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Contrasing ACR/VF and EULAR GPA guidelines from @anisha_dua @RheumNow #RNL2024 https://t.co/RLJx9fJHGk
Richard Conway RichardPAConway ( View Tweet)
"Real world studies: When people stop being polite and start getting real." Dr @anisha_dua #RNL2024
Comparing Walsh to Nagle in terms of primary outcomes, regimens, pt populations, and plasma exchange.
@RheumNow https://t.co/io8OGnWxdS
Dr. Rachel Tate uptoTate ( View Tweet)
Is there data for PLEX in GPA?
@anisha_dua #RNL2024 @RheumNow
PEXIVAS negative study
But subgroups show decreased dialysis...
But, no improvement in mortality and increased infection risk https://t.co/K9VbcNNsge
Eric Dein ericdeinmd ( View Tweet)
#RNL2024 @RheumNow
@anisha_dua
Throwing the kitchen sink in severe GPA
CYC + RTX combo - sick population (median GFR 9, 47% on HD, 52% DAH, all received PLEX too)
- 85% survival, 69% not ESKD, low rates of relapse (13% at 36 mos)
But, prolonged B cell depletion, aggressive Rx https://t.co/9AZFMQ3o9P
Eric Dein ericdeinmd ( View Tweet)
#RNL2024 is up and at ‘em this Sunday morning! @RheumNow @KDAO2011 @RichardPAConway @ericdeinmd https://t.co/AtL9QiRnW4
Dr. Rachel Tate uptoTate ( View Tweet)
@anisha_dua reviews differences between EULAR vs ACR Vasculitis guidelines #RNL2024 @RheumNow https://t.co/1aIbnX5KBI
TheDaoIndex KDAO2011 ( View Tweet)
@anisha_dua reviews GPA management in 2024. Here are your ACR/VF 2021 and EULAR 2022 guideline updates. Review these regimen options for your patients. #RNL2024 @RheumNow https://t.co/SvQoe0YKKV
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
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
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)
"Please remember to discuss personal goals with patients (such as having children) centered around options that would not risk personal health (disease worsening, flaring, death, etc), such as surrogacy in pregnancy." @DrCassySims @RheumNow #RNL2024
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
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
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
TheDaoIndex KDAO2011 ( View Tweet)
Pregnancy in vasculitis checklist:
- goals and timeline
- disease activity in 12 mos
- is there end organ damage?
- Review Rx
- h/o clots/miscarriages, APLS?
- Check Ro/La
- Role for ASA?
- Refer to MFM
Catherine Sims #RNL2024 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
How do vasculitis pts do during pregnancy?
Variable due to different diagnoses of flares
Gatto 2012: TA 3% flare, GPA 45% flare
Fredi 2015: 35% flare
Nguyen 2021: LVV 25% flare, 36% SVV
-Catherine Sims
#RNL2024 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
2nd kidney biopsy in lupus nephritis have value. @andreafava
#RNL2024
@RheumNow https://t.co/47J1CGQL81
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#RNL2024 day 2:
- Vasculitis Pod with @anisha_dua and @philseo
- STEP talks: @DrLisaCS on myositis malignancy screening, @EBRheum on ANCA myths, @RheumNow dead words in rheum
- Spondy Pod with @JointMD @lihi_eder @LianneGensler
Eric Dein ericdeinmd ( View Tweet)