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NSAIDs in Pregnancy (3.3.2023)

Dr. Jack Cush reviews the lastest journal articles, news, and FDA announcements from the past week on RheumNow.  This week, the importance of IFNa, Subclinical PsA and NSAID safety during Pregnancy.

  1. Study of 87 pts with isolated Nail Psoriasis noted that 11% went on to have #PsA (concurrently or within 3 years). NP findings were mainly onycholysis in79% and nail pitting in 70%

  2. Prospective study of 490 mod-to-severe psoriasis compared prospectively by exam & US for PsA - 384 w/o arthritis (Silent PSO), 80 non-PSO & 106 w prodromal or active PsA (12.7%). US synovio-enthesitis in 1.8% of controls & 16.1% of silent PSO (p< 0.001)

  3. 5 Nordic register study of new b/tsDMARD starts in in PsA - 5659 ADA (56% biologic-naïve) & 4767 other b/tsDMARD (21% naïve) starts. ADA more often 1st line; newer b/tsDMARDsin biologic-experienced. 2nd line retention: ADA 65%, ABA 45%, Otez 43%.

  4. CorEvitas registry data shows H2H comparison of 369 CCP+ abatacept & 475 CCP+ tofacitinib treated patients showed equivalent drug responses (reduced CDAI or PRO's); b/tsDMARD naive pts had numerically better ABA response at 6 mos (P = 0.662)

  5. 51 Juvenile SLE (j-SLE) studied for neuropsychiatric Dz (j-NPSLE)- 39% presented with jNPSLE. While no clear biomarker/imaging of j-NPSLE identified, they found CSF neopterin (& IFN-α) levels signif higher w/ active j-NPSLE & CNS involvement (p=0.0008)

  6. While anifrolumab targets IFN alfa in SLE, its unclear how much IFNa is needed for Rx response. A study of 40 pts shows Rx naive SLE has signif higher serum IFN activity; this is assoc w/ fever, leukopenia, ALE rash and oral ulcers & more organ damage

  7. Drs Schett & Mackensen reported a case of refractory inflammatory myositis successfully treated with CD19 CAR T cells. 41yoM w/ +Jo-1, myositis, ILD, Raynauds, periorb edema, not responding to steroids, RTX, IVIG, tacrolimus, CTX

  8. Swedish registry of Axial SpA pregnancies, 1580 births (matched 1:10), saw improved Preg outcomes & incr biologic use. SpA pts had signif. incr in preterm (RR 1·43), preeclampsia (1·44), C-Sect (1·59), infant SIE (1·29) - Each decreased by annually 0.5%

  9. Korean study Neonatal/maternal outcomes w/ NSAIDs. 1.8 million pregn assoc w/ early preg NSAIDs exposure - incr risks for major congenital malformations (adjRR 1.14), low birth Wt (1.29) & maternal oligohydramnios (1.09); higher w/ COX-2i or NSAIDs>10d

  10. Study of 78 pt suspected of #GCA undergoing Temp. artery Bx and US. Nearly half (35) Dx w/ GCA. Both had similar sensitivities(69% and 63%, respectively), but specificity higher w/ biopsy (100% vs 79%). Compression sign had best diagnostic performance

  11. Sarilumab is FDA Approved for PMR 

  12. VEGA - The Efficacy of Combination Biologics in Ulcerative Colitis 

  13. Register for RheumNow Live 2023 !


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