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Interaction Of Systemic Lupus Erythematosus And Rheumatoid Arthritis With Pregnancy

Year 2015, Volume: 12 Issue: 5, 194 - 197, 01.09.2015

Turgut Kültür

Abstract

Since clinical and laboratory findings in rheumatological diseases are also seen in healthy pregnants, diagnosis of activity of rheumotological diseases in pregnancy is difficult. Decrease in complement levels is the most reliable laboratory test of rhematological diseases in pregnancy. Since white blood cell count ESR and CRP levels are normally increased in pregnancy their diagnostic significance is limited. RA patients often enter in remission period in pregnancy but activity in disease is seen in 1 year following post partum period. RA is associated with low birthweight & increased caeserian section rates.SLE generally becomes activated in pregnancy. SLE pregnancies are associated with frequent complications. Fetal loss, preterm labor, hypertension, gestational diabetes, preeclampsia, low birth weight APAS in pregnancy is associated with increased fetal loss rate and thrombosis. Anti ro and anti la levels in pregnancy is associated with congenital heart blocks. For those reasons, pregnancies of SLE patients should be treated as high risk pregnancies and should be followed at third level health centers fetal monitorisation is vital. Disease activation in the 6 month period before conception is associated with gestational complications. For all those reasons preconceptional consultation should be given to SLE patients for becoming pregnant after at least 6 months of silent period of disease.

