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Sle pregnancy

Ilaria Cavazzana, Laura Andreoli, Maarteen Limper, Franco Franceschini, Angela Tincani
PURPOSE OF REVIEW: This review focuses on new clinical aspects of antiphospholipid syndrome (APS) in the last 5 years. RECENT FINDINGS: The pathogenesis of APS is related to endothelial activation by mechanisms other than autoantibody-mediated massive coagulation. These include Toll-like receptors, the m-TORC pathway, and neutrophil activation, inducing an uncontrolled inflammatory cascade. Given these new pathogenetic hypotheses, the treatment of APS could be directed towards a fine balance between anticoagulation and immunomodulation...
March 15, 2018: Current Rheumatology Reports
Ayako Ohyama, Hiroto Tsuboi, Hisashi Noma, Mayu Terasaki, Masaru Shimizu, Hirofumi Toko, Fumika Honda, Mizuki Yagishita, Hiroyuki Takahashi, Hiromitsu Asashima, Shinya Hagiwara, Yuya Kondo, Isao Matsumoto, Takayuki Sumida
OBJECTIVES: The purpose of this study is to clarify associations between maternal clinical features and adverse pregnancy outcomes (APOs) in mothers with connective tissue diseases (CTDs). METHODS: We retrospectively examined maternal clinical features including backgrounds, autoantibodies, CTD flare-ups, and therapies during pregnancies as well as fetal outcomes in 90 pregnancies (66 mothers) at our hospital from January 2006 to September 2016. RESULTS: Underlying CTDs were SLE (N = 41), MCTD (N = 10), RA (N = 15), SS (N = 10), and others (N = 14)...
March 13, 2018: Modern Rheumatology
Tomás Urrego, Blanca Ortiz-Reyes, Adriana L Vanegas-García, Carlos H Muñoz, Luis A González, Gloria Vásquez, José A Gómez-Puerta
BACKGROUND AND OBJECTIVE: Diagnosis of lupus nephritis (LN) is usually based on renal biopsy, which is an invasive technique that involves multiple risks. Therefore, different biomarkers have emerged as alternatives for the diagnosis of LN. Nonetheless, studies regarding urinary biomarkers in Latin American patients are limited. The objective of this study was to assess the diagnostic value of urinary transferrin and ceruloplasmin to differentiate patients who have renal involvement from those who do not...
March 9, 2018: Reumatología Clinica
M E Rodríguez-Almaraz, I Herraiz, P I Gómez-Arriaga, P Vallejo, E Gonzalo-Gil, A Usategui, E A López-Jiménez, A Galindo, M Galindo
OBJECTIVE: To evaluate the usefulness of the uterine artery mean pulsatility index (mPI-UtA) and the sFlt-1/PlGF ratio in women with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) for the prediction of placental dysfunction-related adverse outcomes (AO), namely pre-eclampsia (PE) and intrauterine growth restriction (IUGR), and for differential diagnosis between PE and SLE flares. STUDY DESIGN: Observational prospective cohort study of 57 pregnant women with SLE or APS...
January 2018: Pregnancy Hypertension
Reem Abdwani, Laila Al Shaqsi, Ibrahim Al-Zakwani
Objectives: Systemic lupus erythematous (SLE) is a chronic autoimmune disease that affects women primarily of childbearing age. The objective of this study was to determine the neonatal and maternal outcomes of pregnancies in SLE patients compared to pregnancies in healthy controls. Methods: We conducted a retrospective cohort study in a tertiary care hospital in Oman between January 2007 and December 2013. We analyzed 147 pregnancies and compared 56 (38.0%) pregnancies in women with SLE with 91 (61...
January 2018: Oman Medical Journal
Michelle Remião Ugolini Lopes, Adriana Danowski, Andreas Funke, Jozelia Rêgo, Roger Levy, Danieli Castro Oliveira de Andrade
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by antiphospholipid antibodies (aPL) associated with thrombosis and/or pregnancy morbidity. Most APS events are directly related to thrombotic events, which may affect small, medium or large vessels. Other clinical features like thrombocytopenia, nephropathy, cardiac valve disease, cognitive dysfunction and skin ulcers (called non-criteria manifestations) add significant morbidity to this syndrome and represent clinical situations that are challenging...
November 2017: Revista da Associação Médica Brasileira
Asima Khan, Mathew Thomas, Syamala Devi P K
The aim was to study the feto-maternal outcome of pregnancies complicated by systemic lupus erythematosus (SLE). Analysis of a prospectively-maintained database of 73 patients (June 2006-March 2016) was done. Diagnosis of SLE was made by ACR(American College of Rheumatology)-criteria. Protocol scans and blood tests were done and patients with active disease were followed biweekly for 28 weeks, and weekly thereafter. Mean age + SD was 29 ± 4.9. SLE was diagnosed before conception in 86% of patients...
