Large gaps in contraception documentation within the American College of Rheumatology (ACR)’s Rheumatology Informatics System for Effectiveness (RISE) Registry among women with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) highlights that rheumatologists do not have a systematic approach to collecting and recording these data, according to findings from an analysis published in Arthritis Care & Research (Hoboken).

The researchers sought to assess the frequency of contraception documentation among women with SLE and those with RA, and to identify disparities by teratogenic prescription and patient race and ethnicity.

Data on contraception documentation were collected from structured data fields within the RISE Registry among women aged between 18 and 45 years in 2018 who had at least 2 visits to a rheumatologist based on a diagnosis of SLE or RA. The frequency of contraception documentation, according to age, race and ethnicity, patient diagnosis, and the teratogenicity of prescribed antirheumatic agents, was compared using univariate and multivariate analysis.


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The study cohort included 28,835 women, with 9826 diagnosed with SLE and 19,009 diagnosed with RA. Data obtained from 212 rheumatology practices were included in the current study, with an average of 3 providers per practice.

Women with SLE vs RA were significantly younger (35.7±6.9 vs 37.0±6.7 years, respectively) and Black (P <.001 for both).

Results of the study showed that 9.1% of women with SLE or with RA had a documented contraception method within a structured field in 2018. Women with vs without documentation of contraception were younger (SLE, 32.9±7.2 years vs 36.0±6.9 years, respectively; RA, 34.4±7.3 years vs 37.3±6.6 years, respectively; P <.001 for both).

Rates of contraception documentation were significantly lower among women with SLE (8.1%) compared with those with RA (9.6%; adjusted odds ratio [aOR], 0.84; 95% CI, 0.76-0.92). Hispanic, Black, and Asian women were all less likely than White women to have documentation about contraception.

Teratogenic prescriptions were associated with higher rates of contraception documentation among women with RA (aOR, 1.31; 95% CI, 1.16-1.47), but not among those with SLE (aOR, 1.08; 95% CI, 0.91-1.28).

The researchers concluded, “While these data likely underestimate contraception use, they highlight that most rheumatologists do not have a systematic approach to collecting and recording this information in the EHR.”

They added, “This study emphasizes the importance of improving contraception documentation and education in accordance with our patients’ goals for preventing pregnancy or planning the safest possible pregnancy.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Clowse MEB, Li J, Birru Talabi M, Eudy AM, Schmajuk G. The frequency of contraception documentation and women with systemic lupus erythematosus and rheumatoid arthritis within the RISE Registry. Arthritis Care Res (Hoboken). Published online   October 8, 2021. doi:10.1002/acr.24803