Keywords

Pregnancy rheumatoid arthritis SLE

References

  • M.G. Baines, K.G. Millar, P. Mills. Studies of complement levels in normal human pregnancy, Obstet. Gynecol. 1974: 43; 806–810.
  • F. Lima, M.A. Khamashta, N.M. Buchanan, S. Kerslake, B.J. Hunt, G.R. Hughes. A study of sixty pregnancies in patients with the antiphospholi- pid syndrome, Clin. Exp. Rheumatol. 1996: 14; 131–136.
  • T.D. Le Thi, N. Tieulie, N. Costedoat, et al., The HELLP syndrome in the antiphospholipid syndrome: retrospective study of 16 cases in 15 wo- men, Ann. Rheum. Dis. 2005: 64;273–278.
  • J.A. Gomez-Puerta, R. Cervera, G. Espinosa, et al., Catastrophic antip- hospholipid syndrome during pregnancy and puerperium: maternal and fetal characteristics of 15 cases, Ann. Rheum. Dis. 2007:66 ;740–746.
  • Doria A, Ghirardello A, Iaccarino L, Zampieri S, Punzi L, Tarricone E,Ruf- fatti A, Sulli A, Sarzi-Puttini PC, Gambari PF, Cutolo M. Pregnancy,cyto- kines, and disease activity in systemic lupus erythematosus. Arthritis Rheum. 2004 Dec 15;51:989-95. Pub Med PMID: 15593367.
  • De Man YA, Bakker-Jonges LE, Goorbergh CM, Tillemans SP, Hooijka- as H, Hazes JM, Dolhain RJ. Women with rheumatoid arthritis negative for anti-cyclic citrullinated peptide and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody-positive women autoantibody levels are not influenced by pregnancy. Ann Rheum Dis. 2010;69:420-3.
  • Guthrie KA, Dugowson CE, Voigt LF, Koepsell TD, Nelson JL. Does preg- nancy provide vaccine-like protection against rheumatoid arthritis? Arth- ritis Rheum. 2010 l;62:1842-8.
  • Karlson EW, Mandl LA, Hankinson SE, Grodstein F. Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses’ Health Study. Arthritis Rheum. 2004;50:3458- 67.
  • Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldin- gsnes W, Mikkelsen K, Kaufmann C, Kvien TK. Pregnancy and delivery in women with chronic inflammatory arthritides with a specific focus on first birth. Arthritis Rheum. 2011;63:1534-42.
  • De Man YA, Hazes JM, van der Heide H, Willemsen SP, de Groot CJ, Ste- egers EA, Dolhain RJ. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum. 2009;60:3196-206.
  • Buyon JP. The effects of pregnancy on autoimmune diseases. J Leukoc Biol. 1998 ;63:281-7.
  • Al-Janadi M, al-Balla S, al-Dalaan A, Raziuddin S. Cytokine profile in sys- temic lupus erythematosus, rheumatoid arthritis, and other rheumatic diseases. J Clin Immunol. 1993;13:58-67.
  • Mintz G, Niz J, Gutierrez G, Garcia-Alonso A, Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multi- disciplinary approach. J Rheumatol. 1986 Aug;13:732-9.
  • Tincani A, Bompane D, Danieli E, Doria A. Pregnancy, lupus andantip- hospholipid syndrome (Hughes syndrome). Lupus. 2006;15:156-60.
  • Ruiz-Irastorza G, Khamashta MA. Lupus and pregnancy: integrating clu- es from the bench and bedside. Eur J Clin Invest. 2011;41:672-8.
  • Lockshin MD. Pregnancy does not cause systemic lupus erythematosus to worsen. Arthritis Rheum. 1989 ;32:665-70.
  • Moroni G, Ponticelli C. Pregnancy after lupus nephritis. Lupus. 2005;14:89-94.
  • Hou S. Pregnancy in chronic renal insufficiency and end-stage renal di- sease. Am J Kidney Dis. 1999;33:235-52.
  • Lockshin MD, Cohn E, Aslam A, Buyon JP, Salmon JE. Reply: To PMID 23044629. Arthritis Rheum. 2013;65:1129-30.
  • Ruffatti A, Tonello M, Cavazzana A, Bagatella P, Pengo V. Laboratoryc- lassification categories and pregnancy outcome in patients with primar- yantiphospholipid syndrome prescribed antithrombotic therapy. Thromb Res.2009;123:482-7.
  • Clowse ME, Magder LS, Petri M. The clinical utility of measuring comp- lement and anti-dsDNA antibodies during pregnancy in patients with sys- temic lupus erythematosus. J Rheumatol. 2011;38:1012-6.
  • Ramin SM, Vidaeff AC, Yeomans ER, Gilstrap LC 3rd. Chronic renal dise- ase in pregnancy. Obstet Gynecol. 2006 ;108:1531-9.
  • Abramowsky CR, Vegas ME, Swinehart G, Gyves MT. Decidual vas- culopathy of the placenta in lupus erythematosus. N Engl J Med. 1980:18;303:668-72.
  • Brucato A, Frassi M, Franceschini F, Cimaz R, Faden D, Pisoni MP, Mus- carà M, Vignati G, Stramba-Badiale M, Catelli L, Lojacono A, Cavazzana I, Ghirardello A, Vescovi F, Gambari PF, Doria A, Meroni PL, Tincani A. Risk of congenital complete heart block in newborns of mothers with anti-Ro/ SSA antibodies detected by counterimmunoelectrophoresis: a prospecti- ve study of 100 women. Arthritis Rheum. 2001;44:1832-5
  • Stirnemann J, Fain O, Lachassinne E, Levet R, Carbillon L, Kettaneh A, Aurousseau MH, Uzan M, Thomas M. [Neonatal cutaneous lupus. Ne- cessary interdisciplinary collaboration]. Presse Med. 2002:21;31:1407- 9.
  • Waltuck J, Buyon JP. Autoantibody-associated congenital heart block: outcome in mothers and children. Ann Intern Med. 1994: 1;120:544-51.
  • Saleeb S, Copel J, Friedman D, Buyon JP. Comparison of treatment withf- luorinated glucocorticoids to the natural history of autoantibody-associ- ated congenital heart block: retrospective review of the research registry for neonatal lupus. Arthritis Rheum. 1999;42:2335-45.
  • Izmirly PM, Kim MY, Llanos C, Le PU, Guerra MM, Askanase AD, Salmon JE, Buyon JP. Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-as- sociated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis. 2010;69:1827-30.
  • Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med. 1990 1;112:682-98.
  • Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199:127;1-6.

