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Tan Z, Shao M, Zhou Y, Wang L, Ma Y, Xiang N, Yuan X, Wang B, Xie X, Zhou M, Wang Y, Li S, Li X. Increased risk of adverse gestational outcomes in pregnant women with primary Sjögren's syndrome. RMD Open 2024; 10:e003616. [PMID: 38806189 PMCID: PMC11138269 DOI: 10.1136/rmdopen-2023-003616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVES This study aimed to identify risk factors contributing to diverse pregnancy outcomes in primary Sjögren's syndrome (pSS) cases. METHODS A retrospective analysis was conducted on pregnant individuals with pSS, who received outpatient or inpatient care across multiple hospitals in Anhui Province, China, from January 2015 to December 2022. RESULTS This study included 164 pregnant women with pSS and 328 control subjects, with no statistically significant difference in average age between the two groups. Analysis of pregnancy outcomes revealed that, compared with the control group, pregnant women in the pSS group were more likely to experience miscarriages, both spontaneous (12.80% vs 1.52%, p<0.001) and therapeutic (6.10% vs 0.91%, p<0.05). The proportion of placental abnormalities detected during prenatal ultrasound in women from the pSS group was higher (14.63% vs 6.40%, p<0.05). In the analysis of pregnancy outcomes for live-born neonates, a higher incidence of congenital heart abnormalities was observed in the pSS group (27.34% vs 12.03%, p<0.05). While there were no significant differences between the pSS pregnancies in terms of both normal and adverse pregnancy outcomes, a comparison of fetal survival and fetal loss in pSS pregnancies revealed a greater use of prophylactic anticoagulant therapy in the fetal survival group. Notably, the application of low molecular weight heparin (LMWH) emerged as an independent protective factor for fetal survival. CONCLUSIONS Compared with non-autoimmune controls, pregnancy in women with pSS presents more challenges. Importantly, we observed that the use of LMWH as anticoagulant therapy is an independent protective measure for fetal survival.
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Affiliation(s)
- Zhen Tan
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Meilin Shao
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
- Department of Physiology, Anhui Medical College, Hefei, Anhui, China
| | - Yingbo Zhou
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Li Wang
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Yan Ma
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Nan Xiang
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Xiang Yuan
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Bin Wang
- Huainan First People's Hospital, Huainan, Anhui, China
| | | | - Mingtao Zhou
- People's Hospital of Chizhou, Chizhou, Anhui, China
| | - Yumin Wang
- Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Sidong Li
- University of Science and Technology, Hefei, Anhui, China
| | - Xiaomei Li
- The First Affiliated Hospital of USTC, Hefei, Anhui, China
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2
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Mao R, Zhu L, Long R, Zhou J, Wang X, Wang M, Wang T, Li Y, Long H, Jin L. A new insight on evaluation of the fertility and pregnancy outcome in patients with primary Sjögren syndrome: a propensity score matched study in multi-IVF centers. Reprod Biol Endocrinol 2024; 22:57. [PMID: 38769525 PMCID: PMC11103840 DOI: 10.1186/s12958-024-01228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Primary Sjögren syndrome (pSS) is often related to adverse neonatal outcomes. But it's currently controversial whether pSS has an adverse effect on female fertility and clinical pregnancy condition. More importantly, it's unclear regarding the role of pSS in oocyte and embryonic development. There is a lack of comprehensive understanding and evaluation of fertility in pSS patients. OBJECTIVE This study aimed to investigate oocyte and embryonic development, ovarian reserve, and clinical pregnancy outcomes in Primary Sjögren syndrome (pSS) patients during in vitro fertilization (IVF) treatment from multi-IVF centers. METHODS We performed a muti-central retrospective cohort study overall evaluating the baseline characteristics, ovarian reserve, IVF laboratory outcomes, and clinical pregnancy outcomes between the pSS patients and control patients who were matched by Propensity Score Matching. RESULTS Following PSM matching, baseline characteristics generally coincided between the two groups. Ovarian reserve including anti-müllerian hormone (AMH) and antral follicle counting (AFC) were significantly lower in the pSS group vs comparison (0.8 vs. 2.9 ng/mL, P < 0.001; 6.0 vs. 10.0, P < 0.001, respectively). The pSS group performed significant reductions in numbers of large follicles, oocytes retrieved and MII oocytes. Additionally, pSS patients exhibited obviously deteriorate rates of oocyte maturation, 2PN cleavage, D3 good-quality embryo, and blastocyst formation compared to comparison. As for clinical pregnancy, notable decrease was found in implantation rate (37.9% vs. 54.9%, P = 0.022). The cumulative live birth rate (CLBR) following every embryo-transfer procedure was distinctly lower in the pSS group, and the conservative and optimal CLBRs following every complete cycle procedure were also significantly reduced in the pSS group. Lastly, the gestational weeks of the newborns in pSS group were distinctly early vs comparison. CONCLUSION Patients with pSS exhibit worse conditions in terms of female fertility and clinical pregnancy, notably accompanied with deteriorate oocyte and embryo development. Individualized fertility evaluation and early fertility guidance are essential for these special patients.
