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Psoriatic Arthritis and Pregnancy

Mar 20, 2023

At RheumNow Live this weekend, Dr. Christina Chambers, an epidemiologist at the University of California San Diego and the principal investigator of MotherToBaby Pregnancy Studies, reviewed the available data on psoriatic arthritis and pregnancy, which is relatively small. There is little

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Metanalysis shows Takayasu's arteritis pts are at higher risk of adverse pregnancy outcomes. (27 studies, 825 pregs) showed more miscarriage (16%), hypertension (37%) and pre-eclampsia (14%) in TA patients (p < 0.01)
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
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%
S.Korean population based study shows the frequency of pregnancy induced de Quervain's tenosynovitis (DQT) between 2013-17 was 2.1% of all preg women. Risk factors: ≥ 30 yrs, multiple gestation, C-Section, HTN in preg, RA (DM not a risk)
Low dose prednisolone in RA. GLORIA shows toxicity can be a real issue. @RWCSmtg @RheumNow #RWCS23
Pregnancy & RA: metanalysis of 9 studies, 12K RA pts met vs 10 million controls. RA preg have more maternal complications (C sect OR 1.55; preeclampsia OR, 1.6; preterm OR, 1.8) & neonatal probs (low gestat wt, ICU OR 1.34, & stillbirths OR, 1.99).
Meta-analysis (21 studies, 3948 pregnant pts) HCQ may reduce risk of preeclampsia (OR 0.45) & premature delivery (OR 0.84) in pregnant autoimmune pts. HCQ may also reduce risk of gestational HTN (OR 0.42) & pre-term birth (OR 0.63) in pregnant SLE pts
Variable Pregnancy Outcomes with Belimumab in SLE An analysis looked at outcomes in pregnant SLE exposed to belimumab reported there are few pregnancies and confounding disease and comorbidity factors to provide clear guidance for such patients.

Simon Says “Don’t Do This” (1.27.2022)

Jan 27, 2023

Dr. Jack Cush reviews this week’s journal articles, focuses on studies that should not have been done and responds to viewer questions in Ask Cush Anything.

  1. "Dry Synovitis" exist in juvenile arthritis pts? Study of 12 DS pts, says its different from Poly #JIA; onset 6.1 yrs

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Variable Pregnancy Outcomes with Belimumab in SLE

Jan 24, 2023

An analysis of the belimumab clinical trials, the Belimumab Pregnancy Registry (BPR), and postmarketing/spontaneous reports looked at outcomes in pregnant systemic lupus erythematosus (SLE) exposed to belimumab reported there are few pregnancies and confounding disease and comorbidity factors

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Worse Birth Outcomes in RA and SLE

Jan 11, 2023

A population-based retrospective cohort study patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) and their infants demonstrated significant adverse pregnancy outcome, particularly the infants of women with SLE. This included maternal/infant rehospitalization,

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Three (3) Worst Drugs to use in #Lupus patients who want to be pregnant (MTX, MMF, CTX) #UTSWSLE2022
SLE preg delivery hospitalizations (77560) was associated with increased risk of CV complications, including preeclampsia [aOR 2.12] , peripartum cardiomyopathy (4.42), CHF (4), arrhythmias (2.2), AKI (7.7), stroke (4.8), VTE (6.9) w/ incr hosp costs

Lupus Linked With Greater Risk of Cardiovascular Complications of Childbirth

Dec 02, 2022

Pregnant women with systemic lupus erythematosus (SLE) were more prone to cardiovascular complications during delivery, and their risk seems to have increased over the past 15 years, according to national administrative data.

The cross-sectional study supports the role that the

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Practical Guidance for the Clinical Rheumatologist in Unplanned Pregnancies

Nov 25, 2022

Discussions regarding family planning, contraception, and pregnancy should be approached at each clinic visit to ensure providers understand patients’ personal goals. These conversations have the potential to decrease the risk of unplanned pregnancies. However, rheumatologists may need to manage

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Impact of COVID 19 on Pregnancies in Women with RMD Dr. Cassy Sims ( @DrCassySims) discusses abstract 0950 at #ACR22.

SLE: Variability in Racial Disparities in Pregnancy Outcomes

Significant disparities exist in pregnancy outcomes in women with systemic lupus erythematosus (SLE), with previous cohorts identifying Black women as having a higher risk of maternal mortality compared to White women with SLE.

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Are your SpA pts planning on conceiving? Be careful with NSAID use French study found age and NSAID use associated with longer time-to-conception. Factors not associated: smoking, BASDAI score, DMARD use #ACRBest Abs#1673 @RheumNow #ACR22
Stop MTX and increase folic acid to 5 mg/day for pts who find themselves with an unintentional #pregnancy. -@CuoghiE #ACR22 @rheumnow
Dr. Megan Clowse gives 2 major tips on how rheumatologists can help avoid catastrophic pregnancies: ✳️Routinely ask open-ended Qs to promote HONEST dialogue about repro health ✳️Provide ACCURATE info & guidance using discussion guides and handouts #ACR22 @RheumNow @rheumarhyme
🔥Ignite Talk 10:20AM South Philly Stage🔥 abstract #0946 SLE, birth control, & pregnancy planning 🔥30% of women used no birth control despite only 17% voicing interest in pregnancy 🔥More 1/2 of women interested in pregnancy were not medically ready #ACR22 @RheumNow
🧨Late breaking abstract🧨 #ACR22 @RheumNow #ACRbest Identifying fetal myocardial targets in congenital heart block (CHB) Abstract #L13 🫀maternal serum underwent mass spec. that identified Ab to 4 protein targets that predicted CHB including anti-ATP1A1 as early as 7w
What has changed since the 2020 @ACRheum #reproductive guidelines? Abstract #1717 425 SLE/RA patients: 📍 significant improvement in pre-#pregnancy counseling and discussions in reproductive goals 📍No improvements in birth control use or documentation