspects.
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So rather than reinventing the wheel, we used those international major guidelines from EULAR and ACR, and the panel was informed by the systematic review of literature which was focused on the APLAR regions to see whether those consensus statements are appropriate to our regions or not.
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So I think in terms of its practical utility, it goes over and above what EULAR and ACR offer in this specific context of countries from the APLAR region.
3:41
Okay, thank you. And I like what you said about that collaborative effort, and from what I understand this is the first consensus statements regarding reproductive issues for the APLAR region. Correct?
3:55
That is correct. Thank you. Yeah. So it's really relevant and very timely, particularly now that the interest in reproductive issues — reproductive health in patients with rheumatic diseases — is growing, and it encompasses all of the conditions that we rheumatologists care for.
4:22
So for the audience out there, could you share some of the important highlights of the consensus statements that we can actually look forward to, as we also look into the official document?
4:43
Just some of the highlights that you would want to share with the audience.
4:47
Thank you, Sheila. So we came up with, after multiple rounds of discussions and voting, four overarching principles and 86 statements.
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These 86 statements have been divided into 16 broad clinical categories, ranging from the assisted reproductive techniques, the fertility preservation, to all the three phases of pregnancy including the postpartum phase, the usage of drugs, contraception, everything.
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I would say two or three things are very very important in terms of anybody who's interested in managing reproductive issues in autoimmune diseases.
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One is what we said in the overarching principles — that the rheumatologist should take a lead or interest in this area of care provision.
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With the in-depth knowledge of rheumatic conditions they have, rheumatologists are at the right position to take the lead in affairs related to reproductive issues in women with autoimmune diseases.
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And the second thing which we want to highlight is the absolutely mandatory aspect of pre-pregnancy counseling and assessment.
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We all know that when the counseling is appropriate, assessment is tuned to ensuring that they are on pregnancy-compatible medications, and also that they understand the risks and benefits of proceeding with pregnancy depending on the clinical scenario.
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And their disease activity is brought down to the minimum possible — with, for example, prednisone of less than 5 mg per day — that is the best chance in terms of a couple having a successful pregnancy outcome.
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Related to drugs, the important message is that in many countries in the APLAR region the use of steroids is rampant, and sometimes this is the only drug which patients end up taking because of cost issues.
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So it is important to include the aspect of minimizing the exposure to glucocorticoids during any phase of pregnancy — pre-pregnancy, during pregnancy, and postpartum.
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Then some of the misconceptions about methotrexate are important to highlight.
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In the statements we particularly addressed — and it's supported by the earlier EULAR guidelines also — that it is contraindicated during pregnancy and it has to be stopped 2 to 3 months before conception is planned.
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But most importantly, in the lactational period, in women who are breastfeeding, the drug can be used if there is no other clinical alternative.
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So these are some of the things I think it's important to remember in the context of this aspect of care provision in our countries.
8:19
Okay, thank you. Thank you for sharing that, Dr. Raindran.
8:23
So I think coming up with these guidelines within the APLAR region really helps the rheumatologists from the APLAR region cater more — and get
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more relevant statements — because of the differences in how we also practice rheumatology in this part of the world, particularly regarding access to medicine.
8:52
So I think that's one of the important aspects of the consensus statements that you were able to come up with.
9:05
So I was just wondering — while you were coming up with these statements, was there any specific topic which really became a matter of debate in terms of what is available, or do we give it, do we not give it?
9:28
Just thinking about the context — apart from a whole different geography, we also have different cultures, and that's where I'm coming from with regards to this question.
9:42
Yeah, great question, Dr. Sheila. I think in developing these types of statements, every statement is a subject of intense debate.
9:54
But I'm grateful for all the panelists who went word by word into these statements and ensured that the statements themselves are very clear, precise, and accurate.
10:06
We faced more intense debate than the baseline sort of debate in terms of investigations, because there is not uniform access to some of the
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investigations which are important — the timing of those investigations during pregnancy, because that is again impacted by lack of access or unequal access —
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about the usage of drugs, because some of the drugs are not available in many of the countries, or at least some of the countries
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— and then aspects such as imaging related to the role of antibodies related to conduction defects, because again those aspects are not uniformly available.
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But the panelists sought to provide a very practical framework which allows the individual units within different countries to use their clinical judgment in imparting the best possible care for women who have autoimmune rheumatic diseases.
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And I would like to emphasize that male health was not ignored.
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Two specific statement sets particularly addressed men's health in the context of autoimmune diseases.
11:43
Okay, I was actually about to ask you to comment on that part of the consensus statements, because I think that's also very important — because sometimes we tend to just focus on the female as the person conceiving and giving birth.
12:06
But then we also have to consider the husband or the partner, or male health in general, and with reproduction it involves both the female and the male.
12:16
So I think you did a really good job in including that aspect in the consensus statements.
12:24
So just a few more words from you, Dr. Raindran.
12:29
I know you're very busy, but could you give at least two or three key messages — specific practical points — that our audience can get from these consensus statements so that when they get back to clinics they can actually use them in daily practice?
12:50
Okay, I think I would be repeating myself, but I encourage all of the audience — clinicians out there — to get hold of the statements.
13:04
APLAR has made it available for free, easily downloadable, and very easy to read — very simple statements in terms of language and clarity.
13:16
But if you ask me again, I would reiterate: one is the rheumatologist taking the lead, ensuring that there is proper counseling — pre-pregnancy counseling — and, just to underscore what you said, taking the male partner along as well, which is very very important in terms of shared decision-making.
13:39
Second would be ensuring that the drugs used in the preconception phase itself are geared to keep the disease activity at the minimum possible, at minimum possible dosages, and ensuring that they are pregnancy-compatible.
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And the third aspect is that during the pregnancy, many of the drugs are stopped or discontinued because of fear of adverse effects on the growing fetus.
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If the consensus statements are followed in terms of drug usage, I would not see any occasion where a pregnancy-compatible medication has to be stopped during the pregnancy.
14:30
And then of course, reach out to your colleagues who have a special interest in this particular field.
14:37
Thank you. Very well said, Dr. Raindran.
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Again, thank you for joining us in this interview, and for everyone out there, don't forget to follow me on X at @rheumarampa and tune in to RheumNow for more information and updates on APLAR.
14:57
Thank you, Dr. Sheila, and thank you RheumNow for this opportunity to collaborate.
15:03
Thank you very much. Thank you again, Doctor. Thank you.
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