1/600 Falls May Die (4.5.2024)
Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com - including problems w/ falls, pain and treatment of Dupuytren’s contractures.
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Activity & Pain Tolerance (3.29.2024)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, including where you should sit in clinic and why you should worry about secondary Sjogren's in RA.
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Higher Rates of Childlessness in Rheumatic Diseases
A large Finnish population study shows that several rheumatic diseases may impair reproduction and pregnancy outcomes, with significantly higher rates of childlessness or fewer children overall for women.
A nationwide cohort study of 5 339 804 Finnish citizens, born 1964–1984,
Naysayers & Disrupters (3.22.2024)
Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.
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1st trimester exposure to Plaquenil is not assoc. w/ risk of congential malformations (MCM). Swedish registry data on 1007 births (453 exposed) & 2500 births (144 exposed) in SLE & RA, respectively. MCM risks in SLE &RA were 3.4-5.7%, no diff betw groups https://t.co/lzbd7AQqy1 https://t.co/AsFYYBQQtm
Dr. John Cush @RheumNow( View Tweet )
Ides of March (3.15.2024)
Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.
Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory
Japanese study of 96 #SLE pregnancies: 59 in remission @ conception. Remission had fewer adverse preg outcomes (OR 0.27) vs those w/ activity. No difference in APO based on serologies, but Pred ≥7.5/d us had signif. more APO. (OR 3) https://t.co/BvOeiSERN9 https://t.co/ePh1dqdJvS
Dr. John Cush @RheumNow( View Tweet )
Review of autoimmune Dz & adverse preg outcomes: Incr risk of:
- Miscarriage w/ Sjögrens (RR 8.85) & SLE (OR 4.9)
- Preeclampsia w/ SLE (OR 3.2)
- IUGR w/ scleroderma (OR 3.2) & celiac (OR 1.71)
- Preterm birth w/ SLE (OR 2.79).
https://t.co/bll2x2aS9Z https://t.co/Eg0sVBcPmR
Dr. John Cush @RheumNow( View Tweet )
Sniffles & Arthritis (3.1.2024)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Are these associations with infection, biomarkers and weather real or imaginary? Linked or luck? Causal or casual? You decide....
No clear link between weather & MSK symptoms
Danish registries study shows maternal Autoimmune Dzs (all) were assoc w/ incr risk of childhood cancers (OR=1.25, 95% CI 1.06, 1.47), acute lymphoblastic leukemia (OR =1.52), Burkitt lymphoma (OR=2.6) & CNS tumors (OR=1.45); same seen for RA mothers https://t.co/HQO972ch9R https://t.co/dDEJUo8unq
Dr. John Cush @RheumNow( View Tweet )
Autoimmune disease and pregnancy
EurekAlert!
For many aspiring mothers with autoimmune disease, pregnancy can be daunting and full of unknowns. In some cases, those suffering from specific autoimmune conditions have chosen to forego pregnancy altogether due to concerns about their disease treatments and adverse pregnancy outcomes
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Very insightful talk on Vasculitis and pregnancy by Catherine Sims.
Pregnancy compatible medications.
Remission state.
Checking antibodies ; risk of transmission, pregnancy and fetal morbidity.
#RNL2024
@RheumNow https://t.co/81NAN1ulO5
Links:
Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )
@drcassysims recommends @NIH resource: https://t.co/ebtvc2zYbE to guide lactation- updated and run by pharmacists. #RNL2024 @rheumnow
TheDaoIndex @KDAO2011( View Tweet )
MTX and cyclophosphamide are the two drugs @DrCassySims recommends holding during breast feeding in our vasculitis patients. #RNL2024 @RheumNow
Dr. Rachel Tate @uptoTate( View Tweet )
@DrCassySims checks APS ab on ALL pregnant (vasculitis) patients. "HCQ decreases neonatal lupus risk by half, meaning great reward for little risk." CS at #RNL2024 @RheumNow
Dr. Rachel Tate @uptoTate( View Tweet )
Nipple Raynaud's is an issue for some women with rheumatic diseases that occurs during breastfeeding and can be very painful @DrCassySims #RNL2024 @rheumnow
https://t.co/HbaRpUnEBF
TheDaoIndex @KDAO2011( View Tweet )
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
Eric Dein @ericdeinmd( View Tweet )
@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
TheDaoIndex @KDAO2011( View Tweet )
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
Dr. Rachel Tate @uptoTate( View Tweet )
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
Dr. Rachel Tate @uptoTate( View Tweet )
"The most successful pregnancies are planned during periods of well controlled disease on pregnancy compatible medications." Dr. C Sims #RNL2024 @RheumNow @DrCassySims
Dr. Rachel Tate @uptoTate( View Tweet )
Rheumatology drugs in pregnancy. Just missing leflunomide in that big no no section @DrCassySims @RheumNow #RNL2024 https://t.co/ZPtTGRqPki
Richard Conway @RichardPAConway( View Tweet )
@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
TheDaoIndex @KDAO2011( View Tweet )
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
Eric Dein @ericdeinmd( View Tweet )
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
Eric Dein @ericdeinmd( View Tweet )
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