February 12, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Mimi Y Kim, Marta M Guerra, Elianna Kaplowitz, Carl A Laskin, Michelle Petri, D Ware Branch, Michael D Lockshin, Lisa R Sammaritano, Joan T Merrill, T Flint Porter, Allen Sawitzke, Anne M Lynch, Jill P Buyon, Jane E Salmon
OBJECTIVE: Studies in mouse models implicate complement activation as a causative factor in adverse pregnancy outcomes (APOs). We investigated whether activation of complement early in pregnancy predicts APOs in women with systemic lupus erythematosus (SLE) and/or antiphospholipid (aPL) antibodies. METHODS: The PROMISSE Study enrolled pregnant women with SLE and/or aPL antibodies (n=487) and pregnant healthy controls (n=204) at <12 weeks gestation and evaluated them monthly...
January 25, 2018: Annals of the Rheumatic Diseases
Akio Kawabe, Kazuhisa Nakano, Yukiyo Aiko, Satoshi Aramaki, Takeshi Onoue, Dan Okura, Yoshiya Tanaka
Pregnancy in women with systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH) remains a high risk. We successfully managed a pregnancy in a patient with SLE-PAH. A 31-year-old pregnant woman with SLE-PAH had worsening PAH and SLE flare-up during pregnancy and a sudden increase in pulmonary arterial pressure after delivery. SLE-PAH was controlled by continuous intravenous epoprostenol and inhaled nitric oxide therapy combined with high-dose corticosteroids under close hemodynamic monitoring...
January 11, 2018: Internal Medicine
B L Bermas, S C Kim, K Huybrechts, H Mogun, S Hernandez-Diaz, B T Bateman, R J Desai
Background Evidence suggests that continuing hydroxychloroquine (HCQ) during pregnancy in women with systemic lupus erythematosus (SLE) improves outcomes. We sought to describe time trends in the continuation, initiation, and duration of HCQ in a large population-based cohort of pregnant SLE women. Methods A cohort of pregnant women with SLE enrolled continuously in public (Medicaid, 2001-2010) or private (Optum Clinformatics, 2003-2015) health insurance between three months prior to conception and one month after delivery was identified...
January 1, 2018: Lupus
Alexandru Vlagea, Dora Pascual-Salcedo, Rita Álvarez Doforno, Paz Lavilla, Jesús Diez, Beatriz Padilla Merlano, María V Cuesta, Antonio Gil
OBJECTIVE: IgG and IgM antibodies directed at β2-glycoprotein I are included in the classification criteria for the antiphospholipid syndrome (APS) while the IgA antibodies against β2-glycoprotein I (IgA aβ2GPI) are not. Conflicting data about the significance of IgA aβ2GPI and APS manifestation can be found and more studies are necessary in order to define the diagnostic value of IgA aβ2GPI. In the present article, we investigated the possible role of IgA aβ2GPI as marker of APS...
February 2018: Thrombosis Research
Chong Zhang, Mei-Ying Liang, Xue Xu, Xue-Wu Zhang, Shi Chen
AIM: This study was conducted to examine the clinical characteristics of new-onset systemic lupus erythematosus (SLE) during pregnancy. METHODS: We performed a retrospective study of all pregnancies in patients with SLE managed at The People's Hospital of Peking University from 2008 to 2015. In total, 97 pregnancies were identified and studied, 22 of which were first diagnosed with SLE during pregnancy or puerperium. RESULTS: New-onset SLE mainly occurred during the first and second pregnancy trimesters...
December 14, 2017: Journal of Obstetrics and Gynaecology Research
Chi Chiu Mok
The calcineurin inhibitors (CNIs) belong to a group of immunosuppressive agents that block T-cell activation through the suppression of the calcium/calcimodulin-dependent phosphatase calcineurin. Agents such as cyclosporine A (CSA) and tacrolimus (TAC) have long been used in patients with systemic lupus erythematosus (SLE). TAC is preferred to CSA in SLE because of the lower frequency of cosmetic, hypertensive and dyslipidemic adverse effects. Recent randomised controlled trials have demonstrated noninferiority of TAC to mycophenolate mofetil (MMF) or cyclophosphamide (CYC) for induction therapy of lupus nephritis...
June 2017: Best Practice & Research. Clinical Rheumatology
Rebecca Fischer-Betz, Christof Specker
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with a high prevalence in females of childbearing age. Pregnancy in SLE nowadays has favorable outcomes for the majority of women. However, flares of disease activity, preeclampsia, fetal loss, and preterm birth are well-known risks in such pregnancies. Anti-SS-A(Ro)/SS-B(La) antibodies put fetuses at risk for congenital heart block and neonatal lupus. Several risk factors for adverse pregnancy outcomes have been identified. Women with antiphospholipid antibodies or antiphospholipid syndrome and lupus nephritis represent a group with high risk for obstetric complications...
