Newsroom Hospital for Special Surgery

Castle Connolly's 2026 Exceptional Women in Medicine

Thu, 26 Mar 2026 10:00:00 -0400

Castle Connolly announces the release of the 2026 Exceptional Women in Medicine.

This list recognizes female Castle Connolly Top Doctors who have demonstrated outstanding leadership, expertise and dedication in their respective fields. In addition to meeting the requirements to be selected as a Castle Connolly Top Doctor, these doctors also have additional qualifications, including research and academic contributions, volunteer work within healthcare, and training at top institutions.

Read the full article at castleconnolly.com.

New SLE Guidelines Endorse Expanding HCQ, Restricting Glucocorticoids

Mon, 10 Nov 2025 13:24:00 -0500

Med Central reports that The American College of Rheumatology has updated its recommendations for the treatment of systemic lupus erythematosus (SLE) with key changes in the areas of screening, treatment, and monitoring. The guideline was recently published in Arthritis Care & Research.

The goal of the new guideline is to provide evidence-based expert guidance on treatment and management of non-renal SLE. The update emphasizes glucocorticoid tapering and discontinuation when possible, and acknowledges the persistent impact of health care disparity as a barrier to accessing care. A separate ACR guideline on lupus nephritis is awaiting publication.

Lisa R. Sammaritano, MD, rheumatologist at HSS served as lead author of the new guideline and presented the update at the annual meeting of the American College of Rheumatology (ACR Convergence 2025).

Read the full article at medcentral.com.

ACR Issues First Update to Lupus Guideline Since 1999

Fri, 07 Nov 2025 13:21:00 -0500

Medpage Today reports that the long-awaited updates to the American College of Rheumatology's (ACR) guideline on systemic lupus erythematosus (SLE) management make clear that hydroxychloroquine (HCQ) should be the centerpiece of treatment for most patients, with other medication classes added as needed to reach low disease activity (LDA) or remission.

Written by Lisa R. Sammaritano, MD, rheumatologist at HSS, and a committee of nearly 50 other experts, the new guideline also stipulates that corticosteroids are OK for gaining symptom control in newly diagnosed patients and when flares erupt, but the duration should be kept as short as possible.

Read the full article at medpagetoday.com.

A Cutting-Edge Cancer Therapy Offers Hope for Patients With Lupus

Wed, 18 Jun 2025 13:24:17 -0400

The New York Times reports that CAR T-cell therapy, a kind of “living drug” that modifies patients’ immune cells to help them attack misbehaving ones, has been used with significant success to treat some cancers, particularly of the blood. A growing body of evidence has suggested that the therapy can also treat a severe form of lupus that, at best, can be managed as a lifelong condition and, at worst, resists treatment and can lead to organ failure and death.

“It’s really promising, and honestly the first therapy that we’ve talked about as a cure,” said Lisa R. Sammaritano, MD, rheumatologist at HSS, and the lead author on a set of recently updated guidelines for lupus treatment. Until now, she said, “we haven’t had a cure — we’ve had control.”

Read the full article at nytimes.com. A subscription is required to access.

Pregnant mothers with lupus face risks but have better outlooks than ever before, doctor says

Tue, 27 May 2025 15:15:06 -0400

CBS News featured Lisa R. Sammaritano, MD, rheumatologist at HSS, in a story highlighting the improved outlook for pregnant women living with lupus. The segment follows HSS patient Kiana Cornejo, who was diagnosed with lupus at age 11 and navigated a high-risk pregnancy with careful planning and medical guidance. Dr. Sammaritano emphasized that with proactive disease management and appropriate medication adjustments, women with lupus can achieve healthy pregnancies.

Watch the story at cbsnews.com.

Need Help With Lupus Nephritis Management? ACR Has Your Back

Thu, 08 May 2025 16:48:00 -0400

Med Page Today reports that over the past dozen years, treatment approaches in lupus nephritis (LN) have changed substantially, and this is reflected in a long-awaited update to the American College of Rheumatology's (ACR) official guideline on the topic.

Whereas a two-step plan -- induction followed by maintenance therapy -- was called for in the ACR's last LN guideline, issued in 2012, medications introduced since then have prompted a "conceptual shift" in LN management, according to Lisa R. Sammaritano, MD, rheumatologist at HSS, and co-author of the new update.

With targeted drugs including the biologic agent belimumab (Benlysta) and the calcineurin inhibitor voclosporin (Lupkynis) now available, management now centers on early and continued use of combination treatment "targeting different arms of the immune system," the group explained.

Read the full article at medpagetoday.com.

2024 Lupus Guideline

Wed, 07 May 2025 11:35:00 -0400

HSS rheumatologists Lisa R. Sammaritano, MD, and Kyriakos A. Kirou, MD, DSc, FACP, and clinical research coordinator Christele Felix contributed to the latest American College of Rheumatology (ACR) Clinical Practice Guideline. The manuscript provides recommendations regarding screening, treatment, and management of lupus nephritis (LN) in both adults and children.

Read the full article at rheumatology.org.

9 Essential Questions to Ask About Managing Lupus

Tue, 01 Apr 2025 12:22:00 -0400

Lisa R. Sammaritano, MD, rheumatologist at HSS and Director of the Rheumatology Reproductive Health Program of the Barbara Volcker Center for Women and Rheumatic Diseases speaks to Health Central about pregnancy and reproductive health considerations for women living with lupus.

Lupus, also known as systemic lupus erythematosus, is a chronic disease that causes the immune system to attack its own tissues. Anyone can get lupus, but mostly women develop the autoimmune condition. The inflammation that goes along with lupus can cause a variety of issues including arthritis, fevers, rashes, and fatigue.

Many women with lupus have concerns about whether they can safely become pregnant.

“Most women living with lupus can have successful pregnancies. The key to pregnancy success lies in planning. The presence of quiet or low-level disease activity improves outcomes for both mother and baby,” explained Dr. Sammaritano. Dr. Sammaritano says that six months of low disease activity before conception can reduce the risk of lupus flare during pregnancy and improve pregnancy outcomes.

Read the full article at healthcentral.com.

HSS Presents Cutting-Edge Discoveries in Rheumatic Disease and Reproductive Health at ACR Convergence 2024

Mon, 18 Nov 2024 11:30:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented several significant studies, with three focused on reproductive health: infant feeding behaviors among women with systemic rheumatic disease, the validation of a model that predicts the likelihood of adverse outcomes among pregnant patients with lupus, and a quality-improvement initiative to increase contraception screening and documentation.

What follows are highlights from these studies:

Factors Associated with Infant Feeding Behaviors Among Women with Systemic Rheumatic Diseases

While guidelines provide recommendations on which medications for rheumatic diseases are safe during breastfeeding, limited research has explored what factors influence the decision to breastfeed among patients with these conditions. HSS researchers leveraged data from the Rheumatology Women’s Reproductive Health and Wellness Cohort to better understand the range of influences.

The cohort included 158 patients who reported on infant-feeding practices. Among those, 56% had systemic rheumatic diseases. The data showed that among these patients, about two-thirds breastfed at some point, while about one-third exclusively formula fed. The participants also reported their satisfaction levels with infant feeding, with only breast discomfort and lack of milk production being associated with lower satisfaction.

The investigators found that although the medications that the patients were taking for their rheumatic disease influenced their infant-feeding practices, disease-agnostic factors also played an important role. These factors included the experiences of friends and family, social media, and workplace policies, among others.

“It’s important to be mindful that these are things that influence people’s practices,” says Sarah B. Lieber, MD, MS, rheumatologist at HSS.

Dr. Lieber explains that rheumatologists are uniquely positioned to study this topic, as they typically care for patients over many years, including during pregnancy and the postpartum period. “We develop close relationships with our patients and they frequently seek our guidance on a wide range of issues,” she says. “Research like this allows us to expand our focus beyond rheumatology-specific concerns, addressing other important factors that may not have been addressed in other contexts to ensure that we honor their preferences with regard to infant feeding.”

Authors: Sarah B. Lieber, MD, MS; Lucy Masto, BS; Amaya Smole, BA; Ranqing Lan, MA; Michael Parides, PhD; Jonah M. Levine, BA; Bessie Stamm, BA; Caroline H. Siegel, MD, MS; Lisa A. Mandl, MD, MPH; Michael D. Lockshin, MD; Medha Barbhaiya, MD, MPH; and Lisa R. Sammaritano, MD.

Predicting Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus: External Validation of the PROMISSE Model Using Multiple Independent Cohorts

Lupus is associated with severe adverse pregnancy outcomes, including pre-eclampsia, very early preterm deliveries, and in rare cases, fetal death. Fortunately, these occur in only 20% of patients. Early identification of women with SLE who are at high risk of pregnancy complications is vital. A team led by HSS investigators followed more than 400 pregnant patients with lupus — all of whom were enrolled in the PROMISSE Study, a multicenter, multiethnic/racial study — with the goal of using clinical features and laboratory tests to identify those patients at high risk for pregnancy complications. They identified two promising algorithms for predicting poor pregnancy outcomes using PROMISSE data.

