Incidence rates of arterial and venous thrombosis after diagnosis of systemic lupus erythematosus

Sarabi, Zhaleh Shariati; Chang, Erika; Bobba, Raja; Ibañez, Dominique; Gladman, Dafna D.; Urowitz, Murray B.; Fortin, Paul R.

doi:10.1002/art.21314

Cited by 65 publications

(63 citation statements)

References 43 publications

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“…The incidence rate among women Յ30 years of age is 0.05 per 1,000 person-years (38), and in postmenopausal women, it is 0.08-0.11 per 1,000 person-years (35)(36)(37). In stark contrast, thrombosis has been reported in 10-20% 3076 SÁ NCHEZ-GUERRERO ET AL of lupus patients (39)(40)(41), and the incidence rate among patients in whom the disease is prevalent is 5.1 per 1,000 patient-years (39) and up to 51.9 per 1,000 patient-years in an inception cohort of lupus patients (40). Considering that the use of exogenous estrogens is associated with a thrombosis RR of 2.1-3.6 (35)(36)(37), the absolute risk imposed by menopause hormonal therapy in women with SLE seems to be unacceptable.…”

Section: Discussionmentioning

confidence: 99%

“…In conclusion, since women with SLE are at an increased risk of developing premature menopause (2), osteoporotic fractures (44), cognitive dysfunction (45), premature atherosclerosis (46), thrombosis (40), and cardiovascular events (47), and their quality of life often is poorer than that of the general population (48), the effects of menopause in addition to these conditions, and the risk-benefit profile of menopause hormonal therapy in these women and those with other chronic diseases, need to be explored in depth. Menopause hormonal therapy did not affect the course of disease activity, at a clinically significant level, in women with SLE who were in the menopausal transition or in early or late postmenopause.…”

Section: Discussionmentioning

confidence: 99%

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Menopause hormonal therapy in women with systemic lupus erythematosus

Sánchez‐Guerrero

González-Pérez

Durand-Carbajal

et al. 2007

Arthritis & Rheumatism

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Objective. To evaluate the effects of menopause hormonal therapy on disease activity in women with systemic lupus erythematosus (SLE).Methods. We conducted a double-blind, randomized clinical trial involving 106 women with SLE who were in the menopausal transition or in early or late postmenopause. Patients received a continuoussequential estrogen-progestogen regimen (n ‫؍‬ 52) or placebo (n ‫؍‬ 54). Disease activity was assessed at baseline and at 1, 2, 3, 6, 9, 12, 15, 18, 21, and 24 months, according to the SLE Disease Activity Index (SLEDAI). The primary outcome measure was global disease activity, estimated by measuring the area under the SLEDAI curve. Secondary outcome measures included maximum SLEDAI score, change in SLEDAI score, incidence of lupus flares, median time to flare, medication use, and adverse events. Results were studied using intent-totreat analysis.Results. At baseline, demographic and disease characteristics were similar in both groups. Mean ؎ SD SLEDAI scores were 3.5 ؎ 3.3 and 3.1 ؎ 3.4 in the menopause hormonal therapy and placebo groups, respectively (P ‫؍‬ 0.57). Disease activity remained mild and stable in both groups throughout the trial. There were no significant differences between the groups in global or maximum disease activity, incidence or probability of flares, or medication use. Median time to flare was 3 months in both groups. Thromboses occurred in 3 patients who received menopause hormonal therapy and in 1 patient who received placebo. One patient in each group died during the trial due to sepsis.Conclusion. Menopause hormonal therapy did not alter disease activity during 2 years of treatment. However, an apparently increased risk of thrombosis seems to be a real threat in women with SLE who receive menopausal hormone therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Menopause hormonal therapy in women with systemic lupus erythematosus

Sánchez‐Guerrero

González-Pérez

Durand-Carbajal

et al. 2007

Arthritis & Rheumatism

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“…Los anticonceptivos de progestinas son menos trombogénicos, pero se ha observado que el uso de ACO con desogestrel tiene mayor riesgo de trombosis venosa que con el uso de norgestrel o levonogestrel (20,21). Las mujeres con LES tienen un riesgo aumentado de trombosis en comparación a la población general, con reportes de 1:10 a 1:100 (22). Su origen es multifactorial; se han identificado como factores de riesgo: estrógenos, tabaquismo, edad, actividad de la enfermedad, dosis de glucocorticoides, duración de la enfermedad, etnia, dislipidemia, obesidad, insuficiencia venosa, vasculitis, síndrome nefrótico y significativamente los anticuerpos antifosfolípicos positivos (23)…”

Section: Lupus Eritematoso Sistémico Y Anticon-cepciónunclassified

Anticoncepción hormonal en mujeres jóvenes con enfermedades reumatológicas

et al. 2014

Rev. chil. obstet. ginecol.

