Abortion decision threatens care for more than one million patients with arthritis | Expert Opinion

What does abortion have to do with a doctor who treats systemic autoimmune and inflammatory diseases like rheumatoid arthritis and lupus? More than you’d think.

My patients are mostly female. Many of their diseases, like lupus, are present in the childbearing years, and these diseases disproportionately affect women. Pregnancies are always at the forefront of our minds. We want our patients to conceive in a healthy way, with their underlying diseases controlled. But some of the medications we use can affect a pregnancy.

One of the drugs I frequently prescribe is methotrexate. In small doses, when given as pills or injected under the skin, methotrexate prevents inflammation, making it an amazing drug for rheumatoid arthritis. In large doses, oncologists give methotrexate as chemotherapy for certain cancers.

» READ MORE: After two ectopic pregnancies, I fear what might happen without Roe v. Wade

When I see patients, I routinely ask if they are planning on becoming pregnant in the coming year. If the answer is yes, I do not give them methotrexate and will consider other therapies. If they are already on methotrexate, we ask them to stop it at least three months before trying to conceive.

At higher doses than what is used to treat rheumatoid arthritis, methotrexate can also induce abortion. If a woman does conceive while taking it, she is at risk of miscarriage, and also at high risk of fetal anomalies.

Already, women are being told that they can’t have access to methotrexate because of the Supreme Court’s decision to overrule Roe v. Wade. In states where abortions have now become more restricted, such as Texas and Oklahoma, CVS has instructed its pharmacists not to fill a methotrexate prescription unless the patient can prove it’s not for an abortion. In other states where abortion is still legal, patients are struggling for access because either their doctors won’t prescribe it or their insurance won’t pay for it.

There are a number of conditions that methotrexate treats, such as psoriasis, Crohn’s disease, and lupus, which affect hundreds of thousands of people in the U.S. More than one million Americans have rheumatoid arthritis. What happens if they can’t access their medications?

And methotrexate isn’t the only medicine at risk because of its ties to abortion. Misoprostol can help prevent stomach ulcers — but because it can also be used for abortion, patients that used to rely on it are potentially now at risk of losing access.

“Methotrexate isn’t the only medicine at risk because of its ties to abortion.”

I can only imagine the nightmare of paperwork, phone calls, and appeals that will happen if methotrexate becomes highly regulated or if there is an access issue.

Methotrexate is also significantly cheaper than other newer therapies for arthritis, such as Humira (adalimumab) or Xeljanz (tofacitinib), which can cost tens of thousands of dollars per year.

Sadly, we have been here before. Rheumatologists watched as hydroxychloroquine, the anchor drug for lupus, took center stage at the beginning of the COVID-19 pandemic. We helplessly watched our lupus patients flare when they could not get the drug that had kept their disease under control for years, because of a supply shortage. We pleaded with pharmacies to dispense more than 15 days of medication at a time. We would not like to see another one of our most reliable drugs in the spotlight again.

I’m not just worried about my patients losing access to their medication. For my patients with lupus, I offer them Cellcept (mycophenolate mofetil), which prevents transplant patients from rejecting new organs but can also help lupus patients whose lungs and kidneys are affected by their condition. It also can cause birth defects.

I’ve had patients conceive while on mycophenolate and had to advise them to abort. I’m sure there are many doctors of transplant patients who have had the same difficult conversations. I don’t want to see those get any harder because Pennsylvania lawmakers have made preordained decisions about someone’s health care.

There is already a workforce shortage in rheumatology. We are drowning in paperwork. I worry that bans on our drugs will accelerate burnout, and cause doctors to leave for states where their jobs are less difficult and they will not be criminalized. Young students and trainees will avoid states with restrictive laws.

Overturning Roe v. Wade does not just turn women’s rights back 50 years. It threatens five decades of progress in all fields of medicine, from arthritis to organ transplants to cancer care. A ban on abortion is a threat to how my patients live and how I practice.

Belinda Birnbaum is a rheumatologist in Bryn Mawr.