Remission or low disease activity at pregnancy onset are linked to improved foetal outcomes in women with systemic lupus erythematosus: results from a prospective observational study.

Autor:	Ntali S; Private Practice Rheumatologist, Thessaloniki, and Rheumatology and Clinical Immunology, University Hospital of Heraklion and University of Crete Medical School, Heraklion, Greece., Nikolopoulos D; Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Athens, and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece., Pantazi L; Rheumatology Unit, Sismanogleio General Hospital, Athens, Greece., Emmanouilidou E; Rheumatology and Clinical Immunology, University Hospital of Heraklion and University of Crete Medical School, Heraklion, Greece., Papagoras C; First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece., Fanouriakis A; Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Athens; Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, and Department of Rheumatology, 'Asklepieion' General Hospital, Voula, Athens, Greece., Dimopoulou D; 4th Internal Medicine Clinic, Ippokrateio General Hospital of Thessaloniki, Greece., Kallitsakis I; Private Practice Rheumatologist, Chania, Greece., Boki K; Rheumatology Unit, Sismanogleio General Hospital, Athens, Greece., Dania V; Rheumatology Unit, Sismanogleio General Hospital, Athens, Greece., Sidiropoulos PI; Rheumatology and Clinical Immunology, University Hospital of Heraklion and University of Crete Medical School, Heraklion, and Laboratory of Rheumatology, Autoimmunity and Inflammation, Institute of Molecular Biology and Biotechnology-FORTH, Heraklion, Greece., Boumpas DT; Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Athens, and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece., Bertsias G; Rheumatology and Clinical Immunology, University Hospital of Heraklion and University of Crete Medical School, Heraklion, and Laboratory of Rheumatology, Autoimmunity and Inflammation, Institute of Molecular Biology and Biotechnology-FORTH, Heraklion, Greece. gbertsias@uoc.gr.
Jazyk:	angličtina
Zdroj:	Clinical and experimental rheumatology [Clin Exp Rheumatol] 2022 Sep; Vol. 40 (9), pp. 1769-1778. Date of Electronic Publication: 2022 Jan 05.
DOI:	10.55563/clinexprheumatol/g4rby6
Abstrakt:	Objectives: Systemic lupus erythematosus (SLE) patients show variably increased risk for pregnancy complications. We analysed pregnancy outcomes (foetal and maternal), patterns of disease activity and use of medications in a contemporary Caucasian SLE population. Methods: Prospective observational study, involving hospital units and private rheumatologists in Greece, of incident pregnancies (period 2015-2018) in women with SLE. Clinical and obstetrical monitoring was performed at regular intervals up to 9 months post-partum. Regression and mixed model analyses were used to determine predictors for adverse foetal outcomes and flares. Results: We monitored 82 pregnancies in 64 SLE patients. Foetal loss, prematurity and small for gestational age neonate occurred at 15.8%, 34.1% and 8.5%, respectively; 53.7% of pregnancies were complicated with at least one adverse outcome. Patients with antiphospholipid antibodies (aPL) had increased risk (odds ratio [OR] 5.67, p=0.015), whereas those at low disease activity at pregnancy onset were protected (OR 0.20, p=0.024) against foetal complications. Persistent activity and glucocorticoid intake during pregnancy also predicted poor foetal outcomes. SLE patients experienced an average 1.08 mild/moderate and 0.27 severe flares. The latter occurred more frequently post-partum, in patients with alopecia (OR 8.92, p=0.003), hypocomplementaemia (OR 10.34, p=0.038) and nephritis (OR 7.32, p=0.052). Lupusactivity post-labour was paralleled by decreased use of hydroxychloroquine, glucocorticoids and azathioprine. Conclusions: In SLE women, foetal complications are common especially in the presence of aPL and increased activity, which corroborates the importance of pregnancy planning and tight disease control at pregnancy onset. Flares, mostly mild or moderate, can occur both during and after pregnancy.
Databáze:	MEDLINE
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