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Objective: To develop recommendations on the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, post-partum and breastfeeding based on the best evidence and experience. Methods: Recommendations were generated using nominal group and Delphi techniques. An expert panel of 12 rheumatologists was established. A systematic literature review and a narrative review (websites, clinical guidelines and other relevant documentation) were performed and presented to the panel in its 1st meeting to be discussed and to help define recommendations. A first draft of recommendations was generated and circulated for comments and wording refinement. A national survey analyzing different aspects of this topic was undertaken separately, followed by a Delphi process (2 rounds). Agreement with each recommendation was ranked on a scale of 1 (total disagreement) to 10 (total agreement), and was considered to be achieved if at least 70% voted ≥ 7. The level of evidence and grade of recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. Results: A total of 14 recommendations were generated for the preconception period (oral and hormonal contraception, reproductive techniques), pregnancy (planning, treatment and follow-up), and breastfeeding (treatment and follow-up). High-risk situations such as lupus or antiphospholipid syndrome were included. A consensus > 90% was reached for all but one recommendation. Conclusions: These recommendations are intended to provide rheumatologists, patients, families and other stakeholders with a consensus on the evaluation and management of patients with autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding. [ABSTRACT FROM AUTHOR]

Introduction: Multiple Sclerosis represents a diagnostic and therapeutic challenge in developing countries since treatment delay is associated to disability while the costs of the approved pharmacological agents have a great economic impact. This Mexican consensus was developed with the aim to analyse the necessary procedures and requirements for the comprehensive care of the disease. Material and methods: A meeting consensus was carried out with the attendance of 21 physicians from seven states of the country, specialists in neurology, neuropediatrics, neuroepidemiology and neuroophthalmology, as well as professionals in areas of administration and teaching. The principal health institutions, both public and private, were represented. Results: The necessary diagnostic and therapeutic procedures were analysed according to scientific evidence; commentaries on availability in the country and guidelines and algorithms for their application were elaborated. Discussion: It is recommended that health institutions provide all the approved medications to allow physicians to choose the adequate treatment, according to the patient's condition. Authorization of ‘generic’ interferons (biosimilars) for sale or institutional use is a matter of concern for Mexican neurologists, since regulatory agencies with international impact (i.e. FDA, EMEA) have not approved these products because there is not evidence on their efficacy and safety, neither represent any economic advantage. The present guidelines constitute a medical proposal to develope Official Mexican Norms for the therapeutic management of multiple sclerosis. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis is a chronic systemic inflammatory disease that causes significant morbidity and mortality. The combined use of methotrexate and biological agents directed against tumor necrosis factor (TNF) has achieved significant improvement in clinical, radiographic and functional parameters not seen previously and has revolutionized the therapeutic goal of achieving remission in clinical, structural and functional parameters. The next goal should be to achieve remission without the use of biological drugs and later without medication. Although there is evidence about the efficacy and safety of TNF inhibitors, there is none on remission without the use of biological agents or disease modifying drugs. [ABSTRACT FROM AUTHOR]