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QD12 – I wanna get pregnant

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QD Clinic from RheumNow.Live

This is qd video brought to you by room now dot live for rheumatologists when the going gets tough the rheumatologist go to a room now live in fort worth on march 22 23 24 coming up in a few months check it out room now dot live so today’s case a 33 year old hispanic gal not seen her in a year because she didn’t want to come back cuz she had no insurance i told

Her come cb she needs to be seen she’s been taking totalism em she’s a rheumatoid arthritis patient chronic symmetric polyarthritis wrist elbow knees fingers switch swelling and stiffness positive rheumatoid factor previously treated with methotrexate sims ii during one of her last pregnancies and now she’s on ik tamra and doing well for the last two years on

Totalism ab subcutaneous injection given every other week she’s done fine the last year she’s not seen anyone not had any labs she had enough drug the last three year now she’s back and she’s got two requests one can i refill her ik tamra she’s on a patient assistance program but she just got insurance so maybe your insurance will pay for it and two she’s pregnant

No no she’s not pregnant she wants to get pregnant and the question is what am i gonna do about that and what’s my advice to her so her proposal to me was i want to get pregnant what can i do do i have to stop there to go back on that other medicine do i have to be on no medicine and we went through this once before with her but we’re gonna go through it again

I think the first teaching point here is that if you have women of childbearing potential almost every visit should clearly spell out what their intentions are for future pregnancy if they’re on birth control or they’re otherwise unable to conceive well then you don’t have to have to have this question but all too frequently we don’t discuss it and we should what

Are your intentions as far as future pregnancy i don’t want any more to them any more pregnancy stock well then you can advise them on what the sake forms of contraception may be if you don’t know that information the ecr as a reproductive health guidelines group that actually met oh last year i was a part of it and and it’s it going to be a great publications

Coming up in the next few months it’s gonna be a three parter that’s going to give guidelines for management of patients with rheumatic disease with regard to pregnancy breastfeeding lactation and other reproductive health issues including contraception look for that publication it is going to be dense with useful information and i think it should be actually a

Course taught by the people who are running that and that includes lisa sammartino from hospital for special surgery leading the effort for the acr so what did i do with this patient i told her yes you can get pregnant no you don’t have to change medicine you’re on ik tamara you’re doing well number-one rule of getting pregnant is to be a healthy mom so you can

Make a healthy baby and that can be accomplished on no medicine if a patient’s in remission it can be accomplished with a d bart and safety mars that you can get pregnant on include hydroxychloroquine and sulfasalazine and gold and not methotrexate not laughlin imide even cyclosporine and and whatnot most dangerous drug not is not methotrexate and not laughlin

Amide but is in fact michael phenyl eight mycophenolate is a clear-cut teratogen way more than methotrexate or the foot amide do not get pregnant planned pregnancy on mycophenolate you can get pregnant on a tnf inhibitor i mean there’s a ton of data regarding that but there are other and that because you know this used to be a class b pregnancy risk in some of

The other biologics class c pregnancy risks like prednisone but prednisone is the most dangerous drug we use we peter merkel said it right now i tweeted it incredibly popular tweet prednisone is the most wonderful drug we have in the most dangerous drug we have trying to get pregnant with prednisone is foolish and should not be done this lady’s doing great on ik

Tamra there’s no negative signals in a few hundred patients thus far reported on ik tamra she’s told by me to go ahead and get a get pregnant and if she does i’ll report it to the company in blah blah blah but she’s not pregnant now so don’t write me up and and then if she does get pregnant she could actually stop the drug because her past pregnancy she did very

Very well during the pregnancy off of biologic therapy she may well repeat that you know not all ra patients do fabulous when they get pregnant so that’s the plan again i would have told her same thing had she been on let me think about this socialism app yes any tnf inhibitor yes abbott asset yes rituximab yes a long half-life so you know i don’t want to get

Pregnant when they just got the infusion but that’s probably okay there’s not enough known about the jak inhibitors yeah thus far it doesn’t seem like there’s a negative signal there there’s been actually a publication on this so i think a little more time again they call whenever i’m recording this is interesting but forget about xeljanz right now would be my

Suggestion and maybe ask me next year or ask the other mavens and pregnancy about what they think about using tofacitinib or even beerus it in women who want to get pregnant so that’s today’s lesson tune in for more lessons from the clinic see

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QD12 – I wanna get pregnant By RheumNow