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Affiliation(s)
- Ruolin Mao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Long
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juepu Zhou
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangfei Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tiantian Wang
- Department of Assisted Reproduction, Shanghai Ninth People´S Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Youzhu Li
- Department of Reproductive Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
- Laboratory of Medical Molecular Biology, Si Ming Branch, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
| | - Hui Long
- Department of Assisted Reproduction, Shanghai Ninth People´S Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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3
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Yang Y, Huang XX, Huo RX, Lin JY. Impact of Sjögren's syndrome on maternal and fetal outcomes following pregnancy: a systematic review and meta-analysis of studies published between years 2007-2022. Arch Gynecol Obstet 2024; 309:1135-1149. [PMID: 37921880 DOI: 10.1007/s00404-023-07259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 10/06/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To show the impact of Sjögren's syndrome (SS) on maternal and fetal outcomes following pregnancy. METHODS We performed a literature search based on PubMed, Web of science, Wan fang, China National Knowledge Infrastructure and ProQuest databases from 1 January 2007 to 6 November 2022. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the certainty of the evidence. Systematic reviews and meta-analyses were performed using RevMan 5.3 software. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. Trial sequential analyses were performed by TSA 0.9. RESULTS Nine studies with 2341 patients and 2472 pregnancies with SS were included in our analysis. This current analysis showed pregnancy hypertension and preeclampsia/eclampsia to be significantly higher in pregnant women with SS compared to pregnant women without SS (OR: 1.65, 95% CI: 1.04-2.63; P = 0.03), (OR: 2.06, 95% CI: 1.16-3.65; P = 0.01) respectively. Cesarean section, thromboembolic disease, premature rupture of membranes, and spontaneous abortion were also significantly higher in the SS women with OR: 2.07, 95% CI: 1.48-2.88; P < 0.0001, OR: 9.45, 95% CI: 1.99-44.87; P = 0.005, OR: 1.36, 95% CI: 1.13-1.64; P = 0.001, OR: 9.30, 95% CI: 4.13-20.93; P < 0.00001, respectively. Significantly higher premature births were observed with infants who were born from SS mothers (OR: 2.19, 95% CI: 1.54-3.12; P < 0.0001). Infants defined as 'small for gestational age/intrauterine growth restriction' and 'weighing < 2500 g' were also significantly higher in patients suffering from SS (OR: 2.26, 95% CI: 1.38-3.70; P = 0.001), (OR: 3.84, 95% CI: 1.39-10.61; P = 0.009) respectively. In addition, live birth significantly favored infants who were born from mothers without SS (OR: 21.53, 95% CI: 8.36-55.44; P < 0.00001). Subgroup analysis by sample size revealed that pregnancy hypertension risk has significantly increased in small cohort (OR: 2.74, 95%CI: 1.45-5.18), and a slight increase was found in population-based studies (OR: 1.14, 95%CI: 0.91-1.43). In both small cohorts and population-based researches, cesarean section was significantly higher in SS (OR: 2.13, 95% CI: 1.29, 3.52; OR: 1.85, 95% CI: 1.29-2.64, respectively). The number of infants with intrauterine growth restriction did not grow in the population-based researches (OR: 2.07, 95%CI: 0.92-4.66) although there has been an increase in small reports (OR: 2.53, 95%CI: 1.16-5.51). Subgroup analysis was conducted on the basis of study location (not Asian vs. Asian countries) indicated that cesarean section was significantly higher in SS in both countries (OR: 1.69, 95% CI: 1.31-2.18; OR: 3.37, 95% CI: 2.39-4.77, respectively). CONCLUSION This meta-analysis has shown SS to have a high impact on maternal and fetal outcomes following pregnancy.
