New: Recommendations for antirheumatic treatment in men and women planning a family

The European Alliance of Associations for Rheumatology-published points-to-consider on the use of antirheumatic drugs in reproduction, pregnancy, and lactation. Since then, new evidence has become available, so the points have been reviewed and updated–including an upgrade to full recommendations.

Rheumatic and musculoskeletal diseases (RMD) often affect people during the years when they might be planning a family. The underlying nature of these diseases can affect people’s fertility, and may make women more at risk of some poor pregnancy outcomes, such as having small or premature babies. Some of the antirheumatic treatments used can also affect fertility, and may not be safe to use during pregnancy. What drugs are used for a person’s RMD when they are planning a family is therefore a consideration for both men and women, and impact show treatment might need to be tailored around conception, as well as during pregnancy and breastfeeding.

A series of points-to-consider were released in 2016, but since then treatment approaches have evolved –moving towards a treat-to-target concept that can help to avoid some of the negative impacts of active disease on fertility and pregnancy outcomes. Alongside this, there has been new relevant data published about antirheumatic drugs in the context of pregnancy and breastfeeding –as well as in male reproductive health. To address this, EULAR has reviewed the evidence and upgraded the advice to full recommendations.

The new work, published in the April 2025 issue of the Annals of the Rheumatic Diseases, includes 12 individual recommendations and five overarching principles. These principles emphasise that everyone with an RMD–both men and women –should be offered early and regular counselling about their reproductive health and the need to adjust therapy in relation to pregnancy. But treatment of the RMD before conception and during and after pregnancy should still aim at remission or low disease activity. Importantly, the potential risk to the child should be weighed against the risk to the mother of having a period of untreated disease. Given the known benefits, women should not be discouraged from breastfeeding and there are compatible medications they can take during this period. Finally, the choice of treatment before, during, and after pregnancy should be a shared decision-making process between the treating healthcare providers and the patient.

The 12 new recommendations focus on three areas. First, the specific antirheumatic drugs that can be used for women before and during pregnancy, including which are compatible and which should be discontinued before attempting to conceive a child. They also look at which vaccines can be used in infants who have been exposed to antirheumatic drugs in the womb. Second, the drugs that are compatible with breastfeeding, and thirdly drug choices for men wishing to father a child. 

EULAR hopes that these recommendations will help to improve treatment and outcomes for people with an RMD during their reproductive years. It will be important to share the updated knowledge widely, as it will be helpful to many healthcare professionals outside rheumatology, including those working in internal medicine, gynaecology and obstetrics, family medicine, paediatrics, and pharmacology.

Reference:

Rüegg L, et al. EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis 2025;doi: 10.1016/j.ard.2025.02.023.

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Metabolic Syndrome May Drive Treatment Resistance in Psoriatic Arthritis, Study Finds

Italy: A recent study published in RMD Open: Rheumatic & Musculoskeletal Diseases highlights a critical link between metabolic syndrome (MetS) and treatment resistance in patients with psoriatic arthritis (PsA). Conducted by Dr. Damiano Currado and colleagues from the University of Rome Campus Biomedico, the research reveals that the presence of MetS significantly increases the risk of developing a difficult-to-treat (D2T) PsA phenotype.

Psoriatic arthritis is a chronic inflammatory condition often marked by joint pain, skin involvement, and a range of musculoskeletal symptoms such as enthesitis and dactylitis. While many patients respond well to current therapies, a subset faces persistent symptoms and poor therapeutic outcomes, termed the “difficult-to-treat” phenotype. This study aimed to examine whether metabolic dysfunction contributes to this challenging clinical profile.

The cross-sectional study was carried out at the Rheumatology Clinic of Fondazione Policlinico Campus Bio-Medico of Rome and involved 182 patients diagnosed with PsA. Disease activity and the presence of metabolic syndrome were assessed using established criteria. The D2T classification was based on modified definitions drawn from rheumatoid arthritis guidelines and adapted for PsA.

