Stratifying management of rheumatic disease for pregnancy and breastfeeding

Giles, Ian; Yee, Chee-Seng; Gordon, Caroline

doi:10.1038/s41584-019-0240-8

Cited by 42 publications

(39 citation statements)

References 140 publications

(228 reference statements)

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“…The advent of biologic agents has changed the way we treat rheumatic conditions but these come with their own risks. Maternal IgG alone is a large protein that cannot diffuse passively across the placenta [8]. Maternal IgG is actively transferred across the placenta via the neonatal FC receptor [17].…”

Section: Immunizationsmentioning

confidence: 99%

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Postnatal Care of Woman with Rheumatic Diseases

Mouyis

2020

Adv Ther

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Caring for women in the postnatal period can be challenging. One of the most important aspects is ensuring disease control as there is a risk of flare in the postpartum period. Other aspects of care also need to be addressed with the mother in mind such as breastfeeding or with the neonate in mind such as vaccinations or complications of the maternal condition affecting the neonate. This article highlights aspects of care that need to be addressed in the postpartum period such as flare rates, maternal wellbeing, thromboembolism, vaccinations, contraception and breast feeding.

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Section: Immunizationsmentioning

confidence: 99%

“…The transfer occurs from week 20 of the second trimester. Certain biologic agents contain IgG1 proteins and therefore are also actively transported across the placenta via the neontatal FC receptor from week 20 [8,16]. This results in the baby being exposed to the biologic agent.…”

Section: Immunizationsmentioning

confidence: 99%

Postnatal Care of Woman with Rheumatic Diseases

Mouyis

2020

Adv Ther

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“…Although inconclusive, nulliparity and short-duration breastfeeding have been suggested as risk factors for female RA development [5,6]. In addition, several studies have shown that a substantial number of pregnant patients with RA experience clinical remission, but disease ares frequently occur during the postpartum period [7,8]. Thus, experiences during the course of RA may differ between men and women.…”

Section: Introductionmentioning

confidence: 99%

Sex-related differences in clinical characteristics and comorbidities and their impact on clinical outcome in Korean patients with rheumatoid arthritis

Shin

Park

Kang

et al. 2020

Preprint

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Backgrounds: Rheumatoid arthritis (RA) is more prevalent in women and prior studies have reported several epidemiologic differences between sex and low achievement of remission in women RA. However, these sex differences across various populations remain incompletely understood. This study aimed to elucidate sex-related differences in clinical characteristics and their potential impact on clinical outcome in a large Korean cohort of patients with RA. Methods In total, 5,376 RA patients from the KORean Observational study Network for Arthritis (KORONA) database were examined at baseline and for 3 consecutive years using the disease activity score 28 (DAS28), health assessment questionnaire (HAQ), and health-related outcomes. Within a subgroup with active disease (DAS28 ≥ 3.2) at baseline, sex impacts on clinical outcome during a 3-year period were analyzed using generalized estimating equation (GEE) models. The sex effect on achieving clinical remission was analyzed using Cox-proportional hazard regression. Results At baseline, women (n = 4,574) were younger and had more erosive disease and longer disease duration than men (n = 802) with significantly higher scores in DAS28, HAQ, and patient-reported outcomes. The prevalence of interstitial lung disease, cardiovascular disease, and diabetes in men was significantly higher than that of women. In a RA subgroup with active disease at baseline, a GEE analysis demonstrated that sex significantly influenced the rate of change of DAS28 (p = 0.035) over time. In that group, men are associated with achieving DAS28 sustained remission as well as point remission (both p < 0.001). Conclusion Most comorbidities were more prevalent in men than in women among Korean patients with RA. However, for RA-related clinical outcomes, the longitudinal change in disease activity and the rate of achieving clinical remission were found to be worse in women RA. Therefore, sex-related differences should be considered when managing RA patients.

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confidence: 99%

“…RDs during pregnancy are associated with adverse maternal and fetal outcomes, 2 and therapy discontinuation prompts a disease flare. Disease activity control during pregnancy is crucial for optimal obstetric management 2 . Interestingly, tumor necrosis factor alpha (TNF‐a), interleukin‐1 (IL‐1), and interleukin‐6 (IL‐6), which are produced in response to infections (such as COVID‐19) and tissue injuries (such as RDs), 3 are considered key cytokines for pathophysiology in the aforementioned diseases.…”

mentioning

confidence: 99%