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Affiliation(s)
- Yang Yang
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China
| | - Xin-Xiang Huang
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China
| | - Rong-Xiu Huo
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China
| | - Jin-Ying Lin
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China.
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Uyan Hendem D, Oluklu D, Menekse Beser D, Yildirim M, Tugrul Ersak D, Tanacan A, Sahin D. Evaluation of fetal thymus size in maternal autoimmune diseases: systemic lupus erythematosus, Sjögren's syndrome and antiphospholipid antibody syndrome. Arch Gynecol Obstet 2024; 309:1421-1427. [PMID: 37037914 PMCID: PMC10088775 DOI: 10.1007/s00404-023-07035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To investigate the effect of inflammation on the fetal thymus-thoracic ratio (TTR) in pregnant women with systemic lupus erythematosus (SLE), Sjögren's syndrome (SS) and antiphospholipid antibody syndrome (APS). METHOD This prospective case-control study included 45 pregnant women with SLE, SS, and APS and 90 gestational age-matched healthy pregnant women between 24 and 37 gestational weeks. The ratio of the anteroposterior fetal thymus length to the transverse mediastinal length was calculated as the TTR in the study groups. RESULTS Fetal TTR was significantly lower in the case group (p < 0.001). Fetal TTR in the APS group was significantly lower than SS group (p = 006). The patients using hydroxychloroquine (HCQ) had significantly higher fetal TTR compared to patients not using HCQ (p = 0.004). A moderate negative correlation was found between the disease duration and fetal TTR (r = - 0.552, p < 0.001). In predicting admission to the neonatal intensive unit care (NICU), a value of 0.31 was found for the fetal TTR with a sensitivity of 83.3% and a specificity of 69% CONCLUSION: Maternal inflammation in pregnancies with autoimmune diseases may affect the intrauterine milieu of the fetus and cause a lower fetal TTR. Additionally, the lower level of fetal TTR may be more effective and beneficial for the clinician if combined with other risk factors in predicting NICU admission.
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Affiliation(s)
- Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, 1604th Street, No: 9, Cankaya, 06800, Ankara, Turkey.
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, 1604th Street, No: 9, Cankaya, 06800, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, 1604th Street, No: 9, Cankaya, 06800, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, 1604th Street, No: 9, Cankaya, 06800, Ankara, Turkey
| | - Duygu Tugrul Ersak
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, 1604th Street, No: 9, Cankaya, 06800, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, 1604th Street, No: 9, Cankaya, 06800, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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5
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Fierro JJ, Prins JR, Verstappen GM, Bootsma H, Westra J, de Leeuw K. Preconception clinical factors related to adverse pregnancy outcomes in patients with systemic lupus erythematosus or primary Sjögren's syndrome: a retrospective cohort study. RMD Open 2023; 9:e003439. [PMID: 37652559 PMCID: PMC10476138 DOI: 10.1136/rmdopen-2023-003439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE To identify preconception clinical factors associated with adverse pregnancy outcomes (APO) in patients with systemic lupus erythematosus (SLE) or primary Sjögren's syndrome (pSS). METHODS A single-centre, retrospective cohort study was conducted, which included pregnant women treated at the University Medical Center Groningen between January 2010 and August 2021 who fulfilled classification criteria for SLE or pSS. Demographic data, relevant comorbidities, disease duration, disease activity before and during pregnancy, APO, laboratory parameters and treatment regimens were recorded. Associations between the presence of APO and preconception characteristics were evaluated. RESULTS Our study population included 48 (70%) SLE and 21 (30%) pSS pregnancies concerning 70 fetuses (one twin). Preterm birth (n=9, 19%) was the most frequent APO in SLE pregnancies, while in pSS pregnancies this was miscarriages (n=3, 14%). There were no associations between the presence of APO in SLE pregnancies and clinical parameters, laboratory parameters or medication use prior to conception. In the pSS group, significant associations were found between the presence of APO and body mass index (p=0.010), parity (p=0.046), C4 (p=0.021) and low C4 levels (p=0.002). CONCLUSIONS No preconception risk factors related to APO were found in SLE pregnancies, whereas preconception complement levels were associated with APO development in patients with pSS.
