<b>E</b>ffect of pregnancy on disease flares in patients with systemic lupus erythematosus

Eudy, Amanda M; Siega‐Riz, Anna Maria; Engel, Stephanie M.; Franceschini, Nora; Howard, Annie Green; Clowse, Megan E.B.; Petri, Michelle

doi:10.1136/annrheumdis-2017-212535

Cited by 98 publications

(126 citation statements)

References 27 publications

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“…Studies of disease exacerbation or ares in pregnant SLE patients have been performed in several groups, and even among the case-controlled studies, have shown con icting results [4][5][6][7][8][9][10]21]. Details of patient characteristics and ares among previous case-controlled studies, as well as this study, are shown in Supplementary Table 2.…”

Section: Discussionmentioning

confidence: 93%

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

Louthrenoo

Trongkamolthum

Kasitatnon

et al. 2020

Preprint

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Background: Flares in pregnant patients with systemic lupus erythematosus (SLE) have shown conflicting results. This study aimed to determine the disease activity, and rate and severity of flares in pregnant SLE patients compared with the non-pregnant SLE controls. Methods: The medical records of pregnant patients in the SLE cohort were identified. Controls were non-pregnant female SLE patients who were matched for age at diagnosis and disease duration prior to conception. Disease activity was determined by mSLEDAI-2K. The definition and severity of flares followed the SELANA-SLEDAI Flare Index. The disease activity was measured from 6 months prior to conception (-6M) until termination of pregnancy or delivery.Results: Ninety pregnancies occurred from 77 patients, of whom 36.67% had active disease at the time of conception. The pregnancy group was slightly, but significantly, younger than the control group at diagnosis (21.63 ± 5.89 years vs. 24.05 ± 7.27 years, p = 0.015). The SLE disease activity (mSLEDAI-2K) score was comparable in both groups from -6M to the post-partum period, with that in the control group being slightly but significantly higher than that in the pregnancy group at conception (3.57 ± 4.28 vs. 1.91 ± 3.44, p = 0.003). Of the 90 pregnancies, the overall incidence of flares in both groups was similar during pregnancy (39 vs. 26, p = 0.070). There also was no difference in the incidence of flare during each trimester, with 19 vs.7 flares among 90 pregnancies (p = 0.588) in the 1st, 12 vs. 12 among 82 (p = 0.682) in the 2nd, and 6 vs. 7 among 71 (p = 0.266) in the 3rd trimester. The incidence of flare during the post-partum period also was similar (42 vs. 30 flares among 90 pregnancies, p = 0.091). There was no difference in the severity of flare in each trimester, overall flare during pregnancy or post-partum flare. Conclusions: This study found no difference in flare rate or severity of flares between pregnant SLE patients and non-pregnant SLE controls, who were matched by sex, age at diagnosis and disease duration prior to pregnancy.

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Section: Discussionmentioning

confidence: 93%

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

Louthrenoo

Trongkamolthum

Kasitatnon

et al. 2020

Preprint

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“…Many studies support maternal and pregnancy benefit of HCQ and low risk for mother and fetus . Potential contraindications include allergy, adverse side effects, or intolerance.…”

Section: Results/recommendationsmentioning

confidence: 99%

“…We strongly recommend HCQ, azathioprine/6‐mercaptopurine, colchicine, and sulfasalazine, medications commonly used for RMD, as compatible for use throughout pregnancy ( ).…”

Section: Results/recommendationsmentioning

confidence: 99%

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Sammaritano

Bermas

Chakravarty

et al. 2020

Arthritis & Rheumatology

434

520

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Objective To develop an evidence‐based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD). Methods We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary. Results This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti‐Ro/SSA and/or anti‐La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre‐pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy‐compatible medications, and ongoing physician‐patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD. Conclusion This guideline provides evidence‐based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low‐level data. We intend that this guideline be used to inform a shared decision‐making process between patients and their physicians on issues related to reproductive health that incorporates patients’ values, preferences, and comorbidities.

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“…An important message to providers and patients is that many women with rheumatic diseases have successful pregnancies and healthy babies . Moreover, some women will choose to pursue pregnancy even if they face substantial health risks .…”

Section: Discussionmentioning

confidence: 99%

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study

Talabi

Clowse

Blalock

et al. 2020

Arthritis Care & Research

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Objective Little is known about whether and how rheumatologists provide family planning counseling and reproductive health care (FPCC) to reproductive‐age women with rheumatic diseases. This qualitative study sought to assess rheumatologists’ perspectives, attitudes, and practices regarding FPCC. Methods Semistructured interviews were conducted with a geographically diverse US sample of rheumatologists (n = 12). Interviews were transcribed verbatim, and a code book was inductively developed based on transcript content. Two coders applied the code book to all transcripts, and coding differences were adjudicated to full agreement. The finalized coding was used to conduct a thematic analysis. Results Six themes were identified across interviews. Rheumatologists said that they 1) feel responsible for providing some FPCC to patients, 2) experience tension between respecting patients’ autonomy and their own anxieties about managing high‐risk pregnancies, 3) view patient‐initiated conversations as FPCC facilitators, and they regard lack of guidelines and the presence of competing clinical priorities as barriers to FPCC, 4) are reluctant to prescribe contraception, 5) desire greater access to resources to help guide FPCC, and 6) recognize the benefits of multidisciplinary collaboration with gynecologists. Conclusion Rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive‐age female patients. However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance. Rheumatologists do not prescribe contraception but rarely refer patients to gynecologists for contraceptive care. Future work should focus on eliminating barriers and identifying solutions that support rheumatologists’ efforts to provide high‐quality FPCC to patients.

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Effect of pregnancy on disease flares in patients with systemic lupus erythematosus

Abstract: Our study supports and extends previous findings that the incidence of flare is increased during pregnancy and within the 3 months postpartum. Continuing HCQ, however, appeared to mitigate the risk of flare during and after pregnancy.

Cited by 98 publications

References 27 publications

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study

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