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.
All News
Article
Article
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.
Article
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
Article
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
sheila
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
Akhil Sood MD
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
Richard Conway
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
Akhil Sood MD
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
Bella Mehta
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
sheila
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
Bella Mehta
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
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
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
Antoni Chan MD (Prof)
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
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
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
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
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
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
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