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Affiliation(s)
- Juan J Fierro
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
- Microbiología y Parasitología, Grupo Reproduccion, Universidad de Antioquia UdeA, Medellin, Antioquia, Colombia
| | - Jelmer R Prins
- Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gwenny M Verstappen
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna Westra
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
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6
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Graversgaard C, Salmon JE, Schreiber K. First prospective observational data on pregnancies in patients with primary Sjögren's syndrome. THE LANCET. RHEUMATOLOGY 2023; 5:e306-e307. [PMID: 38251594 DOI: 10.1016/s2665-9913(23)00123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Christine Graversgaard
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Jane E Salmon
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Karen Schreiber
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark; Institute for Regional Health Research, Odense University Hospital, Odense, Denmark; Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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7
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de Frémont GM, Costedoat-Chalumeau N, Lazaro E, Belkhir R, Guettrot-Imbert G, Morel N, Nocturne G, Molto A, Goulenok T, Diot E, Perard L, Ferreira-Maldent N, Le Besnerais M, Limal N, Martis N, Abisror N, Debouverie O, Richez C, Sobanski V, Maurier F, Sauvetre G, Levesque H, Timsit MA, Tieulié N, Orquevaux P, Bienvenu B, Mahevas M, Papo T, Lartigau-Roussin C, Chauvet E, Berthoux E, Sarrot-Reynauld F, Raffray L, Couderc M, Silva NM, Jourde-Chiche N, Belhomme N, Thomas T, Poindron V, Queyrel-Moranne V, Delforge J, Le Ray C, Pannier E, Mariette X, Le Guern V, Seror R. Pregnancy outcomes in women with primary Sjögren's syndrome: an analysis of data from the multicentre, prospective, GR2 study. THE LANCET. RHEUMATOLOGY 2023; 5:e330-e340. [PMID: 38251600 DOI: 10.1016/s2665-9913(23)00099-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes in women with primary Sjögren's syndrome have only been evaluated retrospectively using heterogeneous methods and with contradictory results. We aimed to describe adverse pregnancy, delivery, and birth outcome risks in pregnant women with primary Sjögren's syndrome compared with those of a matched general population in France, and to identify factors predictive of disease flares or adverse pregnancy outcomes. METHODS We conducted a multicentre, prospective, cohort study in France using the GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) registry. Women from the GR2 study were eligible if they had conceived before March, 2021, had primary Sjögren's syndrome according to the American College of Rheumatology and European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria, and had an ongoing pregnancy at 12 weeks of gestation. In women who entered in the registry with pregnancies before 18 weeks of gestation, we sought to identify factors associated with primary Sjögren's syndrome flare (≥3-point increase in EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI] score) or adverse pregnancy outcomes (fetal or neonatal death, placental insufficiency leading to a preterm delivery [<37 weeks of gestation], or small-for-gestational-age birthweight). A matched controlled study compared adverse pregnancy, delivery, and birth outcome rates between pregnant women with primary Sjögren's syndrome from the GR2 registry and matched controls from the general population included in the last French perinatal survey (Enquête Nationale Périnatale 2016). FINDINGS 1944 pregnancies were identified in the GR2 cohort, of which 106 pregnancies in 96 women with primary Sjögren's syndrome were included in this analysis. The median age at pregnancy onset was 33 years (IQR 31-36). 