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Rheumatic Diseases Clinics of North America

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https://www.readbyqxmd.com/read/28390572/reproductive-rheumatology-meeting-today-s-challenges
#1
EDITORIAL
Lisa R Sammaritano, Eliza F Chakravarty
No abstract text is available yet for this article.
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390571/reproductive-health
#2
EDITORIAL
Michael H Weisman
No abstract text is available yet for this article.
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390570/menopause-and-rheumatic-disease
#3
REVIEW
Mitali Talsania, Robert Hal Scofield
Menopause occurs naturally in women at about 50 years of age. There is a wealth of data concerning the relationship of menopause to systemic lupus erythematosus, rheumatoid arthritis, and osteoarthritis; there are limited data concerning other rheumatic diseases. Age at menopause may affect the risk and course of rheumatic diseases. Osteoporosis, an integral part of inflammatory rheumatic diseases, is made worse by menopause. Hormone replacement therapy has been studied; its effects vary depending on the disease and even different manifestations within the same disease...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390569/infertility-prevention-and-management
#4
REVIEW
Emily C Somers, Wendy Marder
Infertility and subfertility, menstrual irregularities, and decreased parity may occur in women with autoimmune diseases due to multiple factors, including underlying inflammatory disease, gonadotoxic medications, and psychosocial issues related to living with chronic disease. Awareness of these factors, as well as validation and support of patients confronting reproductive challenges, is important for providing comprehensive care to these women. An understanding of the expanding options for fertility preservation strategies during gonadotoxic medications is essential...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390568/outcomes-in-children-born-to-women-with-rheumatic-diseases
#5
REVIEW
Évelyne Vinet, Sasha Bernatsky
Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are the most prevalent autoimmune rheumatic diseases, predominantly occurring in women during childbearing years. Research has focused on assessing the risk of immediate complications during SLE and RA pregnancies, with studies documenting a higher risk of adverse obstetric outcomes, such as preterm births and infants small for gestational age. Until recently, little was known regarding the long-term health of children born to affected women. We present a review of the current evidence regarding the risk of adverse health outcomes in SLE and RA offspring, and potential mechanisms involved in their pathogenesis...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390567/lactation-and-management-of-postpartum-disease
#6
REVIEW
Bonnie L Bermas
While much of the existing literature in the field of reproductive rheumatology focuses on fertility, preconception counseling, and pregnancy, there is limited information regarding the postpartum period and lactation. Evidence suggests that many rheumatologic disorders flare after delivery, which, along with limitations in medications compatible with breastfeeding, make this time period challenging for women with rheumatologic conditions. This article discusses rheumatologic disease activity during the postpartum period and reviews the safety during lactation of commonly used medications for the management of rheumatic diseases...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390566/vasculitis-and-pregnancy
#7
REVIEW
Leah Machen, Megan E B Clowse
Vasculitis is more often a disease of women beyond their reproductive years, leaving the challenges of pregnancy management difficult to study. Pregnancy complications, including pregnancy loss and preterm birth, are higher among women with all forms of vasculitis. It seems that controlling the disease before pregnancy may improve the chances of pregnancy success. Many medications used for vasculitis are considered low risk in pregnancy, including prednisone, colchicine, azathioprine, and tumor necrosis factor inhibitors...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390565/fertility-pregnancy-and-lactation-in-rheumatoid-arthritis
#8
REVIEW
Pascal H P de Jong, Radboud J E M Dolhain
Fertility is impaired in women with rheumatoid arthritis (RA), whereas less is known about male fertility problems. Pregnancy outcome in patients with RA is slightly less favorable compared with the general population, especially in patients with active disease. Disease activity usually improves during pregnancy, but less than previously thought. Although several antirheumatic drugs are contraindicated in pregnancy, more treatment options are available. There is evidence on the safety of TNF inhibitors in pregnancy...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390564/systemic-lupus-erythematosus-and-pregnancy
#9
REVIEW
Aisha Lateef, Michelle Petri
Systemic lupus erythematosus (SLE) is an autoimmune disease with a strong female predilection. Pregnancy remains a commonly encountered but high-risk situation in this setting. Both maternal and fetal mortality and morbidity are still significantly increased despite improvements in outcomes. Maternal morbidity includes higher risk of disease flares, preeclampsia and other pregnancy-related complications. Fetal issues include higher rates of preterm birth, intrauterine growth restriction, and neonatal lupus syndromes...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390563/biomarkers-for-adverse-pregnancy-outcomes-in-rheumatic-diseases
#10
REVIEW
May Ching Soh, Catherine Nelson-Piercy
Pregnancy is a delicate balance of angiogenic factors. Adverse pregnancy outcomes in the form of placental insufficiency occur when antiangiogenic factors predominate, which manifests as maternal-placental syndrome (MPS). Women with rheumatic disease are at increased risk of MPS. Endothelial damage from circulating antiangiogenic factors and other inflammatory molecules in combination with preexisting maternal vascular risk factors is the likely underlying pathophysiological process for MPS. It is likely that these changes persist, and additional "insults" from ongoing inflammation, medications, and disease damage contribute to the development of accelerated cardiovascular disease seen in young women with rheumatic disease...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390562/preconception-counseling
#11
REVIEW
Monika Østensen
