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Is Pregnancy Truly the Solution for RA?
Pregnancy is perhaps the oldest treatment in rheumatoid arthritis (RA) and has been associated with a natural improvement in disease control in 50-75% of patients. Others, however, are not as successful with unchanged disease activity or worsening of their autoimmune disease.
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Reproductive Issues in axSpA: Fertility and Pregnancy
axSpA affects young patients with symptom onset occurring in early adulthood. Apart from pain and quality of life, reproductive issues also arise because patients who are diagnosed with the disease are also in their… https://t.co/8tLFOvFqdO https://t.co/E3AOOCHTgu
Dr. John Cush RheumNow ( View Tweet)
If a mother has had TNFi during pregnancy, can a baby have a live oral rotavirus vaccine (usually at 2mo)?
This claims data suggests no increase in diarrhoea
Adds to similarly reassuring 🇨🇦prospective cohort data https://t.co/2Tz9zRhPjz
Vaccinate away!
#ACR24 ABST0806 @RheumNow https://t.co/66OIAR8W6l
Links:
David Liew drdavidliew ( View Tweet)
Nice data from the OTIS Autoimmune Disease in Pregnancy Project re: certolizumab-exposed pregnancies:
- spontaneous loss rate comparable to non-disease controls
- no stillbirths
- preterm similar to disease controls
Plenty positive for CZP in pregnancy!
#ACR24 ABST0805 @RheumNow https://t.co/XCRYsioxC0
David Liew drdavidliew ( View Tweet)
A key practice changing study (I hope) from #ACR24 has been the preCARA study. Fertility increases with aggressive disease control. My video on this study is up now on @RheumNow https://t.co/Pf3rdTHbOJ
Richard Conway RichardPAConway ( View Tweet)
In this systematic review & metaanalyis by Dr. RFarhat et al, tacrolimus whole blood levels decrease in the 1st & 2nd trimesters then increase back to pre-pregnancy levels postpartum.
Needs further studies to guide dose adjustment.
@RheumNow #ACR24 abs1535 https://t.co/5MovzPJoFc
sheila RHEUMarampa ( View Tweet)
Study on pregnancy outcomes in SLE with thrombocytopenia:
Higher disease activity, pregnancy loss, and stillbirth rates
Identified risk factors: Anti-β2GP-I positivity and higher SLEDAI score #ACR24 abst#1487 @RheumNow
Bella Mehta bella_mehta ( View Tweet)
Quaack etlal. PreCARA study (vs PARA, historical control). T2T in RA improves fertility - time to pregnancy 84 days vs 196 days. T2T strategy also led to less NSAIDs and prednisolone. @RheumNow #ACR24 Abstr#1647 #ACRbest https://t.co/vYCCUqpCLo https://t.co/PUHJOxgGbL
Links:
Richard Conway RichardPAConway ( View Tweet)
Plenary II: pregnancy in RA
When a treat to target approach is used to achieve remission, pregnancy rates nearly similar to general population!
Time to pregnancy less than half that of non-T2T comparators
@RheumNow #ACR24 https://t.co/B9F9M8t9Kt
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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Improved fertility in women with RA when treated with a Treat-to-Target (T2T) approach aimed at remission.
Key findings:
- Shorter time to pregnancy (TTP) in PreCARA cohort (84 days) vs. PARA cohort (196 days).
- Increased TNF-inhibitor use and lower NSAID/prednisone use in the… https://t.co/YyD2lpXVRC https://t.co/LH5LMOH8al
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Managing DMARDs in pregnancy. Curbside consults by Lisa Sammaritano @RheumNow #ACR24 https://t.co/FQrLNz4yCz
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
The DESIR cohort of Dr. Franc et al. showed that female pts with early axSpA had significantly lower AMH levels vs. general population reflecting low ovarian reserve & fertility.
Mechanism?
Bigger studies need to be done
@RheumNow #ACR24 abs577 https://t.co/842rX79bq6
sheila RHEUMarampa ( View Tweet)
Is it pre-eclampsia or lupus nephritis flare?
Abstract 0809: The sFlt-1/PlGF ratio may help distinguish preeclampsia from lupus nephritis in pregnancy. A low ratio ruled out preeclampsia, while a high ratio ± proteinuria suggests increased risk. @RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
Hamroun et al. Meta-analysis of glucocorticoids in pregnancy and breast-feeding. Increase pre-term birth with GCs, adjusted OR 2.24. Dose-dependent effect. Minimal breastmilk transfer. @RheumNow #ACR24 Abstr#0810 https://t.co/H0o9ElsHmc https://t.co/uciFP6UOhF
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Richard Conway RichardPAConway ( View Tweet)
Abstract #0805
Data from OTIS Registry shows Certolizumab pegol (Cimzia) exposure during pregnancy was not associated with increased risk of major birth defects, structural defects, or adverse pregnancy outcomes. #ACR24 @RheumNow
Akhil Sood MD AkhilSoodMD ( View Tweet)
Contraception counselling in #SLE post intervention
- Contraceptive counseling rates improved from 33.9% to 55.7%
- Women over 35 were 4.09 times more likely post-intervention
- Non-Hispanic Black women were less likely than Hispanic women
#ACR24 abst#0184 @RheumNow https://t.co/sOZXnAe4ov
Bella Mehta bella_mehta ( View Tweet)
High serum BAFF as a novel RF for dev't of preeclampsia in pregnant SLE pts?
This study by Dr. C Sims et al showed that SLE pregnancies w/preeclampsia had significantly higher BAFF levels during the 1st trimester, and likely w/ ⬆️dsDNA or ⬇️ complement
@RheumNow #ACR24 abs424 https://t.co/kNzyuT03r2
sheila RHEUMarampa ( View Tweet)
#ACR24 abst#0430
- Analyzed 61 SLE pregnancies
- Higher early gestational Mean Arterial Pressure before 20 Weeks linked to increased preeclampsia risk
- MAP trends at 8-10 and 17-19 weeks showed highest predictive accuracy for risk prediction
@RheumNow https://t.co/37mg0WX43v
Bella Mehta bella_mehta ( View Tweet)
FDA recently approved - fms-like tyrosine kinase 1 (s-Flt1) / placental growth factor (PlGF), for diagnosing preeclampsia.
sFlt1:PlGF≤38 rules out preeclampsia in SLE
sFlt1:PlGF>85 modestly predicts preeclampsia
Proteinuria impacts prediction accuracy #ACR24 abst#0809 @RheumNow
Bella Mehta bella_mehta ( View Tweet)
Study on pregnancy outcome disparities in SLE:
- Analyzed 685 women, 1888 pregnancies
- Pre-SLE state linked to fewer live births, higher preeclampsia risk
- Outcomes worse post-SLE diagnosis
#ACR24 abst#0440 @RheumNow https://t.co/NpEYQZ73uo
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Bella Mehta bella_mehta ( View Tweet)
