Factors associated with long-term cardiac dysfunction in neonatal lupus

Saxena, Amit; Izmirly, Peter; Bomar, Rebecca; Golpanian, Rachel Shireen; Friedman, Deborah; Eisenberg, Ruth; Kim, Mimi Y.; Buyon, Jill P.

doi:10.1136/annrheumdis-2019-215900

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Predictors of poorer cardiac function included male sex, black ethnicity, lower heart rate, extranodal cardiac disease and pacing requirements. Of the infants with cardiac dysfunction under 12 months measured by echocardiogram, 43.8% were still affected in early adulthood, while 8.9% of those unaffected under 12 months of age developed de novo dysfunction in early adulthood 29. This study highlights the importance of close monitoring and the consideration of early, proactive treatment of cardiac disease to ameliorate earlier cardiac dysfunction and improve long-term outcomes of affected children.…”

Section: Infant and Childhood Outcomes Among Rmd Pregnancies (Connect...mentioning

confidence: 84%

Annals of the Rheumatic Diseases collection on pregnancy 2018–2023: observational data-driven knowledge

Duhig,

Hyrich

2024

Ann Rheum Dis

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Pregnancy can be an exciting time but for those living with rheumatic musculoskeletal diseases (RMDs), it can also be a time fraught with concern, including what effect pregnancy will have on the underlying RMD and what effect the RMD may have on the pregnancy and the baby, including the effects of medications. Generating an evidence base in pregnancy is challenging. Few interventional trials of medications in RMD pregnancies have ever been conducted, often for concerns of safety for both the mother and the child. Therefore, observational research remains important for informing clinical practice and helping women with RMDs make decisions regarding their health preconception and during pregnancy. The Annals of the Rheumatic Diseases (ARD) continues to publish important research on pregnancy in RMDs to increase the evidence base on this subject. Here we present an overview of papers published on this topic between January 2018 and December 2023. Our focus includes papers on pregnancy and RMD outcome, the effects of drug exposure, fetal outcomes as well as fertility.

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Section: Infant and Childhood Outcomes Among Rmd Pregnancies (Connect...mentioning

confidence: 84%

Annals of the Rheumatic Diseases collection on pregnancy 2018–2023: observational data-driven knowledge

Duhig,

Hyrich

2024

Ann Rheum Dis

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“…EFE is a non-specific, protracted response to myocardial wall stress that frequently becomes worse over time and eventually leads to heart failure [ 2 ]. EFE is one of the extranodal manifestations of neonatal lupus, whose natural history and pathogenesis are less understood [ 3 , 4 , 22 , 23 ]. Brito-Zeron et al analyzed the primary characteristics of 116 autoimmune EFE cases included in 14 investigations, of which nearly 20% had EFE diagnoses without CHB and 7% had diagnoses with CHB [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Endocardial Fibroelastosis as an Independent Predictor of Atrioventricular Valve Rupture in Maternal Autoimmune Antibody Exposed Fetus: A Systematic Review with Clinicopathologic Analysis

et al. 2023

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Background: Neonatal lupus (NL) is a clinical syndrome that develops in the fetus as a result of maternal autoimmune antibodies. Congenital complete heart block (CHB) is the most common manifestation, while extranodal cardiac manifestations of NL, such as endocardial fibroelastosis (EFE) and myocarditis, are rare but more serious. Less is known about this atrioventricular valve rupture due to valvulitis as a consequence of maternal autoantibodies. We have described a case of cardiac neonatal lupus with an antenatally detected CHB patient who developed mitral and tricuspid valve chordal rupture at 45 days of age. We compared the cardiac histopathology and the fetal cardiac echocardiographic findings of this case with another fetus that was aborted after being antenatally diagnosed with CHB but without valvar rupture. A narrative analysis after a systematic review of the literature regarding atrioventricular valve apparatus rupture due to autoimmune etiology along with maternal characteristics, presentation, treatment, and outcome have been discussed in this article. Objectives: To describe published data on atrioventricular valve rupture in neonatal lupus, including clinical presentation, diagnostic evaluation, management, and outcomes. Methods: We conducted a PRISMA-compliant descriptive systematic examination of case reports that included accounts of lupus during pregnancy or in the newborn period that resulted in an atrioventricular valve rupture. We gathered information on the patient’s demographics, the details of the valve rupture and other comorbidities, the maternal therapy, the clinical course, and the results. We also used a standardized method to evaluate the cases’ quality. A total of 12 cases were investigated, with 11 cases drawn from 10 case reports or case series and 1 from our own experience. Results: Tricuspid valve rupture (50%) is more common than mitral valve rupture (17%). Unlike mitral valve rupture, which occurs postnatally, the timing of tricuspid valve rupture is perinatal. A total of 33% of the patients had concomitant complete heart block, while 75% of the patients had endocardial fibroelastosis on an antenatal ultrasound. Antenatal changes pertaining to endocardial fibroelastosis can be seen as early as 19 weeks of gestation. Patients with both valve ruptures generally have a poor prognosis, especially if they occur at close intervals. Conclusion: Atrioventricular valve rupture in neonatal lupus is rare. A majority of patients with valve rupture had antenatally detected endocardial fibroelastosis in the valvar apparatus. Appropriate and expedited surgical repair of ruptured atrioventricular valves is feasible and has a low mortality risk. Rupture of both atrioventricular valves occurring at close intervals carries a high mortality risk.