87 (83%) of 105 pregnancies (with ethnicity data) were in White women, 18 (17%) were in Black women; 92 (90%) of 102 had previous systemic activity (ESSDAI score of ≥1; data missing in four pregnancies), and 48 (45%) of 106 had systemic activity at inclusion. Of 93 pregnancies included at week 18 of gestation or earlier, primary Sjögren's syndrome flares occurred in 12 (13%). No baseline parameters were associated with primary Sjögren's syndrome flare. Four twin pregnancies and one medical termination were excluded from the adverse pregnancy outcome analysis; of the remaining 88, adverse pregnancy outcomes occurred in six (7%). Among pregnancies in women with data for antiphospholipid antibodies (n=55), antiphospholipid antibody positivity was more frequent among pregnancies with adverse outcomes (two [50%] of four pregnancies) compared with those without adverse outcomes (two [4%] of 51 pregnancies; p=0·023). Anti-RNP antibody positivity was also more frequent among pregnancies with adverse outcomes than those without, although this was not statistically significant. In the matched controlled study, adverse pregnancy outcomes occurred in nine (9%) of 105 pregnancies in women with primary Sjögren's syndrome and 28 (7%) of the 420 matched control pregnancies; adverse pregnancy outcomes were not significantly associated with primary Sjögren's syndrome (odds ratio 1·31, 95% CI 0·53-2·98; p=0·52). INTERPRETATION Pregnancies in women with primary Sjögren's syndrome had very good prognoses for mothers and fetuses, with no overall increase in adverse pregnancy outcome risk compared with the general population. Women with antiphospholipid antibodies or anti-RNP antibodies require close monitoring, because these factors might be associated with a higher risk of adverse pregnancy outcomes. FUNDING Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, Association Francophone Contre la Polychondrite Chronique Atrophiante, AFM-Telethon, Société Nationale Française de Médecine Interne, Société Française de Rhumatologie, Cochin Hospital, French Health Ministry, Fondation for Research in Rheumatology, Association Prix Véronique Roualet, Union Chimique Belge.
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Affiliation(s)
- Grégoire Martin de Frémont
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nathalie Costedoat-Chalumeau
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France; Centre de Recherche Epidémiologie et Biostatistiques de Sorbonne Paris Cité, Université de Paris, Paris, France
| | - Estibaliz Lazaro
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Rakiba Belkhir
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gaëlle Guettrot-Imbert
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Nathalie Morel
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Gaétane Nocturne
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Anna Molto
- Centre de Recherche Epidémiologie et Biostatistiques de Sorbonne Paris Cité, Université de Paris, Paris, France; APHP, Hôpital Cochin, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | | | - Elisabeth Diot
- CHU de Tours, Service de Médecine Interne, Tours, France
| | - Laurent Perard
- Hôpital Saint-Joseph, Service de Médecine Interne, Lyon, France
| | | | | | - Nicolas Limal
- APHP, Hôpital Henri-Mondor, Service de Médecine Interne, Créteil, France
| | - Nihal Martis
- CHU de Nice, Hôpital Archet, Service de Médecine Interne, Nice, France
| | - Noémie Abisror
- APHP, Hôpital Saint-Antoine, Service de Médecine Interne, Paris, France
| | | | | | - Vincent Sobanski
- CHU de Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Inserm U1286, Université de Lille, Lille, France
