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

@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

• https://twitter.com/KDAO2011/status/1751604329423716773/photo/1

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

"Please remember to discuss personal goals with patients (such as having children) centered around options that would not risk personal health (disease worsening, flaring, death, etc), such as surrogacy in pregnancy." @DrCassySims @RheumNow #RNL2024

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

• https://twitter.com/i/web/status/1751603337965830333

"The most successful pregnancies are planned during periods of well controlled disease on pregnancy compatible medications." Dr. C Sims #RNL2024 @RheumNow @DrCassySims

Rheumatology drugs in pregnancy. Just missing leflunomide in that big no no section @DrCassySims @RheumNow #RNL2024 https://t.co/ZPtTGRqPki

• https://twitter.com/RichardPAConway/status/1751602526909075547/photo/1

@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

• https://twitter.com/KDAO2011/status/1751602416426815978/photo/1

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

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

2nd kidney biopsy in lupus nephritis have value. @andreafava #RNL2024 @RheumNow https://t.co/47J1CGQL81

• https://twitter.com/NoufAhmedAlham2/status/1751599520083738935/photo/1

#RNL2024 day 2: - Vasculitis Pod with @anisha_dua and @philseo - STEP talks: @DrLisaCS on myositis malignancy screening, @EBRheum on ANCA myths, @RheumNow dead words in rheum - Spondy Pod with @JointMD @lihi_eder @LianneGensler

Proteinuria doesn’t correlate with internal activity in lupus nephritis , we really need better biomarkers. @andreafava #RNL2024 @RheumNow https://t.co/bFuxVnUCEB

• https://twitter.com/NoufAhmedAlham2/status/1751598440541241861/photo/1

This is a crucial nuance. Men and women experience pain differently. The tendency to use that to then dismiss pain in women is entirely incorrect. @lihi_eder @RheumNow #RNL2024 https://t.co/X5QQsaIuNP

• https://twitter.com/RichardPAConway/status/1751498591733158363/photo/1
• https://twitter.com/RichardPAConway/status/1751498591733158363/photo/1

Dr. Gabalawy: "How do you know what disease patients will develop in this preclinical autoimmunity state?" @drdavidkarp "it's like when weeds pop up in a garden, it's random ...if ACPA Ab pops up, you might have RA, if it's dsDNA, maybe lupus." #RNL2024 @RheumNow https://t.co/JmDtaTt3sU

• https://twitter.com/KDAO2011/status/1751387693919945057/photo/1