RheumNow Podcast – Lupus Delights (9.18.20)
Sep 18, 2020
Dr Jack Cush reviews the news and journal reports from the past week on RheumNow.com:
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COVID-19 Risks in Pregnant Women
Sep 17, 2020
There has been little science or evidence regarding the effects of COVID-19 infection on pregnancy and vice versa; and now the recent MMWR addresses the subject with two new reports
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RheumNow Podcast - ACR Reproductive Health Slides (9-11-20)
Dr Jack Cush reviews the 2020 ACR Reproductive Health Guidelines
This past week we presented an overview to the new 2020 ACR
ACR 2020 Reproductive Guidelines - Contraception & Counseling
https://t.co
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Dr. John Cush RheumNow ( View Tweet)
Sep 13, 2020
Candian study of 376 pregnancies (284 F) with #SLE and drug use: only 24.2% on antimalarials, 8.2% azathioprine, 19.7% steroids & 4.8% on NSAIDs during pregnancy. 1st trimester discontinuations seen in 16.7% of HCQ & 29.2% AZA https://t.co/a1SMwZuSlm
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Dr. John Cush RheumNow ( View Tweet)
Sep 13, 2020
Swedish registry comparison of 541 PsA 40944 non-PsA pregnancies between 1997-2014, shows PsA pregnancies had increased risks for preterm birth (adj OR 1.63) and caesarean deliveries (OR 1.47), but no increased risks for pre-eclampsia, stillbirth https://t.co/3Udpjh
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Dr. John Cush RheumNow ( View Tweet)
Sep 13, 2020
Discontinuing TNFi before wk 20 is feasible in RA and JIA pregnancy with well- controlled Dz. OTIS study of 490 women compared 25% who D/C TNFi before wk 20 vs 41% taking TNFi after wk 20. D/C TNF not assoc w/ clinical worsening in the 3rd trimester.
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Dr. John Cush RheumNow ( View Tweet)
Sep 12, 2020
New data on tocilizumab in pregnancy, upshot is: "Tocilizumab concentrations in cord blood and infant serum were 80–90% of those in maternal serum" https://t.co/SEmyTnL7dy
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Dr. John Cush RheumNow ( View Tweet)
Sep 12, 2020
Immunomonitoring with microarrays from the SLE PROMISE pregnancy study shows that adverse outcomes (preeclampsia) can be identified by quantifying plasma cell, interferon and neutrophil RNA levels during the pregnancy https://t.co/oLOwkiGhQ2.
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Dr. John Cush RheumNow ( View Tweet)
Sep 11, 2020
117 pregnancies exposed to biologics were compared to 585 pregnancies not exposed to biologics; 6% of newborns had ≥1 congenital anomalies. No significant association between biologic exposure and congenital anomalies (HR 1.06; 95%CI 0.46-2.47) was seen.
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Dr. John Cush RheumNow ( View Tweet)
Sep 11, 2020
RheumNow Podcast - ACR Reproductive Health Slides (9-11-20)
Sep 11, 2020
Dr. Jack Cush reviews the 2020 ACR Reproductive Health Guidelines presented all week here on RheumNow.
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Systematic review of Paternal DMARD exposure prior to pregnancy shows no firm evidence of harm with TNFi, ABA, RTX, azathioprine, cyclosporine, HCQ, leflunomide, MTX or mycophenolate mofetil.
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Dr. John Cush RheumNow ( View Tweet)
Sep 11, 2020
The PARA study shows among 249 pregnancies (2002-08), breastfeading was less in RA - at 4-6, 12 & 26 wks postpartum 43%, 26% and 9% of the RA breastfed (vs 63%, 46% &; 41% in controls). Many patients D/C breastfeeding so they could start medication.
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Dr. John Cush RheumNow ( View Tweet)
Sep 10, 2020
ACR 2020 Reproductive Guidelines - Lactation Guidance
Sep 10, 2020
In this third excerpt from the ACR guidelines on managing reproductive health issues in rheumatic disease patients, we present recommendations regarding the use of glucocorticoids and guidance on lactation and medication use post-partum.
