TY - JOUR T1 - Effectiveness of a multidisciplinary clinical pathway for women with systemic lupus erythematosus and/or antiphospholipid syndrome JF - Lupus Science & Medicine JO - Lupus Sci Med DO - 10.1136/lupus-2020-000472 VL - 8 IS - 1 SP - e000472 AU - Merlijn Wind AU - Maike Hendriks AU - Bernadette T J van Brussel AU - Jeroen Eikenboom AU - Cornelia F Allaart AU - Hildo J Lamb AU - Hans-Marc J Siebelink AU - Maarten K Ninaber AU - Nan van Geloven AU - Jan M M van Lith AU - Tom W J Huizinga AU - Ton J Rabelink AU - Marieke Sueters AU - Y K Onno Teng Y1 - 2021/05/01 UR - http://lupus.bmj.com/content/8/1/e000472.abstract N2 - Objectives SLE and/or antiphospholipid syndrome (SLE/APS) are complex and rare systemic autoimmune diseases that predominantly affect women of childbearing age. Women with SLE/APS are at high risk of developing complications during pregnancy. Therefore, clinical practice guidelines recommend that patients with SLE/APS should receive multidisciplinary counselling before getting pregnant. We investigated the clinical effectiveness of implementing a multidisciplinary clinical pathway including prepregnancy counselling of patients with SLE/APS.Methods A clinical pathway with specific evaluation and prepregnancy counselling for patients with SLE/APS was developed and implemented in a tertiary, academic hospital setting. Patients were prospectively managed within the clinical pathway from 2014 onwards and compared with a retrospective cohort of patients that was not managed in a clinical pathway. Primary outcome was a combined outcome of disease flares for SLE and thromboembolic events for APS. Secondary outcomes were maternal and fetal pregnancy complications.Results Seventy-eight patients with 112 pregnancies were included in this study. The primary combined outcome was significantly lower in the pathway cohort (adjusted OR (aOR) 0.20 (95% CI 0.06 to 0.75)) which was predominantly determined by a fivefold risk reduction of SLE flares (aOR 0.22 (95% CI 0.04 to 1.09)). Maternal and fetal pregnancy complications were not different between the cohorts (respectively, aOR 0.91 (95% CI 0.38 to 2.17) and aOR 1.26 (95% CI 0.55 to 2.88)).Conclusions The outcomes of this study suggest that patients with SLE/APS with a pregnancy wish benefit from a multidisciplinary clinical pathway including prepregnancy counselling.Data are available on reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author. ER -