| | - François Maurier
- Hôpitaux Privés de Metz, Service de Médecine Interne, Metz, France
| | | | - Hervé Levesque
- CHU de Rouen, Service de Médecine Interne, Rouen, France
| | | | | | | | - Boris Bienvenu
- Hôpital Saint-Joseph, Service de Médecine Interne, Marseille, France
| | - Matthieu Mahevas
- APHP, Hôpital Henri-Mondor, Service de Médecine Interne, Créteil, France
| | - Thomas Papo
- APHP, Hôpital Bichat, Service de Médecine Interne, Paris, France
| | | | - Elodie Chauvet
- Polyclinique Médipôle Saint-Roch, Service de Médecine Interne, Cabestany, France
| | - Emilie Berthoux
- Hôpital Saint-Joseph, Service de Médecine Interne, Lyon, France
| | | | - Loïc Raffray
- CHU Félix-Guyon, Service de Médecine Interne, Saint-Denis de la Réunion, France
| | - Marion Couderc
- CHU de Clermont-Ferrand, Service de Rhumatologie, Clermont-Ferrand, France
| | | | - Noémie Jourde-Chiche
- APHM, CHU de la Conception, Centre de Néphrologie et Transplantation Rénale, C2VN, Inserm 1263, Institut National de la Recherche Agronomique (INRA) 1260, Faculté de Pharmacie, Marseille, France
| | | | - Thierry Thomas
- CHU de Saint-Etienne, Service de Médecine Interne, Saint-Etienne, France
| | - Vincent Poindron
- CHU de Strasbourg, Service de Médecine Interne, Strasbourg, France
| | | | - Juliette Delforge
- APHP, Hôpital Jean-Verdier, Service de Médecine Interne, Bobigny, France
| | - Camille Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université Paris Cité, Paris, France
| | - Emmanuelle Pannier
- APHP, Hôpital Cochin Port Royal, Maternité Port Royal, Service d'Obstétrique, Université de Paris, Paris, France
| | - Xavier Mariette
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Le Guern
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Raphaèle Seror
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
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8
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Oluklu D, Yildirim M, Menekse Beser D, Uyan Hendem D, Gulen Yildiz E, Kara O, Tanacan A, Sahin D. Effect of maternal autoimmune diseases on fetal pulmonary artery Doppler indices: A case-control study. Echocardiography 2023; 40:96-102. [PMID: 36607145 DOI: 10.1111/echo.15525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To compare the fetal pulmonary artery Doppler indices of pregnant women with autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and antiphospholipid syndrome (APS) with healthy pregnant women. METHODS Thirty-nine pregnancies were included in the case group, 19 of them SLE, 12 with SS, and eight with APS. The gestational age-matched 54 healthy pregnant women were included in the control group. Peak systolic velocity, time-averaged velocity, systolic/diastolic ratio, pulsatility index, resistance index, acceleration time (AT), ejection time (ET), and AT/ET ratio were obtained from pulmonary artery waveform by using spectral Doppler ultrasound. RESULTS Significantly shorter AT and lower AT/ET ratio were detected in the case group (p = < .001, p = < .001, respectively). The shortening of AT and decreasing of the AT/ET ratio were more predominant in the APS group. However, there was no significant difference between the SLE, SS, and APS groups in fetal pulmonary artery Doppler indices. Also, a moderate correlation was found between maternal disease duration (years) and fetal pulmonary artery AT (r = -.516, p = .001) and AT/ET ratio (r = -.558, p = < .001). CONCLUSION Fetal pulmonary artery Doppler indices may be affected in maternal autoimmune diseases. Further studies are needed to evaluate fetal pulmonary Doppler indices such as AT and AT/ET ratio to predict neonatal respiratory morbidity and lung maturation in pregnant women with SLE, SS, and APS.