The goal of the current work was to externally validate these two models to test their transportability to other populations. In this study, the group obtained data from 966 pregnant lupus patients from six independent cohorts treated at centers in the United States and Europe, a demonstration of global collaboration. Groups that shared data for the validation were from South Carolina, Manhattan, and the Bronx, as well as Germany, Italy, and France. The patient populations varied, with some groups being predominantly white, while others were predominantly Black — either African American or Afro-Caribbean.

The PROMISSE model used statistics and machine learning to create prediction algorithms based on thousands of data points from 400 patients. The new findings with the additional patients confirmed that the algorithms can reliably predict pregnancy outcomes by assessing factors such as the presence of specific autoantibodies, disease activity, blood pressure, medications, and patients’ race and ethnicity. They demonstrate the geographic transportability of the best-performing algorithms. “The study reassured us that this model performs well across a diverse range of patient populations,” says Jane E. Salmon, MD, co-principal investigator and rheumatologist at HSS.

“More than 80% of lupus patients are likely to have an uncomplicated pregnancy, and they should be able to enjoy this time without having to worry. We are now better able to predict risk,” Dr. Salmon adds. “For those at higher risk, we can closely monitor and recommend clinical trials aimed at preventing complications.”

The team also included co-principal investigator and biostatistician Mimi Kim, ScD, and machine learning expert Melissa Fazzari, MS, PhD. Their next step is to develop a publicly available online risk calculator, a tool to allow obstetricians, rheumatologists, and other healthcare providers to better guide their patients based on individualized assessments.

Authors: Melissa Fazzari(Albert Einstein College of Medicine); Jane E. Salmon, MD; Marta Guerra, MS; Nathalie Costedoat-Chalumeau(Inserm; Paris, France); Veronique Le Guern (Cochin Hospital; Paris, France); Gaëlle Guettrot-Imbert(Cochin Hospital, Paris, France); Marta Mosca(University of Pisa; Italy); Dina Zucchi(University of Pisa; Italy); Chiara Tani(University of Pisa; Italy); Rebecca Fischer-Betz (Uniklinik Düsseldorf, Düsseldorf, Germany); Isabell Haase (Heinrich-Heine University Düsseldorf; Düsseldorf, Germany); Anna Broder (Hackensack Network; New Jersey); Navneet Kaur (Touro University Medical Group, Sacramento); Jill Buyon (NYU Grossman School of Medicine); Brooke Cohen (NYU Grossman School of Medicine); Diane Kamen (Medical University of South Carolina); Jessica English(Medical University of South Carolina); Anna Arar (Medical University of South Carolina); and Mimi Kim (Albert Einstein College of Medicine).

Quality Improvement Initiative to Increase Contraception Screening and Documentation for Reproductive-Aged Women Prescribed Teratogenic Medications in an Academic Rheumatology Center

Contraception use among patients with rheumatologic diseases who are taking medications that may cause fetal defects is low. They are not always counseled on contraceptive options or prescribed effective contraception. In addition to primary care providers and gynecologists, rheumatologists play an important role in contraception counseling for patients with rheumatic disease. However, there are several barriers to rheumatologists providing contraception counseling to patients. Documentation of contraception use in patients with rheumatic disease is poorly standardized nationally. Researchers from HSS, who previously looked at developing a more streamlined process for documentation of sexual activity and contraception in these patients, expanded their work in this new study to improve documentation in this patient population.

In the study, they implemented a pop-up alert in the electronic health record across all ambulatory areas. Over a period of 24 weeks, the alert was set to trigger during clinical visits for female patients between the ages of 18 and 50 who were taking one of these high-risk medications. The alert reminded the nurses to ask about patients’ sexual activity and contraceptive use and document it in the medical record.

Despite the initiative, the investigators found that for the most part, documentation rates did not increase significantly over the time period, except in the unit where the project had previously been piloted. “In that unit, we had nursing champions who were invested in the process and understood the importance of asking these questions,” says Nancy Pan, MD, rheumatologist at HSS. “They can encourage their colleagues to help, including by suggesting ways to normalize what is often a sensitive topic with patients yet is critical to providing the best medical care possible for them.” She adds that despite these results, she and her colleagues learned from this program and that their findings are prompting new interventions to optimize contraception documentation, counseling, and ultimately referrals to women’s health providers.

“When patients choose to take these medications, we always make sure to counsel them on contraception,” Dr. Pan says. “However, as a patient’s personal circumstances can change, it’s essential that we reassess their needs regularly. Optimizing documentation of contraception is an important first step to achieving improved health outcomes in these patients.”

Authors: Caroline H. Siegel, MD, MS; Avi Mikhaylov; Emily Wu; Deanna Jannat-Khah, DrPH; Erika Abramson(Weill Cornell Medicine), Lisa R. Sammaritano, MD; and Nancy Pan, MD.^.

HSS Presents New Research at the ACR Convergence 2024

Sat, 16 Nov 2024 10:30:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented exciting research related to rheumatology and orthopedics.

Research highlights include a study showing that online search trends can lead to more personalized rheumatic disease care, and blood changes in people at risk for rheumatoid arthritis, a study revealing that having rheumatoid arthritis was not a risk factor for needing a blood transfusion during or after total knee replacement, new discoveries in antiphospholipid syndrome, the effectiveness of avacopan for severe vasculitis, new insights on rheumatic diseases and reproductive health and a study that shows knee osteoarthritis causes more pain and inflammation in women.

New Study Signals How Online Search Trends Could Lead to More Personalized Rheumatic Disease Care

Physicians are learning how to better support the needs of people with rheumatoid arthritis from online search trends, according to a new study from researchers at HSS and colleagues at Columbia University Vagelos College of Physicians & Surgeons.

New Research Reveals Alterations in Blood of People at Risk of Developing Rheumatoid Arthritis

A new study by HSS and collaborating centers identified distinct immune cell patterns in the blood that signal an increased risk of developing rheumatoid arthritis before symptoms occur.

Surprising Study Finds No Link Between Rheumatoid Arthritis and Transfusion Risk After Knee Replacement

Having rheumatoid arthritis was not a risk factor for needing a blood transfusion during or after total knee replacement, according to a new study by HSS researchers.

New Antiphospholipid Syndrome Research Findings Presented at ACR Convergence 2024

Investigators from the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) presented new research findings in antiphospholipid syndrome (APS). These studies explore differences in clinical manifestations of APS in children versus adults, identify key risk factors for thrombosis in persistently antiphospholipid antibody-positive patients, and investigate the prevalence and implications of lupus-related autoantibodies in patients without lupus.

Study Shows Avacopan Effective for Most Serious Vasculitis Cases

New multicenter study by HSS and others by HSS shows avacopan is effective in achieving disease control with less steroid exposure in patients with ear, nose and throat manifestations of ANCA associated vasculitis.

HSS Presents Cutting-Edge Discoveries in Rheumatic Disease and Reproductive Health at ACR Convergence 2024

HSS presented a number of studies focused on reproductive health for patients with rheumatic diseases including factors influencing infant feeding, predicting pregnancy outcomes in lupus, and improving contraception screening for women on teratogenic medications in rheumatology.

Study Shows Knee Osteoarthritis Causes More Pain and Inflammation in Women

Women with knee osteoarthritis experience more pain and inflammation than men, according to a new study led by researchers at HSS and The Rockefeller University.

Let’s Define Undifferentiated Connective Tissue Disease

Thu, 22 Aug 2024 20:42:18 -0400

HSS rheumatologists including Medha Barbhaiya, MD, MPH, Caroline H. Siegel, MD, MS, Lisa R. Sammaritano, MD, Michael D. Lockshin, MD, and Lucy Masto, BS, share their insights with The Rheumatologist on undifferentiated connective tissue disease (UCTD) and HSS's registry aimed at improving diagnosis, tracking progression, and enhancing patient care.

UCTD is a diagnosis given to patients who do not fulfill current classification criteria for named connective tissue diseases (CTD)—systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), or Sjögren’s disease—but who nonetheless have clinical signs and symptoms and serological evidence of autoimmune CTDs.

To improve understanding and acceptance of a UCTD diagnosis, the Barbara Volcker Center at HSS, has created a prospective Undifferentiated Connective Tissue Disease and Overlap Registry that systematically reviews medical records of patients with UCTD to verify they do not meet ACR/EULAR-endorsed classification criteria for SLE, SSc, RA, Sjögren’s, inflammatory myopathy or antiphospholipid syndrome, then annually collects clinical data and biologic samples.

Read the full article at the-rheumatologist.org.

Why Obstetric History Matters When Assessing CV Risk in Women With Autoimmune Disease

Thu, 09 May 2024 09:21:00 -0400

Medscape discusses why obstetric history matters when assessing cardiovascular disease risk in women with autoimmune disease.

Systemic autoimmune disease is well-recognized as a major risk factor for cardiovascular disease, but less recognized as a cardiovascular risk factor is a history of pregnancy complications, including preeclampsia, and cardiologists and rheumatologists need to include an obstetric history when managing patients with autoimmune diseases, a specialist in reproductive health in rheumatology told attendees at the 4th Annual Cardiometabolic Risk in Inflammatory Conditions conference.