Sistemik Lupus Eritematozis ve Romatoid Artritin Gebelik İle Etkileşimi

Year 2015, Volume: 12 Issue: 5, 194 - 197, 01.09.2015

Turgut Kültür

Abstract

Romatolojik hastalıklar görülebilen çeşitli klinik ve laboratuar bulgular gebelikte normalde de izlenebildiğinden; gebelikte romatolojik hastalıkların alevlenmesi tanısında güçlükler yaşanmaktadır. Gebelikte romatizmal laboratuar testlerinden en güveniliri kompleman düzeyleri azalmasıdır. Beyaz küre, ESR ve CRP gebelikte normalde yükseldiğinden tanı değeri kısıtlıdır. RA gebelikte genellikle remisyona girmekle birlikte postpartum 1. yılda hastalıkta alevlenmeler görülür. RA gebelikte düşük doğum ağırlığı ve artmış sezaryen oranları ile ilişkilidir. SLE, gebelikte genellikle agreve olur. SLE gebelikleri yüksek oranda komplikasyonlar ile ilişkilidir Gebelik kayıpları, preterm doğum, hipertansiyon, gestasyonel diyabet, preeklamsi, düşük doğum ağırlığı . Gebelikte lupus nefriti; fetal kayıp, preeklampsi, son dönem böbrek yetmezliği ve maternal mortalite gibi ağır komplikasyonlarla ilişkilidir. Gebelikte APAS’ u yüksek oranda gebelik kaybı ve tromboz ile ilişkilidir. SLE hastalarında anti- Ro ve anti-La konjenital kalp bloğu ile ilişkilidir. Bu nedenlerle SLE gebelikleri yüksek riskli gebelik olarak değerlendirilip, 3. basamak merkezlerde yakın takip edilmelidir. Fetal monitörizasyon hayatidir. Konsepsiyonda 6 ay öncesi dönemde aktive hastalık gebelik komplikasyonları ile ilişkilidir. Bu nedenlerle SLE hastalarında gebelikten önce 6 ay sessiz hastalık olması durumunda gebelik planlaması için prekonsepsiyonel danışmanlık verilmelidir.