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Small study of 25 pregnancies in RA compared those who continued biologics till conception vs those who stopped before conception. Continuing biologics till conception lead to a significantly shorter time to pregnancy. https://t.co/x9EptzkvYr
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Dr. John Cush RheumNow ( View Tweet)
Sep 10, 2020
Dr Uma Mahadevan and colleagues have published guidelines for managing pregnancy in IBD patients. Rec coordinated care w/ maternal-fetal medicine subspecialist, GI doc, preconception planning, more on treatement https://t.co/oAFcGlOU2y
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Dr. John Cush RheumNow ( View Tweet)
Sep 10, 2020
ICYMI - The Pregnancy & Lactation Labeling Rule Explained
Sep 10, 2020
A recent article from Healio.com reviewed the FDA’s Pregnancy and Lactation Labeling Rule (PLLR) that became effective June 30th. This rule applies only to currently marketed prescription drug products available in the United States and does not affect the labeling of drug products available
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ACR 2020 Reproductive Guidelines - Medication Use with Pregnancy
Sep 09, 2020
The American College of Rheumatology (ACR) has published guidelines to manage reproductive health issues in rheumatic disease (RMD) patients before, during and after pregnancy. In this second exerpt from their guidelines articles we present recommendations (and good clinical practice
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Free full read review "Postnatal Care of Woman with Rheumatic Dz". 46% of RA pts will flare postpartum; breast feeding is ok w/ most biologics; Hold Live vaccines if Pt is on a biologic during pregnancy; VTE prophylaxis essential for 10 d–6 wks postpartum.
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Dr. John Cush RheumNow ( View Tweet)
Sep 09, 2020
QD Videos from RheumNow Live. "I wanna get pregnant" (a controlled RA patient on tocilizumab) https://t.co/vfLgQPrl98
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Dr. John Cush RheumNow ( View Tweet)
Sep 09, 2020
ICYMI - 11 Pearls for Pregnancy Management in Rheumatoid Arthritis
Sep 09, 2020
Rheumatoid arthritis affects women in their child-bearing years and many will face the issue of pregnancy and RA management at some point. Here are11 considerations for those managing RA patients who wish to become pregnant.
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Case series compared 247 pregnancies in IgA Vasculitis patients vs 556 control pregnancies showing IgA Vasculitis had no effect on fertility and did not induce flares. But IgAV had more spont. abortions, gestational HTN, preterm delivery.
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Dr. John Cush RheumNow ( View Tweet)
Sep 09, 2020
296 women with HTN during pregnancy (half/147 NSAID-exposed) - NSAID use was not associated with a significant change in BP (vs no NSAID) and there was no added need to start or increase BP meds in those on NSAIDS. https://t.co/g56xgQEPjr
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Dr. John Cush RheumNow ( View Tweet)
Sep 09, 2020
Metanalysis of 10 studies and 204 RA patients suggests that during pregnancy disease activity improved in 60% of patients but flared post-partum in nearly half (47%). https://t.co/FgzH6ifU4Y
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Dr. John Cush RheumNow ( View Tweet)
Sep 08, 2020
ACR 2020 Reproductive Guidelines - Contraception & Counseling
Sep 08, 2020
The American College of Rheumatology established a guidelines committee that consisted of both patients, rheumatologists and maternal-fetal health experts. After a a systematic review of the medical literature regarding contraception, assisted reproductive technology, fertility preservation,
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Analysis of Natl Inpatient Sample database (1998-2014) compared outcomes in 87605 SLE pregnancies vs matched cohort: found SLE had more C-section, IU fetal death, Pre-eclampsia, VTE, CKD, HTN, longer stays Presented by Dr.
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Dr. John Cush RheumNow ( View Tweet)
Sep 08, 2020
Recent Blogs
Patients and physicians are riddled with misconceptions when pregnancy is concerned. As construed by Dr. Jack Cush, most rheumatologists treat pregnancy like a cancer and avoid the gravid patient, deferring to obstetricians who do not have training in rheumatology to manage the rheumatic condition as well as the pregnancy.
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