"Autoimmune diseases, lupus in particular, increase the risk for both cardiovascular disease and maternal placental syndromes," Lisa R. Sammaritano, MD, rheumatologist at HSS, told attendees. "For those patients who have complications during pregnancy, it further increases their already increased risk for later cardiovascular disease."

"It is always important to obtain a reproductive health history from patients with autoimmune diseases," said Dr. Sammaritano. "This is an integral part of any medical history. In the usual setting, this includes not only pregnancy history but also use of contraception in reproductive-aged women. Unplanned pregnancy can lead to adverse outcomes in the setting of active or severe autoimmune disease or when teratogenic medications are used."

Read the full article at medscape.com.

Castle Connolly Releases 2024 Exceptional Women in Medicine

Tue, 12 Mar 2024 15:34:00 -0400

Castle Connolly announces the release of the 2024 Exceptional Women in Medicine. This list recognizes female Castle Connolly Top Doctors across the U.S. who have demonstrated outstanding leadership, expertise and dedication in their respective fields. There are over 8,300 doctors represented, across 77 different specialties and all 50 states.

The Exceptional Women in Medicine list is compiled through a rigorous selection process that includes peer nominations, extensive research, and evaluation by the Castle Connolly research team. In addition to meeting the criteria to be selected as a Castle Connolly Top Doctor, these physicians have qualifications including contributions to healthcare through volunteer work, awards and honors, training at top institutions, research and academics, and innovations in their field of specialty.

Read the full article at castleconnolly.com.

HSS Presents New Reproductive Health Research at the ACR Convergence 2023

Tue, 14 Nov 2023 12:05:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented a number of important studies focused on reproductive health for patients with systemic lupus erythematosus, rheumatoid arthritis, and other rheumatic diseases, including issues related to fertility, sexual function, use of contraception and HPV vaccination.

What follows are some highlights from the meeting:

Association of Menstrual Cycles and Disease Flare Activity in Women with Systemic Lupus Erythematosus and Rheumatoid Arthritis
In this study, researchers surveyed female rheumatology patients to determine whether the menstrual cycle affects the timing of disease flares. More than 300 patients responded to the survey, and the analysis reported at the meeting included data from 122 respondents with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) — 49 with SLE and 73 with RA.

Overall, 39% reported an association between their menstrual cycle and disease flares, with similar rates in both the SLE and RA groups. Those who experienced these flares usually had them within the week before or during their periods. The investigators say these findings could inform physician counseling and that closer monitoring of patients during vulnerable phases of the menstrual cycle could enable more timely intervention and better disease control. Additional research is planned to assess whether demographics, lifestyle and medical conditions may influence this potential association.

Authors: Lucy Masto, BS; Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Sanjana Adurty (Weill Cornell Medical College), Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD, Medha Barbhaiya, MD, MPH.

Contraception Choices in Individuals with Inflammatory Arthritis and Lupus-like Disease Differ Based on Diagnosis and Teratogen Use
This study surveyed women of reproductive age with systemic rheumatic disease about their use of contraceptives. Certain drugs prescribed for rheumatic disease are teratogenic, or can damage a fetus. Data were collected on 249 women with reproductive capacity, including 147 with inflammatory arthritis and 102 with lupus-like disorders.

The 52 participants taking teratogenic medication were more likely to discuss contraception with their rheumatologist compared with those not taking teratogenic medication (44.2% vs. 21.8%), and more frequently reported using permanent contraception (8.0% vs. 1.1%). Those taking teratogenic medication were no more likely to use effective contraception than those who were not: 44.0% reported using less effective methods such as barrier methods and fertility awareness/withdrawal or using no contraception. Those with lupus were less likely to use more effective methods containing estrogen (31.5% vs. 14.7%), even though these methods are safe for some (but not all) lupus patients. The findings highlight the importance of using educational interventions to optimize safe and effective contraception use in patients with systemic rheumatic diseases, especially those taking teratogenic medications and those with lupus-like diseases.

Authors: Caroline H. Siegel, MD, MS, Medha Barbhaiya, MD, MPH, Lucy Masto, BS, Amaya Smole, BA, Bessie Stamm, BA, Jonah M. Levine, BA, Sarah B. Lieber, MD, MS; Lisa A. Mandl, MD, MPH; Michael D. Lockshin, MD; Lisa R. Sammaritano, MD.

Demographic and Clinical Factors Associated with HPV Vaccination in Young Adults with Rheumatic Disease
Although the HPV vaccine is known to be safe and effective in people with rheumatic disease (RD), many do not get vaccinated. This study used data from the electronic health record of patients diagnosed with a rheumatic disease in adolescence, seen at HSS, to look at factors associated with HPV vaccination. Overall, the investigators found that among 321 individuals with rheumatic disease between the ages of 16 and 22, half were not fully vaccinated against HPV (2 or more doses).

Those who were white and non-Hispanic/Latino and those who had commercial insurance were less likely to be fully vaccinated —factors that are associated with lower vaccination rates in the general population. Those who were unvaccinated were more likely to have inflammatory arthritis versus other connective tissue diseases. Those who were fully vaccinated were also more likely to have received flu and COVID-19 vaccines. Further research is needed to identify and mitigate barriers to HPV vaccination in this high-risk group.

Authors: Caroline H. Siegel, MD, MS, Lauren Robinson, MD, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Nancy Pan, MD, Lisa R. Sammaritano, MD.

Educational Intervention to Increase Contraception Screening and Documentation for Reproductive-Aged Women Seen in an Academic Rheumatology Clinic

Only one-third of reproductive-aged women with rheumatic disease are prescribed effective contraception, despite the widespread use of teratogenic medications which can harm a fetus. This initiative aimed to increase the rate of provider screening and documentation of contraception use in the electronic health record for female rheumatology patients ages 18 to 45.

Interventions from the research team included educational presentations and motivating reminders for clinical staff. Over the 24-week study period, the rate of contraception documentation for these patients increased from 11% to 54%. Future phases of this initiative will focus on encouraging rheumatologists to provide contraceptive counseling and referrals to women’s health providers for patients taking teratogenic medications.

Authors: Caroline H. Siegel, MD, MS, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Erika Abramson (Weill Cornell Medicine), Nancy Pan, MD; Lisa R. Sammaritano, MD.

Experiences and Attitudes Related to Assisted Reproductive Technologies Among Women with Systemic Rheumatic Disease
Because systemic rheumatic diseases may be associated with decreased fertility in women, those with such diseases may pursue assisted reproductive technologies such as oocyte cryopreservation (OOC, or egg freezing). This study evaluated how sociodemographic factors and medical history influence OOC experiences and overall attitudes toward reproductive technologies among women with these conditions.

Among the 265 surveyed patients of reproductive age, 21 had done OOC (most before 35 years of age) and 102 had considered OOC. The factors that increased openness to OOC included having no previous pregnancies, having greater infertility concerns, lacking a spouse or partner, having a bachelor’s degree or higher, and having a history of taking certain immunosuppressive drugs. Among those who did not already have fertility issues, 64% reported that, if necessary, they would consider using these technologies only if their rheumatologist advised it was safe. The investigators say this study highlights the importance of studying the use of assisted reproductive technologies in women with systemic rheumatic diseases, and counseling patients regarding these options.

Authors: Sanjana Adurty (Weill Cornell Medical College), Lucy Masto, BS, Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Medha Barbhaiya, MD, MPH, Lisa R. Sammaritano, MD.

HPV Vaccination in Adolescent and Young Adult Patients Seen in an Academic Rheumatology Center
This study looked at rates of HPV vaccination in adolescents and young adults living in New York State who had received care from a rheumatologist. The investigators reviewed data from the electronic health record, including vaccination information from a New York State database, for 534 HSS patients ages 16 to 22. Less than half of patients had been vaccinated for HPV. The study found that HPV vaccination was more common in people with a rheumatic disease diagnosis compared to those who did not have a rheumatic disease, but not after accounting for demographic variables and receipt of other elective vaccines. Additionally, those who had received flu and COVID-19 vaccines were more likely to have been vaccinated for HPV.

The overall low rate of HPV vaccination was concerning because young people with rheumatic diseases may be at increased risk for HPV infection and HPV-associated cancers due to immune dysregulation, immunosuppression, and gaps in preventive healthcare delivery. The researchers note that interventions are needed to improve HPV vaccination rates in this population and that targeting elective vaccine uptake in general may be a useful approach.

Authors: Caroline H. Siegel, MD, MS, Lauren Robinson, MD, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Nancy Pan, MD, Lisa R. Sammaritano, MD.

Knowledge and Misconceptions about Contraception Among Individuals with Inflammatory Arthritis and Lupus-like Diseases
This study looked at what patients with systemic rheumatic disease know about the use of contraceptives, comparing the knowledge of women with inflammatory arthritis to those with lupus-like diseases. This analysis included female patients aged 18-49 years who were seen by a rheumatologist at HSS two or more times between 2020 and 2022, excluding those who reported menopause, oophorectomy, hysterectomy, or other causes of infertility.