The key findings were as follows:

  • 42.9% of the total psoriatic arthritis (PsA) cohort met the criteria for metabolic syndrome (MetS).
  • Among patients with the difficult-to-treat (D2T) phenotype, 81.8% had comorbid MetS.
  • In contrast, only 29.4% of patients in the non-D2T group had MetS.
  • Statistical analysis showed a strong association between MetS and the D2T phenotype, with an odds ratio of 7.56.
  • Patients with MetS were over seven times more likely to show treatment resistance.
  • Path analysis confirmed MetS as an independent factor contributing to the development of the D2T phenotype.

These findings emphasize the role of metabolic health in influencing the course and severity of PsA. The authors emphasize that managing metabolic dysfunctions—such as obesity, hypertension, and insulin resistance—may be crucial in improving therapeutic response and reducing disease burden.

While the study provides valuable insight, the authors acknowledge certain limitations. These include reliance on D2T criteria adapted from rheumatoid arthritis, a single-center design, and the inability to capture certain variables like treatment adherence or patient-reported outcomes. Moreover, as a cross-sectional study, the data cannot establish causality between MetS and the D2T phenotype.

The research represents the first to establish a clear association between metabolic syndrome and treatment resistance in PsA. It suggests that integrated care approaches targeting both PsA and its metabolic comorbidities could enhance treatment outcomes. Strategies such as lifestyle modifications, interdisciplinary collaboration with metabolic specialists, and the use of therapies with minimal metabolic impact may offer a more effective path forward for patients facing this difficult-to-manage form of PsA.

The authors concluded, “Further studies are needed across diverse patient populations to confirm these findings and help refine clinical definitions and treatment pathways for D2T PsA.”

Reference:

Damiano Currado, Francesca Trunfio, Francesca Saracino, Lyubomyra Kun, Annalisa Marino, Erika Corberi, Antonio Orlando, Ludovica Lamberti, Leonardo Frascà, Marta Gatti, Onorina Berardicurti, Marta Vomero, Vasiliki Liakouli, Roberto Giacomelli, Luca Navarini – Patients with psoriatic arthritis and comorbid metabolic syndrome show a difficult-to-treat phenotype: another mosaic tile in the definition of a still undefined subset of patients: RMD Open 2025;11:e005717.

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Childhood Hypertension Triples Long-Term Risk of Serious Kidney Events, Lancet Study Finds

Canada: A landmark population-based study published in The Lancet Child & Adolescent Health has revealed that children and adolescents diagnosed with hypertension face a significantly higher risk of developing serious long-term kidney complications compared to their non-hypertensive peers.

Conducted by Dr. Junayd Hussain and colleagues from the Michael G. DeGroote School of Medicine, McMaster University, the retrospective cohort study assessed kidney outcomes in youth aged 3 to 18 years across Ontario, Canada. The study spanned over two decades—from April 1996 to March 2023—and utilized data from validated health administrative databases to explore the relationship between childhood hypertension and major adverse kidney events (MAKEs), including chronic kidney disease (CKD), kidney failure, or death.

Researchers matched 26,324 children and adolescents with hypertension to 126,834 non-hypertensive controls using propensity score methods. Matching criteria included key factors such as age, sex, birthweight, maternal gestational hypertension, and pre-existing health conditions like diabetes, obesity, and previous kidney injury. This approach ensured a balanced comparison between the groups, eliminating potential biases that might influence the risk of kidney outcomes.

The study revealed the following findings:

  • The incidence of major adverse kidney events (MAKEs) in children and adolescents with hypertension was 5.52 per 1,000 person-years.
  • In comparison, the incidence in non-hypertensive controls was 1.66 per 1,000 person-years.
  • Overall, 7.7% of hypertensive participants experienced a MAKE versus 2.4% in the control group.
  • The risk of MAKEs was three times higher in hypertensive youth, with a hazard ratio of 3.03 (95% CI: 2.86–3.21).
  • The median age at the diagnosis of hypertension among study participants was 15 years.
  • Males made up 58.7% of the hypertensive cohort, indicating a slight male predominance.
  • Most participants had no significant prior medical conditions.
  • A small proportion had congenital heart disease (4.4%), malignancy (6.8%), or were born to mothers with hypertension (3%).

These findings highlight the crucial importance of early detection and effective management of high blood pressure in children and adolescents. Despite being traditionally viewed as a condition of adulthood, hypertension in the pediatric population is becoming increasingly common, now affecting around 6% of youth. Until now, direct evidence connecting childhood hypertension to future kidney health has been limited.