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“…Additionally, 10-17% of patients may develop life-threatening cardiomyopathy. Myocardial damage can occur both in the neonatal period and later in life (up to 10 years of age) (11,12) . Patients with grade II and III AV block may develop subclinical myocardial damage in the neonatal period, resulting in higher myocardial susceptibility to damage from long-term pacing.…”

Section: Heartmentioning

confidence: 99%

“…Pacjentki z ustalonym rozpoznaniem powinny profilaktycznie przyjmować hydroksychlorochinę. (12,13) .…”

Section: Heartunclassified

“…Anti-Ro(SS-A) and anti-La(SS-B) antibodies (Abs) are believed to play a leading role in the pathogenesis of NL, with skin lesions primarily associated with the presence of anti-La(SS-B) Abs, and CHB linked with the presence of anti-Ro(SS-A) Abs (12)(13)(14) . Anti-Ro(SS-A) Abs are represented by 52 and 60 kDa proteins, of which 52 kDa polypeptides are more pathogenic (15,16) .…”

Section: Antibody Transportmentioning

confidence: 99%

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Prevention and treatment of neonatal lupus – a literature review

Meliksetian,

Łopuszyńska,

Kosecka

et al. 2023

Pediatr Med Rodz

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Introduction: Neonatal lupus is a syndrome diagnosed in newborns whose mothers suffer from systemic connective tissue diseases with the presence of antibodies to Ro(SS-A) and La(SS-B) antigens. It most often manifests with skin lesions and cardiac conduction disturbances. The aim of the study was to analyse the risk factors for neonatal lupus based on a literature review. In addition, a number of recommendations were formulated for prevention and further management of affected mothers and their children. Materials and methods: We reviewed PubMed, ResearchGate and Google Scholar databases. A combination of keywords: lupus, pregnant, infant, heart block (according to Medical Subject Headings, MeSH) was used to identify relevant publications. Results: Given the lack of protocols for the diagnosis and treatment of neonatal lupus, ensuring that women can monitor foetal heart rate and quickly access obstetric care in the event of abnormal readings is an important aspect in the early diagnosis of the disease. The question of prevention and treatment remains open, but given the results of recent studies, recommendations on prevention and treatment of this syndrome have been designed. Conclusions: 1. Prophylactic maternal intake of hydroxychloroquine. 2. Weekly doppler ultrasound of the umbilical artery and echocardiography. 3. Planning delivery in specialised health care units. 4. Follow-up of the infant until 6–7 months of age.

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Factors associated with long-term cardiac dysfunction in neonatal lupus

Cited by 8 publications

References 27 publications

Annals of the Rheumatic Diseases collection on pregnancy 2018–2023: observational data-driven knowledge

Annals of the Rheumatic Diseases collection on pregnancy 2018–2023: observational data-driven knowledge

Endocardial Fibroelastosis as an Independent Predictor of Atrioventricular Valve Rupture in Maternal Autoimmune Antibody Exposed Fetus: A Systematic Review with Clinicopathologic Analysis

Prevention and treatment of neonatal lupus – a literature review

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