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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
Dr. John Cush RheumNow ( View Tweet)
Sniffles & Arthritis (3.1.2024)
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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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
Dr. John Cush RheumNow ( View Tweet)
Autoimmune disease and pregnancy
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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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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
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
@drcassysims recommends @NIH resource: https://t.co/ebtvc2zYbE to guide lactation- updated and run by pharmacists. #RNL2024 @rheumnow
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
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)
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)
Dr. A. Armstrong's Key Takeaways for PsO.
TNFi - great in PsA and pregnancy
IL-17i - robust PsO efficacy and in PsA
IL-23i - robust in PsO, fewer injections, and efficacious in PsA.
#RNL2024 @RheumNow @_AprilArmstrong https://t.co/j8LaOGITuf
Dr. Rachel Tate uptoTate ( View Tweet)
QD Clinic - Suspend MTX How Long?
Pregnancy and MTX - how long do you have to be off?
https://t.co/pTz8nlHpWN https://t.co/YrG7cKgbvF
Dr. John Cush RheumNow ( View Tweet)