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Affiliation(s)
- Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Esra Gulen Yildiz
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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9
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Zhu YZ, Zhong JX, Dong LL. Menstrual and Reproductive Characteristics of Patients with Primary Sjogren's Syndrome: A 7-year Single-center Retrospective Study. Curr Med Sci 2023; 43:139-145. [PMID: 36542325 PMCID: PMC9768788 DOI: 10.1007/s11596-022-2675-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Primary Sjogren's syndrome (pSS) is a systemic autoimmune disease that mainly affects the exocrine gland, especially in women. Currently, the results of studies on the menstruation or fertility of pSS patients remain controversial. This study aimed to examine the menstrual and reproductive characteristics of pSS patients. METHODS Clinical data of 449 pSS patients who were admitted to Tongji Hospital in Hubei, China, from January 2015 to November 2021 were obtained and their menstrual and reproductive information analyzed. In addition, the clinical features of pSS patients with premenopausal or postmenopausal onset were compared. RESULTS The spontaneous abortion rate of pSS patients was not higher than the reported rate of the general population and that the age of menarche, menstrual cycle, and menstrual period of pSS patients did not significantly differ from those reported in the general population; however, early menopause seemed to be more common in pSS patients. Skin involvement (27.96% vs. 15.00%, P=0.005) and hyperglobulinemia (10.64% vs. 4.16%, P=0.033) were more common in patients with premenopausal pSS onset, but patients with postmenopausal onset had a significantly greater incidence of interstitial lung disease (32.50% vs. 17.02%, P=0.0004). Also, erythropenia (47.00% vs. 31.25%, P=0.002), hypoalbuminemia (19.49% vs. 8.22%, P=0.0009), and prevalence of high hypersensitive C-reactive protein levels (21.67% vs. 10.94%, P=0.005) were more common in pSS patients with postmenopausal onset. Notably, the rate of abnormal pregnancy was significantly greater in patients with premenopausal onset (9.72% vs. 2.50%, P=0.011). CONCLUSION Patients with pSS onset before or after menopause may have different risks in pulmonary involvement and laboratory manifestations.
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Affiliation(s)
- Ying-Zi Zhu
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ji-Xin Zhong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Ling-Li Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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10
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Rheumatic Diseases in Reproductive Age-the Possibilities and the Risks. Reprod Sci 2023; 30:111-123. [PMID: 35359225 DOI: 10.1007/s43032-022-00901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/20/2022] [Indexed: 01/11/2023]
Abstract
The most common systemic connective tissue diseases (CTD), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), systemic sclerosis (SSc), and Sjögren's syndrome (SjS), affect many women of reproductive age. These diseases may strongly impact the course of pregnancy and increase the risk factors of incompatibility. A literature search was done on MEDLINE, PubMed, and Google Scholar in 2011-2021. The analysis included meta-analysis, randomized control trials, prospective and retrospective studies, and systematic reviews. The literature search allowed us to form conclusions and underline recommendations regarding pregnancy's risk and treatment possibilities in the course of rheumatic disease. Optimal control of CTD activity should be reached at least 6 months before conception. High-risk pregnancies are often accompanied by maternal-placental syndrome, which manifests as preeclampsia, eclampsia, fetal growth restriction, and prematurity. The flare of rheumatic disease can coexist with obstetrical complications, and differential diagnosis can be difficult. Medications that do not influence the risk of fetus complications should be applied before and during pregnancy. Teratogenic drugs (e.g., methotrexate, leflunomide, cyclophosphamide) must be withdrawn before pregnancy. Conventional medications such as hydroxychloroquine, sulfasalazine, colchicine, and the TNFα inhibitor certolizumab can be used safely at any stage of pregnancy. Corticosteroids should be tapered, and other biologics should be avoided due to teratogenicity or carefully administered due to the impact on the fetal immune system. Distinguishing between disease flare and obstetrical complications can be difficult in clinical practice; however, some clinical symptoms and serological markers can be helpful in the differential diagnosis.
