Pregnancy

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Does Rheumatoid Factor Influence Anti-TNF Responses in RA?

Jack Cush, MD

Smolen and colleagues have published a subanalysis of the EXXELERATE study that showed while certolizumab pegol [CZP] concentrations and efficacy was unaffected by high titers of rheumatoid factor (RF), patients treated with adalimumab had a blunted response in the face of high RF titers.

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Birth Control Use in Lupus Published guidelines on lupus mgmt urge that female patients plan and prepare carefully for pregnancy, and use contraceptives when it's not intended -- but these reco’s are rarely followed, a registry study suggested. https://t.co/81mQbp5Sib https://t.co/NJmwxvtR44

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Dr. John Cush @RheumNow( View Tweet )
BCP,OCP

Birth Control Use in Lupus

MedPage Today

Published guidelines on lupus management urge that female patients plan and prepare carefully for pregnancy, and use contraceptives when it's not intended -- but these recommendations are only rarely followed, a registry study suggested.

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All in the Family (8.23.2024)

Jack Cush, MD

Dr. Jack Cush picks highlight reports from the past week on RheumNow.com, with reports on the challenge of lupus nephritis, perplexing skin issues, you don't know JAK (about Tyk) and the value of a good family history.

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Predictors of Pregnancy Outcomes in SLE A review of preconception predictors of pregnancy outcomes in women with SLE highlighted lupus nephritis,chronic hypertension, SLE disease activity and secondary antiphospholipid syndrome as predictors of APO. https://t.co/vA445kSe5t https://t.co/wGhLjCmJ3v

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Dr. John Cush @RheumNow( View Tweet )
Pregnancy, menopause, contraceptives, hormone replacement, aromatase inhibitors may affect lupus outcomes. Review says hormone therapies are contraindicated w/ antiphospholipid syndr, APL Ab positivity, and uncontrolled SLE or flares https://t.co/bZQr8b871n https://t.co/OmXY04GR4p

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Dr. John Cush @RheumNow( View Tweet )
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Higher Cancer Rates (8.16.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, noting his concerns about diet, cancer, ILD, death and dosing challenges.

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Favorable results from Vasculitis Pregnancy Registry; enrolled 147 women, 149 pregnancies; data on 78 pregs. 36% had active vasculitis during Preg, 14 hospitalized (4 w/ vasculitis. 74% Rx vasculitis meds during preg & 97% live births, 21% preterm https://t.co/rq2Y4ij0OW https://t.co/wmmFPvlOGY

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Dr. John Cush @RheumNow( View Tweet )
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Depends on Where You’re Looking (8.9.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com this week.

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Calif Cohort of 19340 rheumatic pts, finds Cardiovascular events (CVE) in 1.4% & antiphospholipid syndr in 5.5%. CVE increased risk of adverse pregnancy outcomes (>50%), including Sm for Gestational age (aRRs 1.2-1.5), Premature birth (aRR 1.6) https://t.co/9lxzrOVEks https://t.co/Jcm7tH61cv

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Dr. John Cush @RheumNow( View Tweet )
CDC warns of Listeria outbreak assoc w/ deli meats - in 12 US states (lead by NY, and MN, MO, IL, WI, PA, VA, GA, NJ, DE, MD, MA, NC), 28 cases, 28 hospitalized, 2 deaths. @risk are the pregnant, elderly, immunosuppressed. Cook deli meats >165F https://t.co/SWKMhIBQEi https://t.co/snLjBKn1UJ

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Dr. John Cush @RheumNow( View Tweet )
EULAR 2024 Recommendations on Reproductive Health https://t.co/QuXQlpQv8O https://t.co/nHC7LOLLl8

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Dr. John Cush @RheumNow( View Tweet )
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. https://t.co/RrkR2V3CI3 https://t.co/CRXUKxUqF2

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Dr. John Cush @RheumNow( View Tweet )
Is a Biomarker for Adverse Pregnancy Outcomes on the Horizon? Pregnancy in lupus patients raises concerns due to potential complications like preeclampsia, eclampsia, and increased mortality rates for both mother and baby. https://t.co/Kv6F21UHze https://t.co/ya8lAkSLC2

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Dr. John Cush @RheumNow( View Tweet )
couple holding hands with baby shoes

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

Aurelie Najm, MD, PhD

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

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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

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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

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Janet Pope @Janetbirdope( View Tweet )
pregnant, pregnancy, mother, fertility

Is a Biomarker for Adverse Pregnancy Outcomes on the Horizon?

Bella Mehta, MBBS, MS

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

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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

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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 )

Recent Blogs

Best of 2022: Myths & Misconceptions with Febrile Disorders

Rachel Tate, DO
Myth vs reality
Still’s disease and autoinflammatory disorders are rare conditions unified by recurrent fevers and inflammation of skin, joints, and other organs. While labs often support the diagnosis, these conditions are best diagnosed by genetic testing, or by specific criteria (in the absence of a genetic test). The following is a table that lists common misconceptions (myths) and their clarifying explanations. Read Post

Myths & Misconceptions with Febrile Disorders

Rachel Tate, DO
Myth vs reality
Still’s disease and autoinflammatory disorders are rare conditions unified by recurrent fevers and inflammation of skin, joints, and other organs. While labs often support the diagnosis, these conditions are best diagnosed by genetic testing, or by specific criteria (in the absence of a genetic test). The following is a table that lists common misconceptions (myths) and their clarifying explanations. Read Post

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