The participants were surveyed about the effectiveness of various contraceptives and about misconceptions related to specific methods in the context of having a rheumatic disease. The researchers found that despite being highly educated (93.2% held a bachelor’s degree or higher), about half of all patients responded incorrectly to questions about the effectiveness of various contraceptive methods. Those with lupus-like diseases were more likely to report that certain hormone-based methods have contraindications, in response to both accurate and inaccurate statements. The researchers say the results reveal the need for better counseling of patients with systemic rheumatic disease.

Authors: Caroline H. Siegel, MD, MS, Medha Barbhaiya, MD, MPH, Lucy Masto, BS, Amaya Smole, BA, Bessie Stamm, BA, Jonah M. Levine, BA, Sarah B. Lieber, MD, MS, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD.

Knowledge Related to Fertility and Infertility Treatments Among Women with Systemic Rheumatic Disease
Systemic rheumatic diseases can be associated with decreased fertility, but patients are not always aware of this connection. This study looked at patients’ understanding of these issues, taking into consideration the patient’s race, ethnicity, and socioeconomic status.

In an interim analysis of 142 reproductive-aged women treated at HSS for rheumatic disease who completed the Fertility & Infertility Treatment Knowledge Score (FIT-KS) test, the investigators found that — compared with women in the general population previously administered the FIT-KS — women with rheumatic diseases were more likely to be non-White, Hispanic/Latina and highly educated, and less likely to have had successful pregnancies. This population was more aware of the risks of infertility due to smoking, sexually transmitted infections and being underweight. These women also had a better understanding of success rates for vitro fertilization in older women but were less knowledgeable about the effectiveness of oocyte cryopreservation (OOC, or egg freezing). Future work will focus on highlighting important knowledge gaps among women with these diseases, particularly related to options for fertility preservation.

Authors: Sanjana Adurty (Weill Cornell Medical College); Lucy Masto, BS, Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Medha Barbhaiya, MD, MPH, Lisa R. Sammaritano, MD.

Reproductive History and HPV Vaccination Awareness Among Women with Systemic Lupus Erythematosus and Rheumatoid Arthritis
Women with systemic rheumatic diseases, particularly those with systemic lupus erythematosus (SLE), may be more vulnerable to HPV infection and HPV-related cervical cancer, but HPV testing and vaccination rates are low in these patients. This study compared HPV vaccination status and awareness in female patients with SLE to female patients with rheumatoid arthritis (RA).

The analysis included 295 participants with similar demographics; notably, those with SLE were slightly younger than those with RA. Both groups were similarly likely to be sexually active and had similar rates of having regular Pap smears; however, women with lupus were more likely to have persistent abnormal smears (13.3% vs. 1.7%). While not statistically significant, two women with lupus reported a cervical cancer diagnosis compared to none with rheumatoid arthritis. HPV vaccination rates were similar for the two groups, with 37% of 158 women eligible for the vaccine (including those made eligible given extended eligibility approved in 2019 for those aged ≤45 years if clinically appropriate) reporting having received full vaccination. Among the 79 women who had never received the vaccine yet were eligible, 90% reported that it had never been offered. These findings underscore the importance of increasing HPV vaccination rates and discussions about cervical cancer screening in women with SLE and RA.

Authors: Amaya Smole, BA, Lucy Masto, BS, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Sanjana Adurty (Weill Cornell Medical College), Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD, Medha Barbhaiya, MD, MPH.

Self-Reported Sexual Dysfunction and Perceptions of Rheumatologist Engagement on This Issue in Patients with Systemic Sclerosis
This study looked at the prevalence and risk factors of sexual dysfunction among people with systemic sclerosis (SSc). HSS researchers developed the Sexual Function in SSc Questionnaire (SFSScQ) to anonymously survey patients on whether they had problems with their sexual function and, if so, whether they had ever discussed it with their rheumatologist. Participants who completed the SFSScQ were also asked to complete the already-established Female Sexual Function Index or the International Index of Erectile Function Questionnaire.

More than half of those who completed both surveys (26 out of 41) reported that they had sexual problems. The researchers note that while the number of survey participants was small, age, sex, race, SSc subtype and time since SSc diagnosis did not appear to be predictors of sexual dysfunction. Importantly, although about half of participants agreed it was important to discuss problems of sexual function with their doctors, 64% of those who reported sexual problems had not done so.

Authors: Liza Morales, Robert F. Spiera, MD, Jessica K. Gordon, MD, Deanna Jannat-Khah, DrPH, Kimberly S. Lakin, MD, MS.

Westfair Business Journal’s 2023 Doctors of Distinction

Mon, 02 Oct 2023 14:22:00 -0400

Westfield Business Journal honors HSS rheumatologist Lisa R. Sammaritano, MD, as a recipient of the 2023 Doctors of Distinction “Female Innovator” award.

The article noted the awards ceremony, held on the evening of September 21, was the tenth annual event hosted by the Westfair Business Journal. Doctors, nurses, physicians’ assistants, dentists, and veterinarians from across Westchester and Fairfield counties were recognized for accomplishments ranging from innovative new procedures to demonstrating the ways that the medical profession can be a family business.

Read the article at westfaironline.com.

ICYMI: 25 Great Women in Rheumatology

Tue, 04 Jul 2023 13:05:00 -0400

Rheum Now highlights 25 women in Rheumatology for their contributions to the field including HSS rheumatologists Mary K. Crow, MD, Jane E. Salmon, MD, Lisa R. Sammaritano, MD, Medha Barbhaiya, MD, MPH.

Read the full article at Rheumnow.com.

First Prospective Study Finds Pregnancies With Sjögren's to Be Largely Safe

Thu, 25 May 2023 14:17:00 -0400

Medscape reports that pregnant women with sjögren's syndrome have pregnancy outcomes similar to those of the general population, according to the first study prospectively tracking pregnancy outcomes among people with the autoimmune condition.

"Most early studies of pregnancy in rheumatic disease patients were retrospective and included only small numbers, making it difficult to know how generalizable the reported results were," said Lisa R. Sammaritano, MD, rheumatologist at HSS. She was not involved with the research.

Most of these previous studies suggested an increased risk of adverse outcomes, such as miscarriages, preterm deliveries, and small-for-gestational-age birthweight. But in addition to small patient numbers, retrospective studies "are subject to greater reporting bias, which may predispose patients with negative outcomes being more likely to be included because they were followed more closely," Dr. Sammaritano said.

"This prospective study has several advantages over the earlier retrospective reports: The same data were collected in the same way for all the patients, the patients were recruited at similar time points, and ― due to the multicenter nature of the cohort ― numbers are larger than in prior studies. All these factors make the results stronger and more generalizable to the sjögren's patients we see in our practices," she added.

Read the full article at medscape.com.

Castle Connolly Releases 2023 Exceptional Women in Medicine

Tue, 21 Mar 2023 11:43:00 -0400

Castle Connolly announces the release of the 2023 Exceptional Women in Medicine. This list recognizes female Castle Connolly Top Doctors across the U.S. who have demonstrated outstanding leadership, expertise and dedication in their respective fields. There are over 8,400 doctors represented, across 77 specialties and all 50 states. HSS is honored to have 20 doctors included on this list.

Read the full press release at newswire.com.

The impact of autoimmune disease on women

Tue, 29 Nov 2022 18:52:00 -0500

New research from HSS led by Lucy Masto, BS; Caroline Siegel, MD, MS; Sanjana Adurty, BA; and senior authors Medha Barbhaiya, MD, MPH, and Lisa Sammaritano, MD, highlights key reproductive health challenges for women with autoimmune rheumatic diseases, including menstrual‑cycle–related flares, low HPV vaccination rates, and misconceptions about contraception. The team also found that assisted reproductive technologies such as egg freezing and IVF can offer important options for patients facing fertility concerns.

Read the full article at contemporaryobgyn.com.

Reproductive Health in Rheumatoid Arthritis

Fri, 22 Jul 2022 16:32:00 -0400

MedPage Today discusses reproductive health for people living with rheumatoid arthritis and includes insight about optimizing fertility, contraception, and pregnancy outcomes from Lisa R. Sammaritano, MD, rheumatologist at HSS and lead author of the 2020 American College of Rheumatology (ACR) Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases.

According to Dr. Sammaritano, “In general, in all of our patients with rheumatic diseases the disorder has an impact on their reproductive life.”

She continued, “The risks are more pronounced for some patients, such as those with lupus and antiphospholipid syndrome, where there is a higher risk of pregnancy loss and elevated estrogen levels that can significantly increase the risk of blood clots, but for women with rheumatoid arthritis [RA], there are still risks we should be cognizant of.”

Read the full article at Medpagetoday.com.

Study Underscores Importance of Multidisciplinary Medical Team for Pregnant Women with Lupus

Thu, 02 Jun 2022 10:00:00 -0400

A study that includes researchers at Hospital for Special Surgery (HSS) underscores the importance of a multidisciplinary medical team to counsel and provide care for women with systemic lupus erythematosus, the most common form of lupus, who become pregnant. Using a nationwide database, the investigators reviewed the records of more than 50,000 patients with lupus who gave birth over a 10-year period. Findings revealed a higher rate of fetal morbidity and severe maternal morbidity compared to women who did not have lupus.