“Recognizing and treating hypertension during childhood could play a pivotal role in preventing progressive kidney damage later in life,” the authors noted. They further emphasized the importance of future large-scale, prospective studies to confirm these results and guide targeted interventions.

“With the burden of chronic kidney disease rising globally, especially among young populations, this study emphasizes the urgency of prioritizing pediatric hypertension as a public health concern,” the authors concluded.

Reference: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(25)00127-0/abstract

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Early Childbirth and Having No Children Linked to Higher Mortality in Postmenopausal Women, Study Shows

Florida: A large-scale study published in the American Journal of Obstetrics and Gynecology highlights how reproductive patterns such as the number of children and the timing of childbirth may influence long-term mortality risk in postmenopausal women.

The research, led by Dr. Zailing Xing from the College of Public Health at the University of South Florida, examined data from over 100,000 women to understand how parity and age at childbirth relate to lifespan—finding that early childbirth and childlessness are linked to higher all-cause mortality, with premature menopause playing a key mediating role.

The study analyzed data from the Women’s Health Initiative, involving 106,760 postmenopausal women. Using propensity score matching and multilevel Cox proportional hazard models, the researchers assessed the association between different reproductive factors and mortality, adjusting for demographic and clinical variables. Mediation analysis was also conducted to explore the role of premature menopause in these associations.

The study led to the following findings:

  • Women with no children had a 9% higher risk of all-cause mortality compared to those with two children.
  • Women with only one child had an 11% higher risk of death later in life.
  • Having three or more children did not significantly affect mortality rates.
  • Women who gave birth to their first child before age 20 had a 14% increased risk of mortality.
  • Last childbirth before age 25 was associated with a 6% higher risk of death.
  • Last childbirth at or after age 40 was linked to a 7% higher mortality risk.
  • Both early and late childbirth negatively impacted long-term survival.
  • Premature menopause was identified as a significant mediator between reproductive history and mortality risk.
  • Women with early childbirth or no children were more likely to experience early menopause.
  • Early menopause was associated with a shorter lifespan among postmenopausal women.

The findings emphasize the potential long-term health implications of reproductive choices and timing. According to the authors, these results highlight the need for early identification of women who may be at increased risk due to their reproductive history. This could help guide interventions aimed at improving long-term health outcomes and survival.

The authors concluded, “The study sheds light on how early-life reproductive factors can shape a woman’s health trajectory well into older age. Recognizing and addressing these risks early may be crucial to supporting healthy aging among women.”

Reference: https://www.ajog.org/article/S0002-9378(25)00379-5/abstract

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New study may pave the way for targeted cancer treatments

Imagine a drug that halts cancer without side effects or risks. That future may be a bit nearer thanks to recent research led by Raj Kumar, Ph.D., chair of the Department of Pharmaceutical and Biomedical Sciences at Touro College of Pharmacy.

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How a drug used to treat Parkinson’s disease might affect the brain

Simon Fraser University researchers are using a new approach to brain imaging that could improve how drugs are prescribed to treat Parkinson’s disease.

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Biocon Biologics Yesafili gets Health Canada nod for eye diseases

Bengaluru: Biocon Biologics Ltd., a fully integrated global biosimilars company and a subsidiary of Biocon Ltd., has announced that Health Canada has granted a
Notice of Compliance (NOC) for Yesafili (aflibercept), a biosimilar to Eylea (aflibercept) injection,
in vial and prefilled syringe presentations, 2 mg/0.05 mL on June 26, 2025.

This approval paves the
way for the launch of YESAFILI in Canada, scheduled for July 4, 2025.

YESAFILI is the first biosimilar to
EYLEA to be approved by Health Canada.
YESAFILI is a vascular endothelial growth factor (VEGF) inhibitor indicated for the treatment of:


• Neovascular (wet) age-related macular degeneration (AMD)

• Visual impairment due to macular edema secondary to central retinal vein occlusion (CRVO)

• Visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO)

• Diabetic macular edema (DME)

• Myopic choroidal neovascularization (myopic CNV)


The approval is based on a comprehensive package of analytical, nonclinical, and clinical data,
confirming that YESAFILI is highly similar with no clinically meaningful differences to EYLEA in terms
of quality, safety, and efficacy.


