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Methotrexate Monitoring (5.13.2022)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Bad news for digitial ulcers in Systemic sclerosis, Readmissions in Lupus and Thrombocytopenia in APL patients.
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$30 Billion and Counting (4.29.2022)
Dr. Jack Cush reviews the news and journal reports and takes viewer questions this week.
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GR2 cohort prospective study of pregnancies in 126 pts w/ SpA over 15 years
-Rx exposure 23% steroids, 11% NSAIDS, 55% biologics
- 116 live births, 7 miscarriages, 3 stillbirths
- 36.5% had unfavorable pregnancy outcomes
- 19% SGA
- 4.8% preterm birth
#EULAR2022 @rheumnow POS1000
TheDaoIndex KDAO2011 ( View Tweet)
#OP0002 #EULAR2022 What immune tests to monitor during pregnancy in #lupus? A meta-analysis found:
💠32% had a flare (new IS or Pred>9mg/d)
💠⬇️C3 and/or C4 in 1st Trimester predicted LN or SLE flare
Worth checking C3/C4 in each trimester @RheumNow https://t.co/fPEXwReK7u https://t.co/BX6fzKzfvC
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Retrospective pregnancy outcome study in 154 Rheumatic pts. Systemic sclerosis pts had higher risk of adverse preg outcomes (vs HC - 60.6% vs 10.0%; OR = 14; SSc had increase in 1st trimester miscarriage, preeclampsia, SGA & Preterm https://t.co/hfd6SsCRmr
Conclusions
Links:
Dr. John Cush RheumNow ( View Tweet)
Watch: Pregnancy Paradox: How Stopping Drugs Leads to Greater Harm
Uma Mahadevan, MD talks about the pregnancy paradox and how stopping medications in pregnancy to protect the fetus can actually lead to greater harm.
https://t.co/HYO5BdjwzZ https://t.co/IGeZ3O8Dno
Links:
Dr. John Cush RheumNow ( View Tweet)
Three (3) Worst Drugs to use in #Lupus patients who want to be pregnant (MTX, MMF, CTX) #UTSWSLE2022 https://t.co/YBeLTuRLO1
Dr. John Cush RheumNow ( View Tweet)
Algorithmic approach to SLE and assessing/treating early pregnancy. #UTSWSLE2022 https://t.co/692el4R9sZ
Dr. John Cush RheumNow ( View Tweet)
Adverse pregnancy outcomes and Risks in #SLE. (Dr. Eliza Chakravarty - OMRF) #UTSWSLE2022 https://t.co/HqscJD2m96
Dr. John Cush RheumNow ( View Tweet)
Nearly 40% of all #SLE pregnancies are unplanned - hence, contraception (unused in 73%) and education are paramount in management of women w/ SLE. (Dr. Lisa Sammaritano- HSS) #UTSWSLE2022 https://t.co/ooryrW9GGn
Dr. John Cush RheumNow ( View Tweet)
Danish case-control registry of 491,274 women shows Psoriasis assoc w/ increased risk of ectopic pregnancy (EP) (OR 1.34), highest in women w/ moderate-to-severe psoriasis (OR 2.77). EP risk was 2.5x higher for women w/ mod--severe PSO https://t.co/vUtNEMDOhr
Links:
Dr. John Cush RheumNow ( View Tweet)
Canadian study of 6012 Pregnancies w/ +COVID-19 PCR test shows Preg pts increased risk of hospitalization (RR 2.65) & ICU adm (RR 5.46) vs gen population and higher risk of preterm birth vs preg women without COVID (RR 1.63) https://t.co/6UAaa0Jf8j https://t.co/aLQbxZArmq
Links:
Dr. John Cush RheumNow ( View Tweet)
Pregnancy outcomes in systemic sclerosis (SSc) studied in 154 pregnancies from SSc, SLE, APS, & controls (2008 to 2019). Adverse Preg Outcomes APO significantly higher in SSc vs HC (61% vs 10%) w/ more miscarriages, preeclampsia, SGA & preterm births https://t.co/P3uksmJy6V https://t.co/nTtgwjdGgL
Links:
Dr. John Cush RheumNow ( View Tweet)
UK drug safety warning, observational data 2700 pregnancies, 1st trimester pregabalin (Lyrica) use was assoc w/ higher rate of congenital malformations (5.9 vs 4.1%). US PI label says Lyrica use in Pregnancy "May cause fetal harm". https://t.co/GdIitpe8KW
Links:
Dr. John Cush RheumNow ( View Tweet)
Steroids associated with adverse events during pregnancy @UmaMahadevanIBD @MayoClinicGIHep https://t.co/VR5CZUH1S7
Edward Loftus EdwardLoftus2 ( View Tweet)
JAMA reports another study showing safety of COVID-19 vaccination during pregnancy with no incr in adverse pregnancy outcomes. Scand study of 157,521 births - 0.7%, 8.3%, 9.1% of were vaxD during 1st, 2nd, 3rd trimesters https://t.co/dZuabwr1Sf https://t.co/CtzMoEV1Ee
Links:
Dr. John Cush RheumNow ( View Tweet)
Canadian population study shows that mRNA COVID-19 vaccination DURING 2nd &3rd trimester of pregnancy did not increase rate of adverse peripartum outcomes (vs no vax or vax post-Preg). Comparison of 97 590 Preg vs 44 815 non-preg https://t.co/n7nWcoLw4S https://t.co/uiVOg5A1S8
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Dr. John Cush RheumNow ( View Tweet)
ICYMI: Drugs for Pregnancy Hopefuls
A Young Woman has uncontrolled RA, but wants to get pregnant.
What do you chose?
https://t.co/Sunx8RWRfM https://t.co/hsFNhVfwHd
Links:
Dr. John Cush RheumNow ( View Tweet)
98 axial SpA women with 335 pregnancies (279 live births) shows preterm birth ( (12.5 v 5.2%), preeclampsia(6.8 v 2.8%) & LBW (8.2 v 2.9%) more prevalent in axSpA, possibly due to incr disease activity during pregnancy & postpartum https://t.co/Bp8QjBXg2K https://t.co/j0xKVvSPIH
Links:
Dr. John Cush RheumNow ( View Tweet)
Healthy mother = healthy baby
Pregnancy and neonatal complications linked to disease activity and inflammation
@RheumNow #RNL2022 https://t.co/MeBnYnSfuK
Robert B Chao, MD doctorRBC ( View Tweet)
