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What guides your choice between prophylactic, intermediate, and full therapeutic dosing of enoxaparin in a woman with APLS and prior fetal loss with no hx of thromboembolic disease?

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Hematology · Oregon Health & Science University

First, it is essential to confirm that patients meet criteria for obstetric antiphospholipid antibody syndrome (OAPS), based on the 2023 ACR/EULAR classification criteria. This includes persistently positive laboratory criteria (confirmed on repeat testing >12 weeks apart), plus otherwise unexplaine...

Would you consider utilizing transdermal estrogen for HRT to treat severe hot flashes in a patient with SLE and a history of thrombosis x2 and positive lupus anticoagulant, but negative aCL/B2GP1 abs?

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Rheumatology · NYU Langone Health

Given the prothrombotic effects of estrogen, they are generally avoided in patients with prior thrombosis and hypercoagulable states. Therefore, in a patient with SLE, secondary anti-phospholipid syndrome, as a single positive aPL with a positive lupus anticoagulant, and prior thrombotic event, the ...

What are your practice recommendations regarding live vaccinations in infants/children of women who are currently on DMARDs and are breastfeeding?

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Rheumatology · University of Chicago

This question needs some clarification to provide an exact answer. However, in regards to DMARDs in lactation, per the ACR 2020 Reproductive Health Guidelines and resources like LactMed and Mother to Baby (both free!), Methotrexate, Leflunomide, and Mycophenolate are not recommended in lactation. Th...

How do you approach the timing of Rituximab during pregnancy in a patient with life or organ threatening autoimmune disease?

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Rheumatology · Weill Cornell Medical College

The short answer is that I give it whenever it is needed for organ or life-threatening disease. Giving it earlier in pregnancy may have less impact on the fetus/neonate. In general, we all try to avoid routine treatment with rituximab during pregnancy due to the expected placental transfer after the...