Bella Mehta, MBBS, MS, a rheumatologist at HSS and lead author of the study, presented the results today at the European Alliance of Associations for Rheumatology (EULAR) 2022 Congress in Copenhagen. “Lupus is a chronic autoimmune disorder that often affects women in their childbearing years,” explained Dr. Mehta. “In our previous work, we demonstrated that over the years, maternal and fetal mortality in lupus patients have improved significantly, and that was very reassuring to patients. However, less was known about morbidity. We set out to evaluate and quantify the indicators of fetal and maternal morbidity in women with lupus compared to those who did not have the disease.”

Using retrospective data from the National Inpatient Sample database, the researchers identified delivery-related hospital admissions from 2008 to 2017. Fetal morbidity indicators included preterm delivery and intrauterine growth restriction. Twenty-one indicators of severe maternal morbidity were identified and defined as unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.

Among the 40 million delivery-related hospital admissions, 51,161 patients were reported to have lupus. These patients were more likely to be older than women who did not have lupus (30.1 years versus 28.2 years), to be African American (25% versus 15%), and to receive Medicare (5% versus 1%).

During delivery, women with lupus were 15 times more likely to develop acute renal failure than those who did not have lupus (1.5% versus 0.1%), four times more likely to develop a cerebrovascular disorder (4.8% versus 1.1%), and nearly four times more likely to require a blood transfusion (4.0% versus 1.1%). Women with lupus were also more likely to develop cardiovascular and peripheral vascular disorders (1.1% versus 0.1%).

In terms of fetal morbidity, mothers with lupus were twice as likely to deliver prematurely (14.5% versus 7.3%) and nearly three times more likely to experience growth restriction in the womb compared to pregnant patients without lupus (8.0% versus 2.7%).

“The number of co-existing health conditions in pregnant women with lupus was much higher compared to women who did not have lupus. It seems likely that these comorbidities are responsible – at least in part – for the increased risk of fetal and maternal morbidity in lupus patients,” Dr. Mehta said. “It is noteworthy that a large percentage of deliveries by women with lupus were at large hospitals and urban teaching hospitals, reflecting the complexities of managing these patients.”

Dr. Mehta continued, “Our study is not meant to discourage women with lupus from getting pregnant. We believe our findings can help both patients and their physicians to assess risk, establish appropriate interventions and ensure that a multidisciplinary medical team is in place to counsel patients and manage their care.”

Authors: Bella Mehta, MBBS, MS, Katharine Kayla J. Glaser, Deanna Jannat-Khah (HSS), Yiming Luo (National Institutes of Health, Medicine, Bethesda), Lisa R. Sammaritano, MD, Jane E. Salmon, MD, Susan M. Goodman, MD (HSS), Fei Wang (Weill Cornell Medicine).

Rheumatoid Arthritis and Endometriosis: Why You’re at Increased Risk

Thu, 28 Apr 2022 15:54:00 -0400

CreakyJoints discusses the link between rheumatoid arthritis (RA) and an increased risk for endometriosis and includes guidance from experts including Lisa R. Sammaritano, MD, rheumatologist at HSS.

A 2021 study in the journal Rheumatology revealed people with endometriosis have a higher risk for RA.

Dr. Sammaritano explained, “This study — performed using data derived from a national health care database in Taiwan — confirms previous publications that have suggested a relationship between endometriosis and a number of autoimmune diseases, in this case, rheumatoid arthritis.”

She continued, “While provocative and interesting, the available published data are limited in quality (and quantity) and do not yet provide a clear mechanism or explanation for this association.”

According to Dr. Sammaritano, “Endometriosis is best described as an estrogen-dependent, chronic inflammatory condition characterized by the proliferation of endometrial glands and stromal tissue outside the uterine cavity. Ongoing inflammation and scarring lead to the typical complications of pain and infertility. It is known to be driven by both hormonal and immunologic factors.”

“Immune system abnormalities have been documented in multiple types of immune cells and inflammatory pathways in patients with endometriosis,” said Dr. Sammaritano. “Not surprisingly, some of these changes are similar to various immune system abnormalities found in autoimmune disorders, with persistent chronic inflammation.”

“Changes or defects in the immune system appear to allow each of these disorders to develop and persist, likely in conjunction with other anatomic and environmental factors,” she added.

Read the full article at Creakyjoints.org.

Lisa Sammaritano, MD, Talks About COVID-19, Pregnancy, and Rheumatic Disease – What We Know So Far

Fri, 21 Jan 2022 18:33:00 -0500

Rheumatology Advisor discusses a recent editorial published in The Journal of Rheumatology by Lisa R. Sammaritano, MD, rheumatologist at HSS, which provided an overview of the available literature on the effects of COVID-19 on pregnant patients with rheumatic disease (RD).

Dr. Sammaritano explained the available data on pregnancy outcomes in rheumatic disease (RD) and COVID-19 collected from the COVID-19 Global Rheumatology Alliance are reassuring despite the obvious cause for concern, specifically a study by Bermas and colleagues, recently published in The Journal of Rheumatology, reporting data from 39 women with RD who contracted COVID-19 infection during pregnancy.

According to Dr. Sammaritano, “There are 2 concerning factors for pregnant patients with RD who develop COVID-19. First, women with RD are already at a higher risk for adverse pregnancy outcomes compared with the general population, with risk depending on diagnosis, disease activity, autoantibody status, medications, and other factors. Second, COVID-19 infections in pregnant women tend to be more severe due to altered immune responses of pregnancy.”

She explained, “Despite a higher rate of hospitalization, the pregnant patients with RD, in the Bermas et al study, did well. None of the patients required intensive care unit (ICU) admission or mechanical ventilation, despite the additional risk factor of pregnancy. There were no patient deaths. Patients may have done well in part due to their overall young age, relatively quiet disease activity, and limited use of immunosuppressive medications.”

Dr. Sammaritano underscored the importance of communication between rheumatologists, obstetricians and gynecologists. “The current COVID-19 pandemic further strengthens the need for a team-based approach – patients should be confident that their physicians with differing expertise have discussed their medical history and agreed on recommendations, especially during a particularly challenging time with COVID-19,” she noted.

Read the full article at Rheumatologyadvisor.com.

Data Analytics Identifies Health Disparities In Pregnancy Outcomes

Thu, 11 Nov 2021 17:38:00 -0500

Health IT Analytics reports on HSS study results presented at the American College of Rheumatology (ACR) 2021 annual meeting finding outcomes among pregnant women with lupus have improved over time but racial and ethnic minority patients are still disproportionately impacted.

HSS rheumatologists Bella Mehta, MBBS, MS, MD, lead study author, and Lisa R. Sammaritano, MD, co-study author, used data from the National Inpatient Sample (NIS) to conduct a retrospective cross-sectional analysis of lupus and pregnancy-related hospital admissions from 2008 to 2017.

Dr. Mehta explained, “We’re happy to see pregnancy outcomes improved over time in all of the groups studied, however, improvements were more evident in some groups than others. African Americans and Hispanics continue to have poor pregnancy outcomes. Further study is warranted to determine where resources are needed to improve access and care for these patients.”

“This kind of large database study is very useful in looking at this type of problem across the country as a whole, rather than a study focused on a single hospital system, as most other studies do,” Sammaritano added.

Read the full article at HealthITanalytics.com.

Research Reveals Racial and Ethnic Disparities Persist in Pregnancy Outcomes of Patients with Lupus

Mon, 08 Nov 2021 10:00:00 -0500

While investigators have known that maternal and fetal outcomes of pregnancy among women with systemic lupus erythematosus (SLE) have improved over time, it is unknown whether the improved outcomes are shared equally among different racial and ethnic groups. Lupus has been shown to disproportionately affect minorities of childbearing age. A new study that includes researchers from Hospital for Special Surgery (HSS) presented today at the American College of Rheumatology (ACR) annual meeting shows that pregnancy outcomes in women with lupus have improved in all racial and ethnic groups over the past decade, but disparities still exist.

“We’re happy to see pregnancy outcomes improved over time in all of the groups studied, however improvements were more evident in some groups than others,” said lead study author Bella Mehta, MBBS, MS, MD, a rheumatologist at HSS. “African Americans and Hispanics continue to have poor pregnancy outcomes. Further study is warranted to determine where resources are needed to improve access and care for these patients.”

In the new study, researchers used the National Inpatient Sample (NIS) to conduct a retrospective cross-sectional analysis of lupus and pregnancy related hospital admissions from 2008 to 2017. The NIS is the largest publicly available all-payer healthcare database designed to produce US regional and national estimates of inpatient utilization, access, cost, quality and outcomes. Patients with lupus were identified by using ICD-9/10 codes. The researchers evaluated the pregnancy outcomes of four groups: Caucasians, African Americans, Hispanics and Asians/Native Americans/Others. Outcomes included in-hospital maternal mortality, fetal mortality, non-delivery related admissions and Cesarean section (C-section).