June 2017: Best Practice & Research. Clinical Rheumatology
Masashi Deguchi, Yoko Maesawa, Shino Kubota, Mayumi Morizane, Kenji Tanimura, Yasuhiko Ebina, Hideto Yamada
The aim of this prospective study was to determine clinical factors associated with adverse pregnancy outcomes in women with systematic lupus erythematosus (SLE). Fifty-six pregnancies from 46 women with SLE were enrolled. Risk factors for pregnancy loss, premature delivery, hypertensive disorders of pregnancy (HDP), and light-for-date neonate (LFD), were evaluated. Univariate and multivariate logistic regression analyses revealed a history of two or more pregnancy losses before 10 gestational weeks (GW) (OR 11...
February 2018: Journal of Reproductive Immunology
Ana Raquel Teixeira, Mariana Rodrigues, Hercília Guimarães, Cláudia Moura, Iva Brito
Neonatal lupus (NL) is a very rare condition with an estimated incidence of 1 in 20.000 pregnancies. It is caused by the transplacental passage of autoantibodies anti-Ro/SSA, antiSa/SSB antibodies and/or anti-U1 RNP antibodies into the fetal circulation. The mother may be completely asymptomatic or have a known inflammatory rheumatic disease, such as Sjögren syndrome (SS) or Systemic Lupus Erythematosus (SLE). Clinical manifestations are diverse, being the most common cutaneous and cardiac. The authors present a case series of eight cases diagnosed with NL between January 2008 and December 2016 in a tertiary hospital and a brief revision of the literature...
October 2017: Acta Reumatológica Portuguesa
Hui Shi, Hui Zheng, Yu-Feng Yin, Qiong-Yi Hu, Jia-Lin Teng, Yue Sun, Hong-Lei Liu, Xiao-Bing Cheng, Jun-Na Ye, Yu-Tong Su, Xin-Yao Wu, Jin-Feng Zhou, Gary L Norman, Hui-Yun Gong, Xin-Ming Shi, Yi-Bing Peng, Xue-Feng Wang, Cheng-De Yang
BACKGROUND: The aim of the study was to determine the prevalence and clinical associations of antiphosphatidylserine/prothrombin antibodies (aPS/PT) with thrombosis and pregnancy loss in Chinese patients with antiphospholipid syndrome (APS) and seronegative APS (SNAPS). METHODS: One hundred and eighty six Chinese patients with APS (67 primary, 119 secondary), 48 with SNAPS, 176 disease controls (79 systemic lupus erythematosus [SLE], 29 Sjogren's syndrome [SS], 30 ankylosing spondylitis [AS], 38 rheumatoid arthritis [RA]) and 90 healthy donors were examined...
November 22, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
Y K Onno Teng, Edwin O W Bredewold, Ton J Rabelink, Tom W J Huizinga, H C Jeroen Eikenboom, Maarten Limper, Ruth D E Fritsch-Stork, Kitty W M Bloemenkamp, Marieke Sueters
Patients with SLE are often young females of childbearing age and a pregnancy wish in this patient group is common. However, SLE patients are at high risk for adverse pregnancy outcomes that require adequate guidance. It is widely acknowledged that pre-pregnancy counselling is the pivotal first step in the management of SLE patients with a wish to become pregnant. Next, management of these patients is usually multidisciplinary and often requires specific expertise from the different physicians involved. Very recently a EULAR recommendation was published emphasizing the need for adequate preconception counselling and risk stratification...
November 20, 2017: Rheumatology
Nicole R Bush, Karen Jones-Mason, Michael Coccia, Zoe Caron, Abbey Alkon, Melanie Thomas, Kim Coleman-Phox, Pathik D Wadhwa, Barbara A Laraia, Nancy E Adler, Elissa S Epel
We examined the prospective associations of objective and subjective measures of stress during pregnancy with infant stress reactivity and regulation, an early-life predictor of psychopathology. In a racially and ethnically diverse low-income sample of 151 mother-infant dyads, maternal reports of stressful life events (SLE) and perceived stress (PS) were collected serially over gestation and the early postpartum period. Infant reactivity and regulation at 6 months of age was assessed via maternal report of temperament (negativity, surgency, and regulation) and infant parasympathetic nervous system physiology (respiratory sinus arrhythmia [RSA]) during the Still Face Paradigm...
December 2017: Development and Psychopathology
S-G Lee, E-K Park, J-H Park, S-M Kweon, Y-K Kim, G-T Kim
We aimed to analyze compliance and persistence with hydroxychloroquine (HCQ) in real practice and identify risk factors for poor adherence in South Korean patients with systemic lupus erythematosus (SLE). This retrospective longitudinal study evaluated 235 SLE patients in whom oral HCQ was newly started from 2002 to 2016 at a tertiary hospital in South Korea. Compliance was assessed using one-year medication possession ratio (MPR) and non-compliance was defined as a one-year MPR < 0.8. Persistence was determined as the time from HCQ treatment initiation to discontinuation without interruption for ≥56 days...
January 1, 2017: Lupus
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