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Naysayers & Disrupters (3.22.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.

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Ides of March (3.15.2024)

Jack Cush, MD

Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.

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Sniffles & Arthritis (3.1.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Are these associations with infection, biomarkers and weather real or imaginary? Linked or luck? Causal or casual?  You decide....

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pregnancy,birth,preterm,baby

Autoimmune disease and pregnancy

EurekAlert!

 For many aspiring mothers with autoimmune disease, pregnancy can be daunting and full of unknowns. In some cases, those suffering from specific autoimmune conditions have chosen to forego pregnancy altogether due to concerns about their disease treatments and adverse pregnancy outcomes.

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1st trimester exposure to Plaquenil is not assoc. w/ risk of congential malformations (MCM). Swedish registry data on 1007 births (453 exposed) & 2500 births (144 exposed) in SLE & RA, respectively. MCM risks in SLE &RA were 3.4-5.7%, no diff betw groups https://t.co/lzbd7AQqy1 https://t.co/AsFYYBQQtm

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Dr. John Cush RheumNow ( View Tweet)
Japanese study of 96 #SLE pregnancies: 59 in remission @ conception. Remission had fewer adverse preg outcomes (OR 0.27) vs those w/ activity. No difference in APO based on serologies, but Pred ≥7.5/d us had signif. more APO. (OR 3) https://t.co/BvOeiSERN9 https://t.co/ePh1dqdJvS

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Dr. John Cush RheumNow ( View Tweet)
Review of autoimmune Dz & adverse preg outcomes: Incr risk of: - Miscarriage w/ Sjögrens (RR 8.85) & SLE (OR 4.9) - Preeclampsia w/ SLE (OR 3.2) - IUGR w/ scleroderma (OR 3.2) & celiac (OR 1.71) - Preterm birth w/ SLE (OR 2.79). https://t.co/bll2x2aS9Z https://t.co/Eg0sVBcPmR

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Dr. John Cush RheumNow ( View Tweet)
Danish registries study shows maternal Autoimmune Dzs (all) were assoc w/ incr risk of childhood cancers (OR=1.25, 95% CI 1.06, 1.47), acute lymphoblastic leukemia (OR =1.52), Burkitt lymphoma (OR=2.6) & CNS tumors (OR=1.45); same seen for RA mothers https://t.co/HQO972ch9R https://t.co/dDEJUo8unq

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Dr. John Cush RheumNow ( View Tweet)
Very insightful talk on Vasculitis and pregnancy by Catherine Sims. Pregnancy compatible medications. Remission state. Checking antibodies ; risk of transmission, pregnancy and fetal morbidity. #RNL2024 @RheumNow https://t.co/81NAN1ulO5

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
@drcassysims recommends @NIH resource: https://t.co/ebtvc2zYbE to guide lactation- updated and run by pharmacists. #RNL2024 @rheumnow

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TheDaoIndex KDAO2011 ( View Tweet)

MTX and cyclophosphamide are the two drugs @DrCassySims recommends holding during breast feeding in our vasculitis patients. #RNL2024 @RheumNow

Dr. Rachel Tate uptoTate ( View Tweet)

@DrCassySims checks APS ab on ALL pregnant (vasculitis) patients. "HCQ decreases neonatal lupus risk by half, meaning great reward for little risk." CS at #RNL2024 @RheumNow

Dr. Rachel Tate uptoTate ( View Tweet)

Nipple Raynaud's is an issue for some women with rheumatic diseases that occurs during breastfeeding and can be very painful @DrCassySims #RNL2024 @rheumnow https://t.co/HbaRpUnEBF

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TheDaoIndex KDAO2011 ( View Tweet)

High risk medications for pregnancy: MTX- 40% pregnancy loss, 6-10% birth defects MMF/CYC - 40% pregnancy loss, 25% birth defects Recommend 2 forms contraception on MMF Change meds slowly to safe Rx and monitor disease activity at least 3 mos before pregnancy #RNL2024 @RheumNow

Eric Dein ericdeinmd ( View Tweet)

@DrCassySims noted if pts get accidentally pregnant on Methotrexate, stop med and give high dose folic acid 5 mg/d and alert high risk OB/MFM #RNL2024 @RheumNow #ReproductiveRheum https://t.co/DFiwaTiHVf

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TheDaoIndex KDAO2011 ( View Tweet)
Clinical Pearl! @DrCassySims currently treats with ASA 81mg po daily during vasculitis pregnancies at 12 weeks for preeclampsia ppx. She notes there is some data/use of 162mg po daily in Europe which may change the way we practice in the future. #RNL2024 @RheumNow

Dr. Rachel Tate uptoTate ( View Tweet)

We can do our best to optimize them for the best possible pregnancy outcomes? 1. Confirm pregnancy goals/timeline 2. Discuss patient’s disease activity over the past 12 mo 3. Document end organ damage and the last time this was assessed 4. Review medications 5. Check… https://t.co/7xQsGW9dKa

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Dr. Rachel Tate uptoTate ( View Tweet)

"The most successful pregnancies are planned during periods of well controlled disease on pregnancy compatible medications." Dr. C Sims #RNL2024 @RheumNow @DrCassySims

Dr. Rachel Tate uptoTate ( View Tweet)

Rheumatology drugs in pregnancy. Just missing leflunomide in that big no no section @DrCassySims @RheumNow #RNL2024 https://t.co/ZPtTGRqPki

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Richard Conway RichardPAConway ( View Tweet)
@DrCassySims: the Pregnancy Checklist for #Vasculitis patients @rheumnow #RNL2024 #ReproductiveRheumatology 👉confirm pregnancy goals 👉review meds, dz activity in the last 12 months 👉document end organ damage 👉assess Ro/La 👉discuss role of ASA 👉work w/ MFM/subspecialists https://t.co/5z4XeMRzGI

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TheDaoIndex KDAO2011 ( View Tweet)
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