Keywords

Gebelik romatoid artrit SLE

References

  • M.G. Baines, K.G. Millar, P. Mills. Studies of complement levels in normal human pregnancy, Obstet. Gynecol. 1974: 43; 806–810.
  • F. Lima, M.A. Khamashta, N.M. Buchanan, S. Kerslake, B.J. Hunt, G.R. Hughes. A study of sixty pregnancies in patients with the antiphospholi- pid syndrome, Clin. Exp. Rheumatol. 1996: 14; 131–136.
  • T.D. Le Thi, N. Tieulie, N. Costedoat, et al., The HELLP syndrome in the antiphospholipid syndrome: retrospective study of 16 cases in 15 wo- men, Ann. Rheum. Dis. 2005: 64;273–278.
  • J.A. Gomez-Puerta, R. Cervera, G. Espinosa, et al., Catastrophic antip- hospholipid syndrome during pregnancy and puerperium: maternal and fetal characteristics of 15 cases, Ann. Rheum. Dis. 2007:66 ;740–746.
  • Doria A, Ghirardello A, Iaccarino L, Zampieri S, Punzi L, Tarricone E,Ruf- fatti A, Sulli A, Sarzi-Puttini PC, Gambari PF, Cutolo M. Pregnancy,cyto- kines, and disease activity in systemic lupus erythematosus. Arthritis Rheum. 2004 Dec 15;51:989-95. Pub Med PMID: 15593367.
  • De Man YA, Bakker-Jonges LE, Goorbergh CM, Tillemans SP, Hooijka- as H, Hazes JM, Dolhain RJ. Women with rheumatoid arthritis negative for anti-cyclic citrullinated peptide and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody-positive women autoantibody levels are not influenced by pregnancy. Ann Rheum Dis. 2010;69:420-3.
  • Guthrie KA, Dugowson CE, Voigt LF, Koepsell TD, Nelson JL. Does preg- nancy provide vaccine-like protection against rheumatoid arthritis? Arth- ritis Rheum. 2010 l;62:1842-8.
  • Karlson EW, Mandl LA, Hankinson SE, Grodstein F. Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses’ Health Study. Arthritis Rheum. 2004;50:3458- 67.
  • Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldin- gsnes W, Mikkelsen K, Kaufmann C, Kvien TK. Pregnancy and delivery in women with chronic inflammatory arthritides with a specific focus on first birth. Arthritis Rheum. 2011;63:1534-42.
  • De Man YA, Hazes JM, van der Heide H, Willemsen SP, de Groot CJ, Ste- egers EA, Dolhain RJ. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum. 2009;60:3196-206.
  • Buyon JP. The effects of pregnancy on autoimmune diseases. J Leukoc Biol. 1998 ;63:281-7.
  • Al-Janadi M, al-Balla S, al-Dalaan A, Raziuddin S. Cytokine profile in sys- temic lupus erythematosus, rheumatoid arthritis, and other rheumatic diseases. J Clin Immunol. 1993;13:58-67.
  • Mintz G, Niz J, Gutierrez G, Garcia-Alonso A, Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multi- disciplinary approach. J Rheumatol. 1986 Aug;13:732-9.
  • Tincani A, Bompane D, Danieli E, Doria A. Pregnancy, lupus andantip- hospholipid syndrome (Hughes syndrome). Lupus. 2006;15:156-60.
  • Ruiz-Irastorza G, Khamashta MA. Lupus and pregnancy: integrating clu- es from the bench and bedside. Eur J Clin Invest. 2011;41:672-8.
  • Lockshin MD. Pregnancy does not cause systemic lupus erythematosus to worsen. Arthritis Rheum. 1989 ;32:665-70.
  • Moroni G, Ponticelli C. Pregnancy after lupus nephritis. Lupus. 2005;14:89-94.
  • Hou S. Pregnancy in chronic renal insufficiency and end-stage renal di- sease. Am J Kidney Dis. 1999;33:235-52.
  • Lockshin MD, Cohn E, Aslam A, Buyon JP, Salmon JE. Reply: To PMID 23044629. Arthritis Rheum. 2013;65:1129-30.
  • Ruffatti A, Tonello M, Cavazzana A, Bagatella P, Pengo V. Laboratoryc- lassification categories and pregnancy outcome in patients with primar- yantiphospholipid syndrome prescribed antithrombotic therapy. Thromb Res.2009;123:482-7.
  • Clowse ME, Magder LS, Petri M. The clinical utility of measuring comp- lement and anti-dsDNA antibodies during pregnancy in patients with sys- temic lupus erythematosus. J Rheumatol. 2011;38:1012-6.
  • Ramin SM, Vidaeff AC, Yeomans ER, Gilstrap LC 3rd. Chronic renal dise- ase in pregnancy. Obstet Gynecol. 2006 ;108:1531-9.
  • Abramowsky CR, Vegas ME, Swinehart G, Gyves MT. Decidual vas- culopathy of the placenta in lupus erythematosus. N Engl J Med. 1980:18;303:668-72.
  • Brucato A, Frassi M, Franceschini F, Cimaz R, Faden D, Pisoni MP, Mus- carà M, Vignati G, Stramba-Badiale M, Catelli L, Lojacono A, Cavazzana I, Ghirardello A, Vescovi F, Gambari PF, Doria A, Meroni PL, Tincani A. Risk of congenital complete heart block in newborns of mothers with anti-Ro/ SSA antibodies detected by counterimmunoelectrophoresis: a prospecti- ve study of 100 women. Arthritis Rheum. 2001;44:1832-5
  • Stirnemann J, Fain O, Lachassinne E, Levet R, Carbillon L, Kettaneh A, Aurousseau MH, Uzan M, Thomas M. [Neonatal cutaneous lupus. Ne- cessary interdisciplinary collaboration]. Presse Med. 2002:21;31:1407- 9.
  • Waltuck J, Buyon JP. Autoantibody-associated congenital heart block: outcome in mothers and children. Ann Intern Med. 1994: 1;120:544-51.
  • Saleeb S, Copel J, Friedman D, Buyon JP. Comparison of treatment withf- luorinated glucocorticoids to the natural history of autoantibody-associ- ated congenital heart block: retrospective review of the research registry for neonatal lupus. Arthritis Rheum. 1999;42:2335-45.
  • Izmirly PM, Kim MY, Llanos C, Le PU, Guerra MM, Askanase AD, Salmon JE, Buyon JP. Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-as- sociated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis. 2010;69:1827-30.
  • Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med. 1990 1;112:682-98.
  • Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199:127;1-6.
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Turgut Kültür

Publication Date September 1, 2015
Published in Issue Year 2015 Volume: 12 Issue: 5

Cite

Vancouver Kültür T. Sistemik Lupus Eritematozis ve Romatoid Artritin Gebelik İle Etkileşimi. JGON. 2015;12(5):194-7.