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Pregnancy

RA: update for women of child bearing potential (and men!)

Fertility in the context of RMDs is a daily concern for a lot of rheumatologists and patients.

EULAR this year proposed new fertility data, especially in Rheumatoid Arthritis, along with an update of the EULAR points to consider for use of antirheumatic drugs in reproduction, pregnancy and

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Have RA and want to get pregnant? What can you do? The answer is simple: disease control. Implementing T2T in RA led to much better fertility. RA therapy is your friend! #EULAR2024 POS0436 Rotterdam @RheumNow https://t.co/aoxNakMix1
David Liew @drdavidliew( View Tweet )
T2T strategy in RA during pregnancy improves time to procreate Results PreCARA (T2T median DAS28CRP 2.33) vs. PARA median DAS28CRP 3.84) median TTP 84d vs. 196d TTP exceeded 12 months in 23% of PreCARA pts compared to 42% in the PARA pts. @RheumNow #EULAR2024 POS0436 https://t.co/DfgEvvtCwR
Aurelie Najm @AurelieRheumo( View Tweet )
Points to consider in pregnancy &lactation in Pts w #rheumatic #diseases #biologics don’t increase rate of serious infections in Mom Baby Compared to other matched pregnant and post partum women reassuring! #EULAR2024 @RheumNow @eular_org

Janet Pope @Janetbirdope( View Tweet )

What to use in men prior to planned conception of partner in #rheumatic #diseases #EULAR2024 ⁦@RheumNow⁩ ⁦@ACRheum⁩ ⁦@eular_org⁩ https://t.co/jMecV8jqUe
Janet Pope @Janetbirdope( View Tweet )

Is a Biomarker for Adverse Pregnancy Outcomes on the Horizon?

With a better understanding of pathophysiology, improved management guidelines, available medications, and a multidisciplinary approach, pregnancy for lupus patients has become more feasible. Despite these improvements, some patients still experience poor outcomes, highlighting the need for

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Systematic Review of #SLE pregnancies in Latin America – 44articles, 4K patients, Hispanic/ Latino with increased preeclampsia when they have LN #EULAR2024 Abst#0986 @RheumNow

Bella Mehta @bella_mehta( View Tweet )

Kaiser/California EHR study of #SLE pregnancies (2011-2020) - 657 pregnancies in 453 prs; The live birth rate = 74%, 23% w/ Spontaneous Ab, 2% ectopic/molar & <1% stillbirths. Variable outcomes by race & ethnicity, aPL status & nephritis history https://t.co/gvmYpTuFon https://t.co/9TeG8kfLmK
Dr. John Cush @RheumNow( View Tweet )
FDA issued a drug safety warning linking thiopurine (AZA, 6MP) use in pregnancy & a rare risk of intrahepatic cholestasis of pregnancy (ICP). ICP has been reported in pts w/ CD, UC, or SLE; however thiopurines are not FDA approved for these Dx https://t.co/s37eRuAtQx

Dr. John Cush @RheumNow( 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

Dr. John Cush @RheumNow( 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

Dr. John Cush @RheumNow( View Tweet )

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,

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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.





  1. Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory

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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....





  1. No clear link between weather & MSK symptoms

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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
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 )