Shreehas Tambe, CEO & Managing Director, Biocon Biologics Ltd., said, “The approval of YESAFILI by
Health Canada—the first biosimilar to EYLEA in Canada—is a proud moment for Biocon Biologics.
We are excited that in July, Canada will be the first country where we will launch YESAFILI, making it
our 10th biosimilar to be commercialized worldwide. This milestone reflects our science-driven
innovation, global commercialization strength, and continued commitment to expanding access to
high-quality, affordable biologics for patients across the globe.”

Ramy Ayad, Head of Canada at Biocon Biologics, stated, “This is a significant achievement for Biocon
Biologics in Canada. With the approval of YESAFILI, we are delivering on our promise to improve access
to advanced biologic therapies. Canadian ophthalmologists and patients will soon have a high-quality,
affordable biosimilar option for serious retinal diseases.”

Read also: Biocon Gets CDSCO Panel Nod to Market Trastuzumab PGS in India

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Focus on Health equity: PM urges States to boost Healthcare Infrastructure

New Delhi: Prime Minister Shri Narendra Modi chaired the 48th meeting of PRAGATI, the ICT-enabled, multi-modal platform aimed at fostering Pro-Active Governance and Timely Implementation, by seamlessly integrating efforts of the Central and State governments, at South Block.

During the meeting, the Prime Minister reviewed certain critical infrastructure projects across the Mines, Railways, and Water Resources sectors. These projects, pivotal to economic growth and public welfare, were reviewed with a focus on timelines, inter-agency coordination, and issue resolution.

Prime Minister underscored that delays in project execution come at the dual cost of escalating financial outlays and denying citizens timely access to essential services and infrastructure. He urged officials, both at the Central and State levels, to adopt a results-driven approach to translate opportunity into improving lives.

Also Read:Yoga is the pause button humanity needs, says PM Modi as he leads 11th International Yoga Day

During a review of Prime Minister-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), the Prime Minister urged all States to accelerate the development of health infrastructure, with a special focus on Aspirational Districts, as well as remote, tribal, and border areas. He emphasized that equitable access to quality healthcare must be ensured for the poor, marginalized, and underserved populations, and called for urgent and sustained efforts to bridge existing gaps in critical health services across these regions.

Prime Minister emphasised that PM-ABHIM provides a golden opportunity to States to strengthen their primary, tertiary and specialised health infrastructure at Block, District and State level to provide quality health care and services.

Prime Minister reviewed exemplary practices fostering Aatmanirbharta in the defence sector, undertaken by various Ministries, Departments, and States/UTs. He lauded these initiatives for their strategic significance and their potential to spur innovation across the defence ecosystem. Underscoring their broader relevance, Prime Minister cited the success of Operation Sindoor, executed with indigenous capabilities, as a powerful testament to India’s advancing self-reliance in defence sector.  

Prime Minister also highlighted how the States can avail the opportunity to strengthen the ecosystem and contribute to Aatmanirbharta in defence sector.

Also Read:Doctors are like Gods, says Rajnath Singh at KNS Hospital Silver Jubilee Celebration

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Haryana takes action against Health Officials over Illegal Abortions

Chandigarh: In a decisive move to strengthen the Beti Bachao-Beti Padhao campaign and improve the sex ratio at birth (SRB) in Haryana, the state’s Special Task Force (STF) on Tuesday initiated disciplinary action against two senior health officials for alleged dereliction of duty.   

According to the news reports, the STF decided to charge-sheet the former Chief Medical Officer (CMO) of Charkhi Dadri, for “persistent non-performance” in duties related to sex ratio monitoring. Similarly, directions were issued for initiating charges against the Senior Medical Officer (SMO) of CHC-Gopi in Bhiwani, citing low SRB in his area of responsibility. 

The decisions were taken during a high-level STF meeting chaired by Additional Chief Secretary (Health), Sudhir Rajpal. The SRB stood at 906 girls per 1,000 boys as of June 23, a slight dip from 910 recorded in December 2024, prompting renewed focus on enforcement and community intervention.

