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Reproductive Issues in axSpA: Fertility and Pregnancy

Sheila Reyes, MD

Axial spondyloarthritis (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 reproductive age. Two interesting abstracts about reproductive issues in axSpA will be presented during the poster sessions on Saturday, November 16, 2024.

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Predictors of Adverse Pregnancy Outcomes in Lupus

Jack Cush, MD

A large metanalysis of systemic lupus erythematosus (SLE) patients and pregnancy outcomes suggests that adverse pregnancy outcomes are more likely in those with lupus nephritis, chronic hypertension, SLE disease activity before and at concept

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ANA+ consult (10.18.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.

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Which One is the Loneliest Number (9.27.2024)

Jack Cush, MD

Dr. Jack Cush reviews the regulatory approvals, announcements, guidelines and interesting journal articles from the past week on RheumNow.com. When not to use muscle relaxants, how frequent is loneliness in RA/PsA/SpA, and when to refer patients with Still's disease.

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Systemic Sclerosis Insights (9.13.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.

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Low Placental Transfer Rates with Risankizumab

Jack Cush, MD

There are significant concerns about the safety of drug use during pregnancy and lactation, especially newer biologic agents. This is complicated by a lack of research. 

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Does Rheumatoid Factor Influence Anti-TNF Responses in RA?

Jack Cush, MD

Smolen and colleagues have published a subanalysis of the EXXELERATE study that showed while certolizumab pegol [CZP] concentrations and efficacy was unaffected by high titers of rheumatoid factor (RF), patients treated with adalimumab had a blunted response in the face of high RF titers.

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#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

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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)
A systematic review highlights the impact of glucocorticoids (GC) during pregnancy and lactation. Increased risks of preterm birth were noted with GC exposure, advocating for minimized doses and pregnancy-compatible treatments. Encouragingly, low levels of GC found in breast milk… https://t.co/7CnJUBrUDQ https://t.co/ZeGHFHNT13

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Predictors of Adverse Pregnancy Outcomes in Lupus A large metanalysis of systemic lupus erythematosus (SLE) patients and pregnancy outcomes suggests that adverse pregnancy outcomes are more likely in those with lupus nephritis, chronic hypertension, SLE disease activity before… https://t.co/31dqOyD3ZR https://t.co/L9LMn2CPYS
Dr. John Cush RheumNow ( View Tweet)
Retrospective population study of 383 #AS women who were pregnant (3.8/100,000) compared to controls. AS-Preg pts more likely to be older; White, w/ higher incomes, MORE thyroid Dz, Pregs, C-Sections, gestational DM, placenta previa, more neonatal SGA, IUFD… https://t.co/pgsmKgljwx https://t.co/IMJ8CTrqhY
Dr. John Cush RheumNow ( View Tweet)
Eu Heart J - Cardiometabolic risk factors in RA Pregancy rose in last 15 yrs. RA-Preg at higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, acute kidney injury, venous thromboembolism during hospitalizations. https://t.co/7SnjWFluCf https://t.co/H93ELPZWWz

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Dr. John Cush RheumNow ( View Tweet)
JCI article on Mechanisms underlying sex differences in autoimmunity - factors include sex hormones, X chromosome genes, sex-specific epigenetic effects of estrogen & environment, and microRNA effects. Also mitochondria & autoantibodies discussed https://t.co/hTrizE8jFK https://t.co/VixAZsYBzb

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Dr. John Cush RheumNow ( View Tweet)
In utero exposure to upadacitinib review w/ 128 maternal exposures & known outcomes; 80 from RCTs & 48 Postmarketing Pregs. From RCTs - 54-46% live births, 24-38% spont. abortions, 21-15% elective Ab, 1-2% ectopics from RCTs & Postmarketing. No evidence of teratogenicity… https://t.co/s3VJspI59V https://t.co/tV48sKyF8x
Dr. John Cush RheumNow ( View Tweet)
Lupus nephritis & CKD considerations: - Non-immune factors: obesity, HTN, Na- or protein-diets, NIDDM, pregnancy, mephrotoxic meds, smoking can add to CKD - use inhibitors renin–angiotensin & SGLT2 inhibitor w/ proteinuria & low GFR https://t.co/IgL4hpixOm https://t.co/FvmLhf7tQq

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Dr. John Cush RheumNow ( View Tweet)
Full read review of Neonatal lupus syndrome - caused by pathogenic maternal autoAbs (SSA, SSB) in fetal circulation. Mild Sxs in 25%, severe Sxs are rare; Heart block in up to 2% of neonates born to mothers with positive antibodies. https://t.co/iH4MBRGvg1 https://t.co/kXxIeQC47m

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Dr. John Cush RheumNow ( View Tweet)
So You've Got RA and Want to Get Pregnant? Dr. David Liew reviews abstract POS0436 presented at Eular 2024 in Vienna, Austria. https://t.co/vG9l7kOReq https://t.co/xhumOCisOM

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Dr. John Cush RheumNow ( View Tweet)
Birth Control Use in Lupus Published guidelines on lupus mgmt urge that female patients plan and prepare carefully for pregnancy, and use contraceptives when it's not intended -- but these reco’s are rarely followed, a registry study suggested. https://t.co/81mQbp5Sib https://t.co/NJmwxvtR44

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Dr. John Cush RheumNow ( View Tweet)
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