Disease activity at conception predicts lupus flare up to two years after birth: A multicentre long term follow-up study.

Autor: Radin M; University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Piazza del Donatore di Sangue 3, Turin 10154, Italy., Schreiber K; Department of Thrombosis and Haemophilia, Guy's and St Thomas' Hospital, London, United Kingdom; Department of Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark., Cecchi I; University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Piazza del Donatore di Sangue 3, Turin 10154, Italy., Signorelli F; Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil., de Jesús G; Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil., Aso K; Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan., Kono M; Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan., Urban ML; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Bacco B; Clinical Immunology Department, AO Mauriziano, Umberto I, University of Turin, Italy., Gallo Cassarino S; Clinical Immunology Department, AO Mauriziano, Umberto I, University of Turin, Italy., Lo Sardo L; Clinical Immunology Department, AO Mauriziano, Umberto I, University of Turin, Italy., Foddai SG; University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Piazza del Donatore di Sangue 3, Turin 10154, Italy., Barinotti A; University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Piazza del Donatore di Sangue 3, Turin 10154, Italy., Gómez-García I; Rheumatology Service, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia Hospital, University of Cordoba, Cordoba, Spain., Quaglia MI; Hospital Córdoba and Materno Neonatal. Cátedra de Medicina I UHMN 3. Universidad Nacional de Córdoba. Córdoba, Argentina., Tissera Y; Hospital Córdoba and Materno Neonatal. Cátedra de Medicina I UHMN 3. Universidad Nacional de Córdoba. Córdoba, Argentina., Gervasoni F; Department of Surgical Sciences, Obstetrics and Gynecology, Sant'Anna University Hospital, University of Turin, Italy., Aguirre-Zamorano MÁ; Rheumatology Service, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia Hospital, University of Cordoba, Cordoba, Spain., Alba P; Hospital Córdoba and Materno Neonatal. Cátedra de Medicina I UHMN 3. Universidad Nacional de Córdoba. Córdoba, Argentina., Benedetto C; Department of Surgical Sciences, Obstetrics and Gynecology, Sant'Anna University Hospital, University of Turin, Italy., Atsumi T; Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan., Amengual O; Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan., Emmi G; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Andrade D; Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Marozio L; Department of Surgical Sciences, Obstetrics and Gynecology, Sant'Anna University Hospital, University of Turin, Italy., Roccatello D; University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Piazza del Donatore di Sangue 3, Turin 10154, Italy., Sciascia S; University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Piazza del Donatore di Sangue 3, Turin 10154, Italy. Electronic address: savino.sciascia@unito.it.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2022 Dec; Vol. 57, pp. 152113. Date of Electronic Publication: 2022 Oct 22.
DOI: 10.1016/j.semarthrit.2022.152113
Abstrakt: Objective: To assess predicting factors that might influence systemic lupus erythematosus (SLE) disease activity in women in an extended follow-up period of two years after giving birth with clinical assessments every three months.
Methods: The study was design as an international retrospective study, enrolling 119 women with a first birth and with a two years follow-up.
Results: Joint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%, renal in 41% and 75% of patients were positive for anti-dsDNA. The mean SLE disease activity index 2000 (SLEDAI-2K) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4. At follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months (mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement (48%), renal (33%), cutaneous (28%) and haematologic (20%). Patients with remission of disease (SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares (18/49-37% vs. 43/70-61%; p=0.008). Patients who experienced a flare during pregnancy (17 patients) had higher rates of flares during follow-up (76% vs. 47%; p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5; p<0.001), lower rate of remission of disease at conception (12% vs. 46%; p<0.001), lower rates of SLEDAI-2K at conception (5.9±5.6 vs. 2.3±4; p<0.001) and lower rates of exclusive breastfeeding (24% vs. 57%: p=0.009). Results were confirmed after performing multivariate analysis.
Conclusion: Remission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients.
Competing Interests: Declaration of Competing Interest None declared.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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