Low frequency of flares during pregnancy and post-partum in stable lupus patients
| Autor: | Julia Davis-Porada, Joan T. Merrill, Jill P. Buyon, Michael D. Lockshin, Allen D. Sawitzke, D. Ware Branch, Carl A. Laskin, Marta M. Guerra, Michelle Petri, Mimi Y. Kim, Jane E. Salmon, Lisa R. Sammaritano |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty lcsh:Diseases of the musculoskeletal system SLE Disease Logistic regression Severity of Illness Index law.invention 03 medical and health sciences 0302 clinical medicine Stable Disease law Risk Factors Pregnancy Internal medicine medicine Humans Lupus Erythematosus Systemic 030212 general & internal medicine Prospective Studies skin and connective tissue diseases Post partum 030203 arthritis & rheumatology Systemic lupus erythematosus business.industry Flares Postpartum Period medicine.disease Rheumatology 3. Good health Pregnancy Complications Pregnancy Trimester First Logistic Models Antibodies Antinuclear Disease Progression Female lcsh:RC925-935 business Biomarkers Flare Research Article |
| Zdroj: | Arthritis Research & Therapy, Vol 22, Iss 1, Pp 1-8 (2020) Arthritis Research & Therapy |
| ISSN: | 1478-6362 |
| DOI: | 10.1186/s13075-020-2139-9 |
| Popis: | Background Lupus patients are at risk for pregnancy loss, and it has been generally accepted that women with SLE should have low disease activity prior to conception. However, there are conflicting results regarding the effect of pregnancy on SLE flares. This study aims to identify predictors of flares during and after pregnancy in SLE patients with inactive or stable disease activity during the first trimester and to characterize and estimate the frequency of post-partum flares in these patients. Methods SLE patients in the multicenter, prospective PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study were evaluated for flares during and after pregnancy using the SELENA-SLEDAI Flare Index. Flares during pregnancy were assessed in all 384 patients and post-partum flares in 234 patients with study visits 2–6 months post-partum. Logistic regression models were fit to the data to identify independent risk factors for flare. Results During pregnancy, 20.8% of patients had mild/moderate flares and 6.25% had severe. Post-partum, 27.7% of patients had mild/moderate flares and 1.7% had severe. The mild flares rarely required treatment. Younger age, low C4 and higher PGA at baseline were independently associated with higher risk of having at least one mild/moderate or severe flare during pregnancy. Older patients were at decreased risk of flare, as well as those with quiescent disease at baseline. No variables evaluated at baseline or the visit most proximal to delivery was significantly associated with risk of flare post-partum. Medications were not associated with flare during or after pregnancy. Conclusion In patients with inactive or stable mild disease activity at the time of conception, lupus disease flares during and after pregnancy are typically mild and occur at similar rates. Flares during pregnancy are predicted by the patients’ age and clinical and serological activity at baseline. |
| Databáze: | OpenAIRE |
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