The investigators found that from 2008 to 2017, there were a total of 61,012 SLE pregnancy related hospitalizations. The median age of pregnant women in the sample was 29 for African American and Hispanic women, 30 for Caucasians, and 31 for Asians/Native Americans/Others. African Americans and Hispanics were more likely to be on Medicaid (51% and 49% respectively) versus Caucasians (30%) and Asians/Native Americans/Others (33%).

During the 10-year study period, fetal mortality and non-delivery related admissions and C-section rates improved in all racial/ethnic groups. Maternal mortality rates were very low throughout the study period, with none observed among Caucasians. Overall fetal mortality declined in all racial/ethnic groups, with a numerically greater reduction in Hispanic (from 291 in 2008-2009 to 101 in 2016-2017 per 10,000 admissions) and Asian/Native American/Other (from 267 in 2008-2009 to no observations in 2016-2017 per 10,000 admissions) versus Caucasian (from 136 in 2008-2009 to 108 in 2016-2017 per 10,000 admissions) and African American (from 385 in 2008-2009 to 308 in 2016-2017 per 10,000 admissions). In the latest data from 2017, African Americans continued to have worse fetal mortality than Hispanic or Caucasian patients, and Asians/Native Americans/Others had the least fetal mortality. In data from 2017, African Americans had the most non-delivery admissions, followed by Hispanics, Asians/Native Americans/Others and Caucasians. In 2017, C-section rates were highest in African Americans, followed by Caucasians, Asians/Native Americans/Others, and Hispanics.

“We have learned over the years that patients with lupus can become pregnant but need to do so in a certain way. That is, they should have quiet disease activity at conception and they shouldn’t become pregnant if they have serious internal organ damage such as renal failure,” said study co-author Lisa R. Sammaritano, MD, a rheumatologist at HSS. “What this study shows is there is still a persistent disparity between non-Caucasian ethnic groups and Caucasians in terms of pregnancy outcomes in women with lupus, but both groups have had improvement over ten years.

“It’s good to see that improvements have been across racial and ethnic groups, but we need to continue to work toward identifying the reasons disparities still exist,” she continued. “This kind of large database study is very useful in looking at this type of problem across the country as a whole, rather than a study focused on a single hospital system, as most other studies do.”

Authors: Bella Mehta¹, Yiming Luo², Deanna Jannat-Khah³, Jiehui Xu⁴, Lisa Sammaritano³, Jane Salmon³, Michael Lockshin¹, Susan Goodman³ and Said Ibrahim⁵. ¹Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, ²National Institutes of Health, Bethesda, MD, ³Hospital for Special Surgery, New York, NY, ⁴Weill Cornell Medicine, New York, NY, ⁵Weill Cornell Medicine, Cleveland, OH.

Experts Share Insights & Advice on Reproductive Health for Patients with Rheumatic Disease

Fri, 24 Sep 2021 15:03:00 -0400

The Rheumatologist highlights an informational webinar on reproductive health, pregnancy and parenting for patients with rheumatic disease, which included expert panelist Lisa R. Sammaritano, MD, rheumatologist at HSS.

Dr. Sammaritano explained, “Most women with rheumatic diseases can have successful pregnancies, and most people with rheumatic diseases can have children, if desired.” She underscored the importance for patients with rheumatic diseases who want to have a family to work with rheumatologists and rheumatology professionals on family planning.

“Our goal in thinking about family planning is to plan for well-controlled disease on pregnancy-compatible medication, with a pre-pregnancy evaluation to identify risks and make recommendations about monitoring and therapy. Family planning, in general, usually requires contraception and the safe use of some of our rheumatology medications,” she continued.

Dr. Sammaritano co-authored the 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases, which cited that most patients with rheumatic diseases underuse effective contraception and may experience unplanned pregnancies. This situation can increase exposure to risks, such as worsened disease activity, that can threaten maternal health and well-being and lead to adverse pregnancy outcomes.

Read the full article at The-rheumatologist.org.

Lisa Sammaritano, MD, on Lupus Nephritis and Reproductive Health: Part 2

Wed, 09 Jun 2021 18:11:00 -0400

In this RheumatologyConsultant podcast interview, HSS rheumatologist Lisa R. Sammaritano, MD discusses the challenges of caring for patients with lupus nephritis during pregnancy, including the safest medications to use and how to manage flares of disease.

Dr. Sammaritano explained how she does her utmost to ensure patients will not have active lupus nephritis during pregnancy, as it may increase several risk factors. She said, “As a part of that, we counsel our patients from early on before they tell us they want to become pregnant, so that they understand if the time is right for them to consider pregnancy, that their lupus, especially their nephritis, if they've had nephritis, needs to be quiet.”

Dr. Sammaritano advised providers to “have a clear discussion with the patient and her partner, if possible, about the risks of pregnancy for her, given her particular disease, activity, damage if that has been present, and antibodies, and then move forward from there.”

Listen to the full podcast at Consultant360.com.

Lisa Sammaritano, MD, on Lupus Nephritis and Reproductive Health: Part 1

Thu, 27 May 2021 18:41:00 -0400

In this RheumatologyConsultant podcast interview, HSS rheumatologist Lisa R. Sammaritano, MD discusses how rheumatologists can work with their patients with lupus nephritis in selecting contraception and planning for pregnancy.

Dr. Sammaritano explained the American College of Rheumatology (ACR) guidelines for reproductive health is a great reference for providers. She said the guidelines cover, “all aspects of reproductive health for women in lupus, ranging from contraception to fertility preservation and fertility treatment through pregnancy, and including menopause and the question of hormonal replacement therapy for patients.”

Listen to the full podcast at Consultant360.com.

Your Period, Menstrual Cycle, and Inflammatory Arthritis Flares: What’s the Connection?

Thu, 17 Dec 2020 08:15:00 -0500

CreakyJoints reports the link between menstrual cycles and inflammatory arthritis flares remains scientifically unclear. Experts including HSS rheumatologist Lisa R. Sammaritano, MD, agree that more research is needed and discuss some theories.

Research suggests that variations in hormone levels that occur during the menstrual cycle may influence arthritis disease activity and the severity of symptoms. “It seems likely that hormones may impact disease activity directly, such as by promoting or alleviating inflammation,” said Dr. Sammaritano. They may have a systemic effect on the immune system, as well as within the joint.

Another potential connection between flares in arthritis symptoms and your period is pain perception. When estrogen levels are low, women may report more pain, according to some literature. “It may be that a change in pain threshold contributes to pain and fatigue during the premenstrual phase, in addition to a true increase in inflammation,” explained Dr. Sammaritano.

If a woman suspects their approaching period exacerbates arthritis symptoms, there are ways to ease flares such as nonsteroidal anti-inflammatory drugs (NSAIDs) — such as over-the-counter ibuprofen and naproxen sodium — which can relieve pain and reduce inflammation. If these medications aren’t already being taken regularly for arthritis-related pain, a doctor may suggest adding it to your regimen the week before your period, said Dr. Sammaritano, advising to speak with a health care provider to determine if it is appropriate and safe.

Read the full article at Creakyjoints.org.

Pregnancy studies on psoriasis, PsA medications pick up

Thu, 01 Oct 2020 10:31:00 -0400

Dermatology News reports on the study of pregnancy and drug treatment with psoriasis and Psoriatic Arthritis (PsA) according to HSS rheumatologist Lisa R. Sammaritano, MD, and others.

Dr. Sammaritano recommends some of her patients to contact the Organization of Teratology Information Specialists (OTIS), as it is now listed in drug labeling as the “pregnancy registry” contact for many of the medications. OTIS has enrolled women with psoriasis and/or PsA in studies of nine medications, most of them biologics (both TNF-alpha blockers and newer anti-interleukin agents). “Their [OTIS] pregnancy registry studies have added important information to the field over the years,” said Dr. Sammaritano, however she does not recommend registry participation for patients who stop biologics at the diagnosis of pregnancy. As “the start of IgG antibody transfer during pregnancy is about 16 weeks,” Dr. Sammaritano voiced her concern of including these patients might lead to falsely reassuring findings. “We are most interested in [knowing the outcomes of] patients who must continue the drugs through pregnancy,” she explained.

Read the full article at MDedge.com/dermatology.

Let’s Talk Women’s Health in Rheumatic Diseases

Fri, 18 Sep 2020 10:03:00 -0400

In this Rheumatology Advisor podcast, HSS rheumatologist Lisa R. Sammaritano, MD discussed the rationale for developing the published guidelines by the American College of Rheumatology (ACR) on the management of reproductive health in women with rheumatic diseases, and key takeaways for clinicians.

Dr. Sammaritano explained it [the guidelines] provides an intersection in two fields of medicine, and in some ways education to rheumatologists, unlike other guidelines that focus on one specific area within rheumatology itself. “As our patients get healthier, they are able to consider things they weren’t able to consider in the past. And that is planning out their family life - deciding when and if they want to have children. And even when and if they wanted to pursue reproductive health technology (such as IVF and egg freezing), all of these things have become much more common in recent years. And available to greater numbers of women, including our patients.” She added, “I think it was a combination of better health and more information and a better ability to stratify patients who are at greatest risk and identify patients for who these things really do not pose such a tremendous risk where they could not pursue them. And that is a majority of our patients.”