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RESUMENAntecedentes: Las enfermedades reumatológicas (ER) se presentan con mayor frecuencia en mujeres en edad fértil. Es durante este período que muchas mujeres consultan por trastornos de los flujos rojos, dismenorrea y prevención del embarazo. Objetivo: Realizar una puesta al día del uso de anticoncepción hormonal (AH) en mujeres jóvenes con ER, especialmente en las portadoras de lupus eritematoso sistémi-co (LES) y artritis reumatoide (AR). Método: Se revisó la literatura en Pubmed para los términos AH en ER, con especial énfasis en guías clínicas y ensayos clínicos aleatorizados. Resultados: El uso de AH en pacientes con LES inactivo o con actividad leve no ha mostrado un empeoramiento de la enfermedad. Tampoco existe evidencia categórica que demuestre un mayor riesgo trombótico en aquellas con anticuerpos antifosfolípidos negativos, para las cuales se recomienda el uso de cualquier tipo de AH. En pacientes con AR no se ha demostrado asociación del uso de AH y aumento de la actividad de la enfermedad. Además la interacción farmacológica entre AH y medicamentos reumatológicos es mínima. Existe escasa evidencia del uso de AH en mujeres menores de 18 años con ER. Conclusión: Basado en la evidencia disponible las pacientes con ER con anticuerpos antifosfolípidos negativos podrán utilizar AH según los criterios de la OMS, lo que abre las puertas a mayores alternativas terapéuticas y prevención de embarazo para estas adolescentes y mujeres jóvenes con ER.PALABRAS CLAVE: Anticoncepción, lupus eritematoso sistémico, artritis reumatoide, enfermedades reumatológicas, trombosis SUMMARYBackground: Rheumatologic diseases (RD) are most common in women of childbearing age. It is during this period that many women consult for menstrual disorders, dysmenorrhea and pregnancy prevention. Objective: To update the use of hormonal contraception (HC) in young women with RD. Method: Literature was reviewed in PubMed for HC and RD terms, with special emphasis on clinical guidelines and randomized clinical trials. Results: The use of HC in patients with inactive or mild activity systemic lupus erythematosus has not shown a worsening of the disease. Also, there is no evidence demonstrating greater thrombotic risk in those with negative antiphospholipid antibodies, for which the use of any type of HC is recommended. In patients with rheumatoid arthritis an association between use of HC and increases disease activity has not been demonstrated. In addition, there is minimal drug interaction between HC and rheumatologic drugs.There is little evidence of the use of HC in women less than 18 years with RD. Conclusion: Based on the available evidence the patients with RD and negative antiphospholipid antibodies could use HC according

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“…Although the mechanism by which SLE increases thrombotic risk is multifactorial and is yet to be fully elucidated there is a strong association between systemic inflammation and venous thrombosis. 4 Indeed, the risk of venous thrombosis in patients with SLE is highest in the first year following diagnosis 5 hence correlating with a time period when SLE is typically more active. It is essential that thrombosis is considered in all SLE patients presenting with features of disease flare and especially those with pleuritic chest pain.…”

Section: Thrombosis In Slementioning

confidence: 99%

Acute systemic lupus erythematosus on the acute medical take: are we missing anything?

2011

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A 42-year-old man with a background of systemic lupus erythematosus (SLE) presented acutely to the medical admissions unit (MAU) with pleuritic chest pain, shortness of breath and arthralgia. He was receiving no regular medications and denied any other medical problems, any cough, recent flights, calf pain or immobility. He described the chest pain as sudden onset, right sided and exacerbated by deep inspiration. He rated the pain as 10/10 severity and required opiate analgesia on admission to the MAU. On clinical examination the pain was increased by palpation at the right inferior anterior costal margin. The remainder of systems examinations were unremarkable with no rash, no synovitis and no audible pleural or pericardial rub. Baseline investigationsOn admission he was apyrexial, he had a good blood pressure of 132/78 and normal oxygen saturations at 98% on air. Heart rate and respiratory rate were raised at 88/minute and 24/minute respectively. He had an entirely normal arterial blood gas (ABG) on room air with a PO 2 of 12.1 KPa. His chest X-ray (CXR) was within normal limits and his electrocardiogram (ECG) is illustrated in Fig 1. What is the differential diagnosis and the most likely diagnosis? Acute SLE with serositisThis presentation is highly suggestive of an acute SLE flare resulting in pleuritic chest pain secondary to serositis. This is supported by raised inflammatory markers (Table 1) and saddle shaped ST elevation on ECG (Fig 1) consistent with pericarditis. Pulmonary embolusPatients with SLE are at increased risk of thrombosis and care must be taken not to miss a pulmonary embolus. Despite the presence of a normal PO 2 and a Wells Score of zero 1 suggesting a low pre-test probability, pulmonary embolus must be considered. Lower respiratory tract infectionThis is a common cause of pleuritic chest pain, but very unlikely here. To be able to attribute this degree of pleuritic pain to infection you would expect clinical findings consistent with infection, eg productive cough, coarse crepitations, bronchial breathing, pyrexia or consolidation on CXR. What is the initial management?Paracetamol, naproxen and codeine phosphate were used for analgesia but the pain persisted requiring morphine before it was controlled. A D-dimer was sent urgently which was raised (Table 1). E El li iz za ab be et th h S S P

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Incidence rates of arterial and venous thrombosis after diagnosis of systemic lupus erythematosus

Cited by 65 publications

References 43 publications

Menopause hormonal therapy in women with systemic lupus erythematosus

Menopause hormonal therapy in women with systemic lupus erythematosus

Anticoncepción hormonal en mujeres jóvenes con enfermedades reumatológicas

Acute systemic lupus erythematosus on the acute medical take: are we missing anything?

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