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ACR21 Best Abstracts - Day 1
The RheumNow faculty have been glued to their monitors all day, watching video, and running down abstract presentations to find the best – several of these stood out as #ACRBests. Here is a listing of “Best” they saw on Day 1.
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Increased Preterm Birth Risk in Psoriatic Arthritis Pregnancies
Pregnancy outcomes may be affected by psoriatic arthritis or antirheumatic treatment; registry cohort study shows that preterm birth and cesarean delivery were mostly increased by antirheumatic treatment, especially biologics.
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RheumNow Podcast – Rheumatologist Smoke-Enders (10.22.2021)
Today I have a few questions: Is tramadol really a weak narcotic? Should we really still be doing placebo-controlled trials? What are we going to do about our patients who are smokers? This and more, in this week's review of the news and journal articles.
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"Healthier moms lead to healthier babies. This is how I frame the discussion regarding medications and PsA in my practice (with regard to reproductive health)." Dr. Talabi #ACR21 @RheumNow #RheumNow
Dr. Rachel Tate uptoTate ( View Tweet)
Dr B Bermas noted AAP guidelines say avoid MTX while breastfeeding, but the literature show very little MTX crosses breast milk. Dr Sammaritano stated that is true, but we don’t know how much MTX accumulates,though. #acr21 @rheumnow @UTSWRheum https://t.co/9I7HszorEO
TheDaoIndex KDAO2011 ( View Tweet)
Would you allow a pt to continue MTX while breastfeeding? #acr21 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
#ACR2021 Dr. L Sammaritano shows evidence for using belimumab during breastfeeding @RheumNow https://t.co/kDXXauoOZQ
Donald Thomas, MD lupuscyclopedia ( View Tweet)
Remember: IUDs are the easiest contraception to recommend to SLE patients... Sammaritano lecture going on now #ACR2021 @RheumNow https://t.co/ZGRFIZyf5h
Donald Thomas, MD lupuscyclopedia ( View Tweet)
Irish registry of AS pts included 76 women who were pregnant
⭐️58% uncomplicated, 41.9% complicated, 11% multiple complications
⭐️frequency of miscarriage ⬆️
⭐️complications included C-section, preterm, NICU admission
#ACR21
@RheumNow
Abs#369 https://t.co/90dolEeTIw
Robert B Chao, MD doctorRBC ( View Tweet)
Lupus Nephritis in pregnancy:
@HopkinsRheum Petri recommendations
⭐️AZA safe for LN, with tacro if needed
⭐️❌Voclosporin (alcohol content)
⭐️Belimumab uncertain
@Rheumnow #ACR21 Great Debate
Eric Dein ericdeinmd ( View Tweet)
#ACR21 #ACR2021
Rheumatology Reproductive Health
👉🏻 Biologics and breast milk
👉🏻 Good vaccine response with TNFi (like with covid vaccines )
👉🏻 ustekimumab seems safe in pregnancy
👉🏻 Tofacitinib/ small molecules may cross placenta/ be in breast milk ➡️ contraindicated in preg/BF https://t.co/qk3sLR4QHz
EnvisionRheumat ERheumat ( View Tweet)
ASRI data: high frequency of pregnancy and fetal complications (miscarriage, c-section, early delivery, NICU admission) in AxSpA pts. We need more studies regarding risks/tx/outcomes/breastfeeding guidance. Abs 0369 #ACR21 #RheumNow @RheumNow https://t.co/4BR2ZPPjyB https://t.co/qyTwtfEMMy
Dr. Rachel Tate uptoTate ( View Tweet)
@jhrheumatology Dr. Petri at #ACR21 Great Debate.
Safety issues with Voclosporin:
1) Nephrotoxicity
2) Infection
3) CV Risk Factors
4) Malignancy
5) Neurologic toxicity
6) Osteoporosis
7) Drug interactions
8) Deaths
9) Pregnancy contraindication
@RheumNow https://t.co/wjluivmKNt
Eric Dein ericdeinmd ( View Tweet)
Is holding MTX during breastfeeding overblown?
@MotherToBaby data showed that infants get 0.4% of mom’s dose 24 hrs post-MTX dose. Skip breastfeeding 1 day post-MTX may be safe. Consider monitoring infant CBC. Studies needed to follow infants longitudinally #ACR21 @rheumnow https://t.co/ikJvkk5BjI
TheDaoIndex KDAO2011 ( View Tweet)
Dr. Chambers review @MotherToBaby prospective data on HCQ use in pregnancy (n=279):
👉no major defects (regardless of dose)
👉no oral clefts
👉SGA slightly lower in exposed group b/c of underlying dz
👉no case of retinopathy in babies after 1 year f/u @rheumnow #Pregnancy https://t.co/vw2eryFgro
TheDaoIndex KDAO2011 ( View Tweet)
Dr. Chambers reviewed @MotherToBaby data of pregnant rheum women during the pandemic noted:
⬆️EtOH use in pregnancy,
⬆️stress, anxiety, depression
⬆️obesity
⬇️likelihood to get prenatal care
#ACR21 @rheumnow #RheumPregnancy https://t.co/GCYCIuiunS
TheDaoIndex KDAO2011 ( View Tweet)
Which of the following would you d/c in the 3rd trimester of pregnancy? #ACR21 #Pregnancy @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
Experts (Drs. M Clowse, Sammaratino) limit mAb TNFi 1 month b/f delivery or extend dosing. But, they do dose again for flares. Risk for infection is low based on the PIANO registry. Postpartum, they restart the meds w/in 1 week (vag delivery), 2 weeks C/S @rheumnow #pregnancy
TheDaoIndex KDAO2011 ( View Tweet)
Dr. M Clowse (on HCQ during pregnancy):
👉All pregnant women get HCQ 400 mg/day regardless of how big they are (she does not dose based on mg/kg/d)
👉with maternal metabolism/volume distrib, levels are low.
#ACR21 @rheumnow #pregnancy @drbags71 https://t.co/dZtFLdKOvk
TheDaoIndex KDAO2011 ( View Tweet)
ICYMI: In a real world study of lupus patients, aspirin use lowered risk of preeclampsia, as did hydroxychloroquine. Risk Factors for preeclampsia were high Dz activity 1st trimester(OR 4.55),BMI >30 (6.14),antiphospholipid synd (8.02),hx preeclampsia (9.8)https://t.co/giBamMAPRM https://t.co/NHKxlmEHQj
Links:
Dr. John Cush RheumNow ( View Tweet)