Dr. Sammaritano cited, “One of the most important points that we hope to make is that rheumatologists should communicate with their patients about this aspect of health. It is an important aspect of health in addition to their rheumatology disorder. Many rheumatologist feel that they are not educated in this area, and so especially with their focus on challenging (and sometimes serious rheumatology illnesses), may forget to talk about this with their patients. But there are a lot of reasons that we should communicate with our patients about this early on. We know that pregnancy in rheumatic disease patients can place particular risks on the patient. We firmly believe for our patients (more than the general population), pregnancy should be planned. The patient should be assessed ahead of time when possible so that we can identify what if any factors can impact both the success of the pregnancy and the safety of the pregnancy for that patient.”

Listen to podcast at Rheumatologyadvisor.com.

Lisa Sammaritano, MD: Final Thoughts, ACR Guidelines on Reproductive Health

Tue, 15 Sep 2020 10:11:00 -0400

HCP Live reports on a presentation by HSS rheumatologist Lisa R. Sammaritano, MD at the 2020 Congress of Clinical Rheumatology-East discussing the recently published American College of Rheumatology (ACR) guidelines on reproductive health in patients with rheumatic conditions. The goal of these recommended guidelines is to encourage open communication and inform shared decision-making between patients and their physicians on issues related to reproductive health, including pregnancies.

“This area of reproductive health in rheumatic diseases has become increasingly important as our patients are in better health because of our better therapies,” explained Dr. Sammaritano. She added rheumatologists should actively engage in these conversations on reproductive health, even if they themselves feel unable to provide comprehensive information, emphasizing the usefulness of the ACR recommendations. “There are really helpful guidelines and management suggestions that are easy to refer to if one needs that,” she said.

Read the full article at HCPlive.com.

Lisa Sammaritano, MD: Rheumatic Diseases, Pregnancy, and the Importance of Communication

Mon, 14 Sep 2020 08:12:00 -0400

HCP Live reports on a presentation by HSS rheumatologist Lisa R. Sammaritano, MD at the 2020 Congress of Clinical Rheumatology-East discussing the importance of rheumatologists and OB-GYNs communicating openly with one another and to patients with rheumatic disease who are considering pregnancy.

“Rheumatology patients have special concerns and risk with regard to pregnancy, and therefore it is very, very important that this be planned,” explained Dr. Sammaritano. Systemic lupus and antiphospholipid antibodies syndrome historically have posed the greatest risk for both the mother’s health and the outcome of the pregnancy. Dr. Sammaritano encouraged rheumatologists to inquire into their patients’ intentions, and to caution against inadvertent pregnancies. Furthermore, the ideal treatment and management scenario would be a level of synergy between both the rheumatologist and OB-GYN; both specialists must be attuned to patient conditions and pregnancy plans. “We may think of this as the domain of the OB-GYN. Of course, they know everything about pregnancy and contraception. But we know everything about lupus and other related diseases,” she said. “And really, it takes both of those knowledge bases to come up with the right solution for any given patient.”

Read the full article at HCPlive.com.

Clinicians must 'quiet' rheumatic disease activity before pregnancy for optimal outcomes

Sat, 12 Sep 2020 20:38:00 -0400

Healio Rheumatology reports on a presentation by HSS rheumatologist Lisa R. Sammaritano, MD at the 2020 Congress of Clinical Rheumatology-East about how to assess pregnancy risk for patients with rheumatic diseases.

Dr. Sammaritano explained it is essential that rheumatologists aim for “low” or “quiescent” disease activity several months before contraception in their patients who desire to become pregnant. “The best outcomes in our patients are in those who have quiet or low disease activity 6 months before pregnancy, and those who are on drugs that are OK with pregnancy,” she said. Dr. Sammaritano sought to offer clinicians strategies to manage complications that may arise in patients who do become pregnant, and to provide insight into medication use before, during and after pregnancy.

Read the full article at Healio.com/news/rheumatology.

Additional coverage: HCPLive.com.

Psoriasis, PsA, and pregnancy: Tailoring treatment with increasing data

Wed, 02 Sep 2020 18:02:00 -0400

MDEdge Dermatology discusses pregnancy for women with psoriasis and/or psoriatic arthritis (PsA) according to experts including HSS rheumatologist Lisa R. Sammaritano, MD.

Dr. Sammaritano advised patients with PsA to plan for pregnancy during a period of inactive disease. “Pregnancy is best planned while patients have quiescent disease on pregnancy-compatible medications,” said Dr. Sammaritano. “We encourage [more] rheumatologists to be actively involved in pregnancy planning [in order] to guide therapy.”

Additionally, Dr. Sammaritano provided guidance for tailoring PsA treatment based on the American College of Rheumatology (ACR) guidelines for managing reproductive health in rheumatic conditions, which include recommendations on biologic and other therapies used to treat the disease.

Read the full article at Mdedge.com.

Scleroderma and Pregnancy

Sat, 15 Aug 2020 10:07:00 -0400

Arthritis Foundation discusses considerations for pregnancy planning when living with scleroderma according to HSS rheumatologist Lisa R. Sammaritano, MD.

While a diagnosis of scleroderma certainly brings challenges to pregnancy, proper planning and prenatal care can help ensure the best possible outcomes for the mother and baby, said Dr. Sammaritano. When planning for pregnancy, it is important to wait at least three years after receiving a diagnosis to become pregnant, as the course of the disease can be unpredictable and flares are more likely. Dr. Sammaritano recommended discussing any family planning issues with a rheumatologist early on, as pre-planning will allow the patient and their physician to make sure disease activity is low while on pregnancy-compatible medications. “This process can take some time, since changing a medication means giving it several months to make sure that it works and doesn’t cause side effects,” she explained.

Read the full article at Arthritis.org.

First Guideline Issued for Managing Reproductive Health in Patients with Rheumatic and MSK Diseases

Thu, 26 Mar 2020 08:52:00 -0400

Practical Pain Management reports on new American College of Rheumatology (ACR) recommendations that provide clinicians with data and background to help manage reproductive health in patients with lupus, rheumatoid arthritis and other rheumatic diseases.

Lead author of the guidelines Lisa R. Sammaritano, MD, rheumatologist at HSS, explains that this guideline is paramount because “it is the first official guidance addressing the intersection of rheumatology and obstetrics and gynecology”.

In a Q&A, Dr. Sammaritano states that rheumatologists should address reproductive health issues with patients during initial visits and that pregnancy should be planned ideally during periods of quiet disease.

“We expect to have more data - hopefully in all areas of the guideline - over time. As with all ACR guidelines, the plan is to update the reproductive health guideline periodically to include the newest information,” adds Dr. Sammaritano.

Read the full article at PracticalPainManagement.com.

Additional coverage: Medpagetoday.com, Creakyjoints.org

Risk Assessment & Treatment in APS Patients

Wed, 12 Jun 2019 17:52:00 -0400

The Rheumatologist reports on a presentation by Lisa R. Sammaritano, MD, rheumatologist at HSS, at the 2019 American College of Rheumatology (ACR) State-of-the-Art Clinical Symposium, about treatment of antiphospholipid syndrome (APS), how to assess the risk of thrombosis, and secondary thrombosis prevention in APS.

Dr. Sammaritano explained patients are at high risk for thrombosis if they are positive for lupus anticoagulant antibodies, and especially at risk if they’re triple positive (which means being positive for lupus anticoagulant, anti-cardiolipin and anti-Beta2GPI antibodies).

“Our recommendation at this point is to [prescribe] low-dose aspirin [for] patients who have a high-risk profile - say they’re triple positive or [have] a very strong lupus anticoagulant [with or without the] presence of other thrombotic risk factors,” said Dr. Sammaritano. “In patients with lupus, the recommendation for low-dose aspirin is stronger,” she noted. Additionally, Dr. Sammaritano recommended lifelong warfarin for the secondary prevention of unprovoked venous thrombosis, based on a trial in which a high-intensity warfarin group was compared with a moderate-intensity group. However, Dr. Sammaritano cautioned the literature on this approach is not clear.

Furthermore, Dr. Sammaritano advised use of low-dose aspirin in combination with low-dose heparin, when there is more risk involved for an APS patient who is pregnant. “If your patients have a lot of risk factors, we can be flexible in using combination therapy,” she said. “If they’ve had one miscarriage, but they’re 40, had to go through IVF and are triple positive, I would add enoxaparin to that patient’s [treatment] rather than wait for them to have three early miscarriages,” she concluded.

Read the full article at the-rheumatologist.org.

19-20 Segment 1: Can IUDs and Other Contraceptives Trigger Autoimmune Disease?

Sun, 19 May 2019 18:30:00 -0400

In a recent podcast episode, Radio Health Journal features Lisa R. Sammaritano, MD, rheumatologist at HSS, to discuss whether intrauterine devices (IUDs) and contraceptives trigger autoimmune diseases, including rheumatoid arthritis, and lupus.

