Recent advancements in inflammatory arthritis (IA), such as early diagnosis, prompt initiation of disease-modifying antirheumatic drugs (DMARDs), including tumor necrosis factor (TNF) inhibitors, and a treat-to-target (T2T) approach aiming for remission, have led to improved patient outcomes and quality of life (1). Nonetheless, for women diagnosed with IA and a wish to conceive (or a pregnancy) represents a challenge because it is known that IA significantly impacts fertility and pregnancy outcomes (2, 3). Specialized care remains crucial to navigate the complexities around conception, pregnancy, and the postpartum phase (4).

At the Department of Rheumatology at Erasmus University Medical Center, women diagnosed with IA who wish to conceive (or are already pregnant) have access to an established comprehensive “Reproductive Rheumatology” care pathway. A care pathway is a multidisciplinary plan that outlines the essential steps in the care of patients with a specific clinical problem, aimed at improving the quality and coordination of care (5). The Reproductive Rheumatology care pathway at Erasmus University Medical Center combines consultations by rheumatologists and specialized rheumatology nurses (RNs). When indicated other specialists, such as gynecologists, will be involved.

In short, at each visit patients receive specialized care tailored to their reproductive goals from both a rheumatologist and a RN, addressing needs from preconception through six months post-delivery. The rationale behind our care pathway stems from our experience that in addition to medical consultations by rheumatologists, which mainly focus on disease and treatment strategies, complementary support is needed (6). The RNs play a pivotal role in addressing these holistic aspects of care, including emotional well-being, sexual health, work-life balance, and practical aspects of parenthood. Nursing consultations also include patient educational opportunities in relation to any concerns regarding pregnancy and rheumatic disease. The purpose of this coordinated approach between rheumatologists and RNs is to provide seamless support throughout every phase of the patient's reproductive journey, optimizing patient care outcomes.

Our primary objective was to evaluate patient satisfaction with our integrated care pathway. As secondary objectives we aimed to describe the problems patients experience during the care pathway process and to identify the unmet needs that were not covered by the care pathway. Ultimately, the results of this study can be used to determine the most effective timing and delivery of counseling information and to enhance the support provided to women with inflammatory arthritis throughout their journey into motherhood.

Out of 181 women invited, 95 responded, resulting in a completion rate of 52.5%. The demographic characteristics of participants are presented in Table 1.

Our study explored the experiences and expectations of women with IA accessing specialized care during pregnancy within the Reproductive Rheumatology care pathway. Overall, participants expressed high satisfaction with the integrated care provided by the care pathway, including rheumatologists and specialized nurses, highlighting the pathway's efficacy in meeting the complex needs of women with IA throughout their reproductive journey.

Challenges encountered, such as managing disease flares and difficulties with conception, were reported by a subset of participants. However, with the support of the care pathway team, most issues were effectively managed, highlighting the accessibility and effectiveness of healthcare interventions in this setting. The finding that a majority of women with unresolved problems were expecting their first child may indicate additional challenges for first-time mothers.

Information needs varied significantly across different pregnancy phases. During the preconception phase, participants sought guidance on medication safety, fertility, and hereditary considerations. In contrast, pregnancy and postpartum phases emphasized disease management, medication safety during breastfeeding, and overall well-being. Postpartum, there was also a strong desire for practical advice ergonomic tips, and shared experiences from other women.

Participants strongly endorsed the role of counseling provided by the care pathway team, reporting increased knowledge and confidence about, pregnancy, and postpartum care. However, challenges in accepting help and maintaining confidence were also noted, suggesting the importance of personalized support strategies tailored to individual needs.

Healthcare professionals should recognize that these factors can significantly influence a patient's overall well-being and should be integrated into clinical care. Additionally, it is important to encourage patients to feel comfortable seeking help, whether from healthcare providers, family, or their social circle. Creating a supportive atmosphere where patients feel empowered to ask for assistance is critical to improving both physical and emotional outcomes.

While our study benefited from a robust methodology, including a tailored questionnaire and high response rate, it is important to acknowledge limitations such as potential response bias, the retrospective nature of data collection and the use of a non-validated questionnaire. Future research could explore longitudinal outcomes and assess the sustained impact of interventions within similar specialized care pathways.

When comparing these findings to other studies on similar care pathways, our approach demonstrates the value of comprehensive integration between specialized nurses and rheumatologists, distinguishing it from traditional models that often lack coordinated care. For example, other studies have highlighted that fragmented care systems can leave patients feeling unsupported and overwhelmed (7, 8).

In contrast, our reproductive rheumatology model mitigates these issues by providing consistent, interdisciplinary, and holistic support throughout each phase of pregnancy. This includes flexible appointment scheduling, customized counseling, and a focus on psychological resilience, tailored to individual needs. These features not only improve patient confidence and acceptance of care but also contribute to enhanced outcomes and satisfaction. We believe these lessons could inform the development of more effective, patient-centered care pathways in the future.

In conclusion, our findings underscore the pivotal role of Reproductive Rheumatology care pathways in supporting women with IA through pregnancy. By addressing specific challenges and information needs, healthcare providers such as RNs can enhance the quality of care and outcomes for these women, ultimately improving their reproductive health and well-being.