During the review meeting, ACS Rajpal emphasised the need for close monitoring of “SAHELIs” working with pregnant women, particularly in areas where abortion cases have been reported. The health department spokesperson stated that the ACS directed strict surveillance of Community Health Centres (CHCs) and called for holding Senior Medical Officers (SMOs) accountable in regions where illegal abortions are taking place.

Also Read: Rajasthan: Sex ratio at birth improves; PCPNDT Act hailed

According to Hindustan Times, the STF also ordered the cancellation of the registration of an AYUSH doctor in Kharkhoda, Sonipat, against whom an FIR has been filed over illegal abortion practices. The ACS (health) further directed that any woman arriving at a hospital with bleeding symptoms must undergo reverse tracking and be tested for consumption of Medical Termination of Pregnancy (MTP) pills. “If any violation of the law is detected, appropriate legal action must be taken without delay,” Rajpal said.

As part of the intensified campaign from June 17 to 23, the department conducted 28 inspections across the state targeting the illegal sale of MTP kits. As a result, one shop was sealed, and two FIRs were registered. Authorities also reported a drastic drop in the number of wholesalers selling MTP kits — from 32 to just 3 — along with decreased sales in 15 districts.

Also Read: UP Govt makes Childbirth Reporting mandatory for Private Hospitals

The ACS directed officials to ramp up raids on ultrasound and MTP centres and increase birth registration drives, particularly in Charkhi Dadri district, where targeted interventions are needed. He also emphasised the need to expand the ‘Beti Bachao-Beti Padhao’ campaign to urban areas, reports Hindustan Times.

To recognise and encourage community involvement, the task force recommended identifying SAHELIs who have actively ensured the safe delivery of girl children. These volunteers will be incentivised by the respective CMOs to honour their contribution and inspire others.

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Thiruvananthapuram Medical College achieves milestone in advanced stroke care

Thiruvananthapuram: The Neurology Department of the Government Medical College (GMC) Thiruvananthapuram has achieved a significant milestone in the field of advanced stroke treatment through its neurointervention facilities.

“Neuro-intervention services at the Medical College began in June 2023. Under the current government, the first Neuro Cath Lab in the country within the neurology department was established here,” Health Minister Veena George said, news agency UNI reported.

Since then, the deployment has successfully performed 320 diagnostic cerebral angiograms and 55 therapeutic neuro-intervention procedures — a total of 375 neuro-interventions. This includes several complex procedures that are rarely performed in India.

Also Read:Kerala Govt to launch Real-time Blood Bank Tracking Application

Congratulating the entire neurology team for bringing numerous patients back to life through these advanced treatments, she said the team has successfully treated extremely rare and complex conditions like aneurysms.

Procedures such as angioplasty on extremely thin blood vessels within the brain were performed with great success. This has placed Thiruvananthapuram Medical College among the very few institutions in India capable of handling such complex procedures.

The hospital has also successfully performed embolisation procedures for rare conditions like dural arteriovenous fistula (dural AV fistula), carotid-cavernous fistula, and arteriovenous malformations (AVMs).

These advanced treatments, which typically cost several lakhs of rupees, are provided either free of charge or at a very low cost under government health schemes. Even patients aged up to 90 have successfully undergone mechanical thrombectomy at the hospital.

A stroke (also called a cerebrovascular accident) occurs when the blood vessels supplying the brain are blocked (thrombosis) or ruptured (hemorrhage).

Stroke treatment is highly time-sensitive – patients must reach the hospital within 4.5 hours of the first symptoms for the treatment to be effective. Symptoms of stroke include sudden facial drooping, weakness in the arms or legs, and slurred speech. Anyone exhibiting these signs should be rushed to a hospital without delay.

To provide comprehensive stroke care, Thiruvananthapuram Medical College has established an advanced stroke centre equipped with facilities such as a CT angiogram, a stroke cath lab, and a dedicated stroke ICU.

A Stroke Helpline is also available for assistance. In case of any suspicion of stroke, immediately call the Stroke Centre’s helpline at 9946332963 for guidance and emergency support. A fully equipped medical team is available 24/7 at the centre to ensure timely and life-saving treatment, reports UNI.

Also Read:Kerala: Health Minister Veena George to inaugurate first ever project on collection, disposal of expired medicines

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