Pregnancy and menopause in patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: practical guide from EULAR

Vagelli, R; Tani, Chiara; Mosca, Marta

doi:10.20452/pamw.3906

Cited by 9 publications

(16 citation statements)

References 23 publications

(23 reference statements)

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“…Another possible mechanism revolves around the fact that the development of rheumatism may be triggered by certain infectious agents or antigens produced by microorganisms and severe keloids are commonly accompanied by infection [36] . We postulate that hormones may also be involved in the association between rheumatism and keloids: the pathological mechanisms underlying the development of some rheumatic diseases are closely associated with imbalances in estrogen and progesterone [37,38] . Of interest, hormone imbalance can contribute to the occurrence of keloids [39] …”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with the progression from keloids to severe keloids

Liu

Xiao

Wang

et al. 2022

Chinese Medical Journal

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Background:Keloids are benign fibrous growths that are caused by excessive tissue build-up. Severe keloids exert more significant effects on patients’ quality of life than do mild keloids. We aimed to identify factors associated with the progression from mild keloids to severe keloids, as distinct from those associated with the formation of keloids.Methods:In this retrospective case-control study, 251 patients diagnosed with keloids at West China Hospital between November 2018 and April 2021 were grouped according to the severity of lesions (mild [n = 162] or severe [n = 89]). We collected their basic characteristics, living habits, incomes, comorbidities, and keloid characteristics from Electronic Medical Records in the hospital and the patients’ interviews. Conditional multivariable regression was performed to identify the independent risk factors for the progression of keloids.Results:Eighty-nine patients (35.5%) were classified as having severe keloids. We found the distribution of severe keloids varied with sex, age, excessive scrubbing of keloids, family income, the comorbidity of rheumatism, disease duration, characteristics of the location, location in sites of high-stretch tension, the severity and frequency of pain, the severity of pruritus, and infection. Multivariable analysis revealed significant associations between severe keloids and infection (odds ratio [OR], 3.55; P = 0.005), excessive scrubbing of keloids (OR, 8.65; P = 0.001), low or middle family income (OR, 13.44; P = 0.021), comorbidity of rheumatism (OR, 18.97; P = 0.021), multiple keloids located at multiple sites (OR, 3.18; P = 0.033), and disease duration > 15 years (OR, 2.98; P = 0.046).Conclusion:Doctors should implement more active and thorough measures to minimize the progression of mild keloids in patients who have any of the following risk factors: infection, excessive scrubbing of keloids, low or middle family income, comorbidity of rheumatism, multiple keloids located at multiple sites, and disease duration > 15 years.

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with the progression from keloids to severe keloids

Liu

Xiao

Wang

et al. 2022

Chinese Medical Journal

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“…Albeit randomized control trials will be needed to specifically investigate the role of those medications in pregnant women with MCTD, one can speculate that agents lowering the disease activity might have affected the pregnancy outcomes. Similarly, the use of LDA was seen to have a protective effect against adverse maternal and fetal outcomes as observed in other connective tissue diseases (e.g., SLE) [42]. A further important question is whether HCQ may play a role in preventing neonatal lupus and especially the recurrence of CHB in the foetus, as demonstrated in women with anti-Ro/SSA [43].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in mixed connective tissue disease: a multicentre study

et al. 2019

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Objectives In this study we aimed to investigate foetal and maternal pregnancy outcomes from a large multicentre cohort of women diagnosed with MCTD and anti-U1RNP antibodies. Methods This multicentre retrospective cohort study describes the outcomes of 203 pregnancies in 94 consecutive women ever pregnant who fulfilled the established criteria for MCTD with confirmed U1RNP positivity. Results The foetal outcomes in 203 pregnancies were as follows: 146 (71.9%) live births, 38 (18.7%) miscarriages (first trimester pregnancy loss of <12 weeks gestation), 18 (8.9%) stillbirths (pregnancy loss after 20 weeks gestation) and 11 (5.4%) cases with intrauterine growth restriction. Maternal pregnancy outcomes were as follows: 8 (3.9%) developed pre-eclampsia, 2 (0.9%) developed eclampsia, 31 (15.3%) developed gestational hypertension and 3 (1.5%) developed gestational diabetes. Women with MCTD and aPL and pulmonary or muscular involvement had worse foetal outcomes compared with those without. Moreover, we report a case of complete congenital heart block (0.45%) and a case of cutaneous neonatal lupus, both born to a mother with positive isolated anti-U1RNP and negative anti-Ro/SSA antibodies. Conclusion In our multicentre cohort, women with MCTD had a live birth rate of 72%. While the true frequency of heart block associated with anti-U1RNP remains to be determined, this study might raise the consideration of echocardiographic surveillance in this setting. Pregnancy counselling should be considered in women with MCTD.

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“…A therapeutic decision should be taken early so bone protection may be achieved [182,207]. Since there are no data on the optimum duration of HRT in LE patients, the shortest possible duration should be chosen (about 1-2 years) [182,198]. There are no controlled data on hormone replacement therapy in purely cutaneous forms of LE.…”

Section: Menopause and Hormone Replacement Therapymentioning

confidence: 99%

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus – Part 2: Therapy, risk factors and other special topics

Worm

Zidane

Eisert³

et al. 2021

J Deutsche Derma Gesell

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Topical treatment Topical glucocorticoidsClass 2-4 topical glucocorticoids are the treatment of choice for cutaneous lupus erythematosus (CLE). A randomized, controlled study has shown that fluocinonide 0.05 % is more effective than hydrocortisone 1 % [1]. Class 4 topical glucocorticoids are indicated for lesions on the capillitium, the palms of the hands/soles of the feet, and for hyperkeratotic lesions, covered by a foil/hydrocolloid dressing where required. Strictly intralesional injections of triamcinolone acetonide may be considered in individual cases, and this may be repeated after 4-6 weeks as needed. Side effects with use over longer periods of time are a limiting factor, so either short-term use over a period of several weeks, or interval treatment is recommended. Recommendation Strength AgreementTopical glucocorticoids are recommended for treating circumscribed CLE lesions.

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Pregnancy and menopause in patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: practical guide from EULAR

Cited by 9 publications

References 23 publications

Risk factors associated with the progression from keloids to severe keloids

Risk factors associated with the progression from keloids to severe keloids

Pregnancy outcomes in mixed connective tissue disease: a multicentre study

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus – Part 2: Therapy, risk factors and other special topics

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