These results suggest that patients are satisfied with a rheumatology telemedicine service, and may prefer this to extensive travelling. Evaluation in other settings is recommended before generalizing this finding.

This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.

BackgroundRheumatologic diseases commonly affect women of childbearing age(.1, 2 There is currently limited data available regarding the safety of vaccinations in infants after in utero exposure to biologics.ObjectivesTo determine the vaccination decisions of mothers with rheumatologic diseases exposed to biologics during pregnancy and the incidence of serious neonatal infections after third trimester exposure.MethodsAll Australian women with inflammatory arthritis, exposed to biologics during the preconception, antenatal and/or postpartum periods, were invited to participate in the Pregnancy Exposed to Biological (PEB) study from May 2009 – . Jan 2018 Recruitment was via direct invitation from patients treating rheumatologists, community groups, and via social media. Following self-referral to the study, retrospective data was collected, including biological exposure, vaccination history and the incidence of serious neonatal infections, defined as infection requiring hospitalisation.ResultsPreliminary data is available regarding 35 offspring from 28 mothers. 34 of 35 offspring were vaccinated. 29 received vaccinations in accordance with the Australian National Immunisation Program Schedule. 1 mother declined to immunise her infant due to personal preference.13 infants were exposed to a tumour necrosis factor inhibitor (TNFi) during the third trimester. Of these, 4 had Rotavirus vaccine delayed from 2 to 4 months and 1 infant until 6 months. 1 infant did not receive the Rotavirus vaccine at 2 months due to exposure to a TNFi while breastfeeding. There were no incidences of serious neonatal infections.ConclusionsCurrent guidelines recommend deferring live vaccines, such as rotavirus, until after 6 months if exposed to a biologic in the third trimesterr.(2–5 Compliance with these recommendations was only observed in one infant in our study. One infant received delayed Rotavirus vaccination due to concern about TNFi exposure during breastfeeding; this is not in keeping with current guidelines. Of the 12 infants exposed to a biologic during the third trimester who did not delay live vaccination until after 6 months, there were no incidents of serious neonatal infections, in keeping with the findings of current published case series.References[1] Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis. 2015;74(10):1836–41.[2] Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795–810.[3] Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016;55(9):1693–7.[4] Health AGDo. 3.3 Groups with special vaccination requirements2017.[5] Ostensen M. ...

BackgroundMany women with rheumatologic diseases require ongoing treatment with TNFi during pregnancy to maintain remission or low disease activity. Until recently, there has been a paucity of published evidence regarding the safe use of these medications during the ante- and postnatal periods to guide clinical practice.ObjectivesTo observe compliance with current guidelines for TNFi therapy in Australian women with rheumatologic diseases during the ante- and postnatal periods and change over time.MethodsAll Australian women with rheumatologic diseases, exposed to biologics (bDMARDs) and targeted synthetic disease modifying antirheumatic drugs (tsDMARDs) during the preconception, antenatal and/or postpartum periods were eligible to participate in the Pregnancy Exposed to Biological (PEB) study. Commencing in 2015, recruitment was via invitation from patient’s treating rheumatologists, community groups, and social media. Following self-referral to the study, retrospective data was collected, including rheumatologic condition and management recommendations made by health professionals.ResultsPreliminary data is available for 37 infants born to 29 mothers from Feb 2009-Dec 2018. Of these, 32 women received TNFi. We assessed 3 outcomes – TNFi continuation during pregnancy, TNFi continuation during lactation and vaccination practice in infants exposed to TNFi. Women exposed to non-TNFi bDMARDs and tsDMARDs were excluded from this abstract, as these are not recommended for use during the perinatal period (2).Specialist Society Guidelines from the British Society of Rheumatology and the British Health Professional in Rheumatology were published in 2016 regarding the safety of TNFi during pregnancy (2). Prior to guideline publication, 67% (n=16/24) of the women in PEB ceased their TNFi pre-conception. Of those in PEB who became pregnant subsequent to guideline publication, only 25% (n=2/8) ceased TNFi pre-conception. Overall, 40.6% (n=13/32) women received a TNFi during the antenatal period consistent with guidelines, which improved from 33.3% (n=8/24) pre-publication, to 62.5% (n=5/8) post publication.84.4% (n=27/32) women exposed to TNFi breastfed their infants. Prior to availability of evidence regarding the safety of TNFi during lactation, 79.2% (n=19/24) of infants were breastfed. After publication, 100% (n=8/8) infants exposed to TNFi were breastfed.In total, 96.9% (n=31/32) of the infants exposed to TNFi in PEB were vaccinated. Rotavirus vaccine should have been delayed in 43.8% (n=14/32) infants, but was not. 9.4% (n=3/32) infants had live vaccines deferred until only 3 months; 3.1% (n=1/32) infants had live vaccines unnecessarily delayed. Only 3.1% (n=1/32) infants had live vaccines appropriately delayed until 7 months. Compliance with vaccination recommendations increased from 43.5% (n=10/24) pre-publication to 62.5% (n=5/8) post publication of guidelines.ConclusionPreliminary data from PEB suggests that there has been a shift in practice following the publication of Specialist Society Guidelines, with increasin...