Dr. Sammaritano said the various parts of our immune systems are meant to fight off such diseases and infections, however, “our immune systems can turn against us,” causing inflammation within the body. The reason why this happens is not completely understood. Furthermore, the role of IUDs and contraceptives as possible triggers of autoimmune disease is also undetermined. Dr. Sammaritano noted, “I had one patient who had a progesterone IUD placed and developed hair loss. It is pretty unusual side effect but it all got better when she had the IUD removed. I do think that IUDs, as with any medication, can cause side effects. But there really have not ever, been a suggestion that an IUD causes an autoimmune disease.”

Listen to the full interview at RadioHealthJournal.net.

Psoriatic Arthritis and Pregnancy

Sat, 20 Apr 2019 14:12:00 -0400

The Arthritis Foundation reports on Psoriatic Arthritis (PsA) and pregnancy, detailing how PsA may affect women who are pregnant or planning to become pregnant or breastfeed.

The Arthritis Foundation spoke to Lisa R. Sammaritano, MD, rheumatologist at HSS, about the effects of PsA medications on a baby. While there is no evidence indicating PsA will affect a woman’s ability to get pregnant, it’s important to practice effective birth control until one is ready to have a child. “Ideally you should discuss family planning issues with your rheumatologist early on, not just when you’ve decided you would like to start having a baby,” said Dr. Sammaritano.

Dr. Sammaritano cited, “Planning will allow patients and their rheumatologists to make sure disease activity is low while on pregnancy-compatible medications. This process can take some time, since changing a medication means giving it several months to make sure that it working and that it does not cause side effects.” Dr. Sammaritano added, “Fortunately, the risks of most drugs prescribed for PsA end when the drug is out of your bloodstream. Neither the drugs you took in the past nor PsA itself should affect the development of your baby.”

Read the full article at arthritis.org.

Managing Rheumatic Diseases and Reproductive Health

Thu, 14 Mar 2019 08:00:00 -0400

In this podcast, Lisa Sammaritano, MD, rheumatologist at HSS, discusses the importance of combining expertise for managing reproductive health in a patient with a rheumatic disease. She talks about educating patients on their options, contraception, medications and other concerns.

Dr. Sammaritano notes that in recent years, as treatments have become better, more and more women with a rheumatic disease have been able to consider pregnancy.

"It's a very important area for rheumatologists to be aware of because we are in a position to give our input to the patient’s OB/GYN," she says "There are certain issues related to the underlying disease that will impact some decisions, whether it’s the type of contraception used or whether or not pregnancy planning is appropriate at a given time." She adds that other issues include fertility therapy and the management of a rheumatic disease during pregnancy.

Listen to the full interview at Consultant360.com.

The ACR Has Introduced a New Reproductive Health Guideline Draft

Thu, 17 Jan 2019 07:00:00 -0500

The Rheumatologist reports on a new reproductive health guideline draft presented at the 2018 ACR/ARHP Annual Meeting.

Lisa R. Sammaritano, MD, rheumatologist at HSS, presented the recommendations from three draft manuscripts that will be submitted for publication in 2019.

The guidelines cover topics such as contraception, fertility/assisted reproductive technology, menopause, pregnancy assessment and management, and medication use.

"The impression that we got from our Patient Panel is that they want to discuss family planning issues early and often with their rheumatologists," said Dr. Sammaritano.

Read the full article at The-Rheumatologist.org.

ACR announces draft guidelines for reproductive health management

Tue, 30 Oct 2018 08:00:00 -0400

Healio Rheumatology reported that HSS rheumatologist Lisa R. Sammaritano, MD, and a team of researchers drafted clinical practice guidelines for the management of reproductive issues among patients with rheumatic conditions.

"We have had an explosion of new therapies over the past 10 to 20 years in rheumatology," said Dr. Sammaritano. She noted that with the addition of new therapies, there is an opportunity to educate both obstetricians and rheumatologists regarding pregnancy planning.

Topics addressed in the guidelines include the use of contraception in women with rheumatic diseases, as well as the use of low-dose aspirin and hydroxychloroquine during pregnancy.

Read the full article at healio.com [registration required].

ACR readies first-ever guidelines on managing reproductive health in rheumatology

Fri, 26 Oct 2018 07:00:00 -0400

MDedge reported that HSS rheumatologist Lisa R. Sammaritano, MD, presented forthcoming guidelines on the management of reproductive health in patients with rheumatic conditions at the American College of Rheumatology (ACR) Annual Meeting.

"Our patients, fortunately, are pursuing pregnancy more often now than in years past. One of the key messages of the guidelines is that patients really do want to discuss these topics with their rheumatologist, even though that often does not happen now. What patients told us [in the guideline-development process] is their rheumatologist knows them better than their gynecologist or any of their other doctors because we have followed them for a long period of time and we understand their disease and their symptoms. They really want our input on questions about contraception, when to plan a pregnancy and medication use," said Dr. Sammaritano.

According to the article, the guidelines were created with extensive input from gynecologists and patients.

Read the full article at mdedge.com.

Barbara Volcker Center Marks 20 Years of Research & Clinical Work

Fri, 19 Jan 2018 07:00:00 -0500

Rheumatic diseases affect women two to four times more often than men. Studying the sex differences in autoimmune conditions has been the focus of the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. In a feature article by The Rheumatologist, HSS rheumatologists recall the history and ongoing mission of the Center as it celebrates its 20th anniversary.

HSS rheumatologist Michael D. Lockshin, MD, and director of the Center, shared his conversations with patient Barbara Volcker, wife of former U.S. Federal Reserve Chairman Paul Volcker. According to the article, Mrs. Volcker met Dr. Lockshin in the 1970s to treat her rheumatoid arthritis.

"She was the type of patient that I really enjoyed taking care of because she challenged me on everything. She would say, 'But that answer doesn't make sense. Give me the information behind it. Convince me.' She drove me to question my own assumptions to respond to her," said Dr. Lockshin.

In the late 1990s, Mrs. Volcker's health worsened, and the Volckers offered to establish a center at HSS to honor her. Dr. Steven Paget, who was physician in chief at HSS, and Dr. Charles Christian, who was the emeritus physician in chief, invited Dr. Lockshin, then acting director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), to discuss the center's mission, and he was ultimately offered the job as director, a position he still holds.

The Center was established in 1997. Mrs. Volcker passed away the following year at the age of 68.

"Her questions are the core of the Center that bears her name," noted Dr. Lockshin.

The Center convened a conference on the biology of sex differences in autoimmune illness—the first of its kind—within a year of opening its doors, notes Dr. Lockshin. The topic later gained national attention for all human health when the Institute of Medicine (later renamed the National Academy of Medicine) convened a committee to address the same question and published a report in 2001, according to Dr. Lockshin, who served on the committee. Doruk Erkan, MD, MPH, a rheumatologist at HSS whose early research focused on antiphospholipid syndrome, joined the Center in 2005 as physician-scientist.

Today, the Center is marking 20 years of research and clinical work devoted to women with various rheumatic conditions. According to Dr. Lockshin, physicians at the Center see more than 3,000 individual patients for issues of pregnancy and contraception, antiphospholipid syndrome, and other rheumatic illnesses.

As part of the Center's research, HSS rheumatologists Jane E. Salmon, MD and Lisa R. Sammaritano, MD are co-investigators of a study on hormone treatment in lupus as well as pregnancy in lupus patients.

Additionally, HSS research associate Mikhail Olferiev, MD received a grant from the center to study the expression of genes across health donors and patients with lupus. "I hope that my study will contribute to a better understanding of an autoimmune disease and possibly identify new therapeutic targets," Dr. Olferiev said.

HSS scientist Theresa T. Lu, MD, PhD also received a grant to study whether fat tissue might influence stromal cells in lymph nodes to contribute to sex differences in rheumatic diseases.

Dr. Lockshin explained that concepts and ideas about pregnancy and issues related to women with rheumatic diseases have changed over time in part because of research discoveries coming out of HSS.

Additionally, the Center recently welcomed a new member, HSS rheumatologist Medha Barbhaiya, MD, MPH. Dr. Barbhaiya explained that she joined HSS because of the Center's strong emphasis on clinical care and clinical research related to lupus, antiphospholipid syndrome, and pregnancy in rheumatic diseases.

Several of its members hold leadership positions associated with the Center's mission, according to Dr. Lockshin. For example, Dr. Erkan chairs both the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking, headquartered at the Center, and the 15th International Congress on Antiphospholipid Antibodies. Kyriakos Kirou, MD, conducts lupus nephritis clinical trials, and Dr. Sammaritano chairs the ACR Reproductive Health Guideline Project. With a background in environmental causes of autoimmune illnesses, Dr. Barbhaiya is involved with the ACR. In addition, Dr. Lockshin served on committees with a focus on pregnancy, sex differences, and other aspects of autoimmune illness and he is past editor in chief of Arthritis & Rheumatism (now Arthritis & Rheumatology).

In a phone interview, Mr. Volcker said that he is delighted with the Center's accomplishments over the years. Furthermore, he said he is sure if Mrs. Volcker were alive she would be "very pleased and happy that her name was attached to it, no doubt in my mind".

Read the full article at the-rheumatologist.org. This also appeared in the January 2018 print issue.