To achieve the best possible pregnancy outcome, women with SLE should be advised to avoid pregnancy when SLE is active. Dr. Clowse said it’s recently come to her attention that in North Carolina and other parts of the United States where abstinence-only education has been the law of the land for the past dozen years, this may mean having that first conversation about contraception with a patient already in her 20s.
"I think it’s really important that we address this with our rheumatology patients," she said.
Dr. Clowse said progesterone-only contraceptives are probably the safest method in SLE patients, with medroxyprogesterone injection (Depo-Provera) generally well tolerated, and the 3-year etonogestrel implant (Implanon) is better tolerated than the levonorgestrel implant (Norplant). She also advises her SLE patients to use barrier methods and to pick up levonorgestrel (Plan B One-Step) on the way home from the clinic to have on hand for emergencies.
Dr. Clowse reported consulting for UCB and receiving grant support from the Arthritis Foundation.