Chronic rheumatic disease may interfere with procreation in women of childbearing age. Female patients should have counseling in regard to family planning and parenting. Preconception counseling requires risk assessment of possible maternal or fetal risks, screening for biomarkers with predictive value for adverse pregnancy outcomes, adjustment of therapy, and a schedule for monitoring and follow-up during pregnancy. Delivering comprehensive information and addressing all patient concerns are both essential for enabling patients to engage actively in decision making...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390561/contraception-in-patients-with-rheumatic-disease
#12
REVIEW
Lisa R Sammaritano
Contraception represents an important area of reproductive health for patients with rheumatic diseases given the potential pregnancy risks associated with active disease, teratogenic medications, and severe disease-related damage. A high proportion of patients with rheumatic disease do not use effective contraception. Long-acting contraceptives are most effective. Antiphospholipid-negative patients with stable systemic lupus erythematosus may use oral combined contraceptives. Antiphospholipid-positive patients, or patients with rheumatic disease with other risk factors for thrombosis, should avoid estrogen-containing contraceptives...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28390560/reproductive-health-screening-in-women-with-autoimmune-diseases
#13
REVIEW
Latisha Heinlen, Eliza F Chakravarty
Although the female predominance of autoimmune diseases is not completely understood, sex hormones are thought to play a role. Attention to lifelong reproductive health is especially important for women with autoimmune disorders. Many of these women require long-term immunosuppressive therapy that may affect their ability to clear infections, including viruses, and may alter natural tumor surveillance mechanisms. As a result, women with autoimmune diseases may have different risks for common reproductive-related malignancies that may in turn affect screening guidelines and other preventive measures, including vaccination...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/27890178/infection-and-malignancy-in-rheumatic-diseases
#14
EDITORIAL
Kevin L Winthrop, Leonard H Calabrese
No abstract text is available yet for this article.
February 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/27890177/infection-and-malignancy-in-rheumatic-diseases
#15
EDITORIAL
Michael H Weisman
No abstract text is available yet for this article.
February 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/27890176/the-risk-of-progressive-multifocal-leukoencephalopathy-in-the-biologic-era-prevention-and-management
#16
REVIEW
Eamonn S Molloy, Cassandra M Calabrese, Leonard H Calabrese
Progressive multifocal leukoencephalopathy (PML) is a rare, typically fatal, demyelinating central nervous system infection caused by reactivation of the John Cunningham virus that generally occurs in immunosuppressed patients. With an evolving understanding of a greater clinical heterogeneity of PML and significant implications for therapy, PML should be considered in the differential diagnosis of neurologic presentations of rheumatic diseases. Increased awareness of PML among rheumatologists is required, as earlier diagnosis and restoration of immune function may improve the otherwise grim prognosis associated with PML...
February 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/27890175/malignancy-and-janus-kinase-inhibition
#17
REVIEW
Padmapriya Sivaraman, Stanley B Cohen
The use of biologics such as anti-tumor necrosis factor and oral Janus kinase inhibitors have revolutionized the treatment of rheumatoid arthritis (RA). The risk of malignancies such as lymphomas, lung cancer, and nonmelanoma skin cancers (NMSCs) is greater in patients with RA compared with the general population. The incidence of all malignancy (excluding NMSC) was similar in tofacitinib users compared with the general population. The rates of overall and site-specific malignancies in patients with RA treated with tofacitinib are similar to what is expected in the RA population and not different from disease-modifying antirheumatic drugs and biologics...
February 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/27890174/immune-related-adverse-effects-of-cancer-immunotherapy-implications-for-rheumatology
#18
REVIEW
Laura C Cappelli, Ami A Shah, Clifton O Bingham
Immune checkpoint inhibitors (ICIs) are increasingly studied and used as therapy for a growing number of malignancies. ICIs work by blocking inhibitory pathways of T-cell activation, leading to an immune response directed against tumors. Such nonspecific immunologic activation can lead to immune-related adverse events (IRAEs). Some IRAEs, including inflammatory arthritis, sicca syndrome, myositis, and vasculitis, are of special interest to rheumatologists. As use of ICIs increases, recognition of these IRAEs and developing treatment strategies will become important...
February 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/27890173/malignancy-and-the-risks-of-biologic-therapies-current-status
#19
REVIEW
Raphaèle Seror, Xavier Mariette
Cancer is a common event in patients with rheumatic diseases. In some cases, the disease, its risk factors, or its treatment could play a role in favoring cancer. This article analyzes the current knowledge on the risk of malignancy associated with biologics in rheumatic diseases and discusses some methodological issues to be considered when evaluating the association between disease, treatments, and the risk of cancer. This article focuses on the risk of overall malignancy but also of skin cancer, lymphoma, and recurrent cancer associated with all biologics marketed for the treatment of rheumatic diseases...
February 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/27890172/opportunistic-infections-in-biological-therapy-risk-and-prevention
#20
REVIEW
Paul A Bryant, John W Baddley
Patients being treated with biological therapies are at increased risk for serious infections, including opportunistic infections. Although more is known about opportunistic infection risk with older biologics, such as antitumor necrosis factor drugs, there is less knowledge of opportunistic infection risk with newer biological therapies. The incidence of certain opportunistic infections (tuberculosis, herpes zoster, pneumocystosis) has been rigorously evaluated in large observational studies. However, data are more limited for other infections (histoplasmosis, nontuberculous mycobacteria)...
February 2017: Rheumatic Diseases Clinics of North America
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