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11
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Barros T, Braga J, Abreu MI, Brandão M, Farinha F, Marinho A, Braga A. Sjögren's syndrome and pregnancy: a Portuguese case-control study. Reumatologia 2022; 60:311-317. [PMID: 36381208 PMCID: PMC9661414 DOI: 10.5114/reum.2022.120754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/03/2022] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Pregnancy in patients with autoimmune disorders is associated with an increased risk of adverse outcomes. Sjögren's syndrome (SS) is one of the most common among autoimmune diseases. Presently data regarding the impact of SS on obstetric outcomes are scarce and inconclusive. This study aims to evaluate the impact of SS on maternal-fetal and neonatal outcomes compared with pregnancy outcomes in the general population. MATERIAL AND METHODS A retrospective case-control study included 26 pregnancies in SS patients and a healthy control group (CG), followed in a Portuguese tertiary center, between 2015 and 2020. Baseline maternal data were collected, and maternal-fetal and neonatal outcomes were evaluated. Statistical analysis used SPSS 25.0, and a p-value of 0.05 was considered statistically significant. RESULTS All pregnancies occurred after the diagnosis of SS, with a mean exposure time between diagnosis and pregnancy of 4.92 ±2.78 years. In the SS group, the incidence of ANA, anti-Ro/SSA, and anti-La/SSB antibodies positivity was 80.8%, 61.5%, and 46.2%, respectively. Hydroxychloroquine (HCQ) was used in 57.7%.Miscarriage was significantly higher in the SS group (19.2% vs. 1.8%, p < 0.01). There was a higher prevalence of fetal growth restriction (OR 11.16, 95% CI: 0.96-129.26). Preterm delivery (9.5% vs. 5.6%, p = 0.503) and mean birth weight (2998.16 g vs. 3155.79 g, p = 0.178) did not differ significantly between the groups. In the SS group, admission to the neonatal intensive care unit (NICU) rate was increased (OR 71.67, 95% CI: 3.78-1357.16). Three pregnancies were complicated by congenital heart block (CHB) (14.3% vs. 0%, p = 0.015). In all cases, the diagnosis was performed during second trimester of pregnancy, and betamethasone was administered. CONCLUSIONS Women with SS had a significantly higher incidence of miscarriage, admission to NICU, and CHB than controls. Congenital heart block was the most critical condition that affects the offspring of mothers with SS. Successful pregnancy in the study group was possible with prenatal monitoring and a multidisciplinary approach.
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Affiliation(s)
- Tânia Barros
- Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Jorge Braga
- Maternal Fetal Unit, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Maria Inês Abreu
- Instituto Ciências Biomédicas Abel Salazar, University of Porto, Portugal
| | - Mariana Brandão
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - Fátima Farinha
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - António Marinho
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - António Braga
- Maternal Fetal Unit, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário do Porto, Portugal
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12
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Geng B, Zhang K, Huang X, Chen Y. A meta-analysis of the effect of Sjögren's syndrome on adverse pregnancy outcomes. Clinics (Sao Paulo) 2022; 77:100140. [PMID: 36403428 PMCID: PMC9678673 DOI: 10.1016/j.clinsp.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to assess the correlation between Sjögren's Syndrome (SS) and adverse pregnancy outcomes, with the aim of providing a basis for preconception and pregnancy interventions in women with SS. METHODS A search of electronic databases in English and Chinese databases from January 2005 to December 2021, was conducted to collect the literature of case-control studies or cohort studies on the association between SS and pregnancy outcome studies. Literature inclusion and data extraction were performed according to established criteria, and the Newcastle-Ottawa scale was used to evaluate the quality of the literature. Stata 15 software was used for meta-analysis. RESULTS A total of nine papers were included in this study. Meta-analysis results showed that SS was associated with spontaneous abortion (RR = 8.85, 95% CI 3.10‒25.26), preterm birth (RR = 2.27, 95% CI 1.46‒3.52), low birth mass (RR = 1.99, 95% CI 1.34‒2.97), and birth defects (RR = 4.28, 95% CI 3.08‒5.96). CONCLUSION SS can increase the incidence of adverse pregnancy outcomes.
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Affiliation(s)
- Baoqing Geng
- Department of Rheumatology and Immunology, Ningbo Huamei hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Keyue Zhang
- Department of Rheumatology and Immunology, Ningbo Huamei hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xianqian Huang
- Department of Rheumatology and Immunology, Ningbo Huamei hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Yong Chen
- Department of Rheumatology and Immunology, Ningbo Huamei hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
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13
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Fang X, Lu F, Wang Y, Guo L, Zhang Y, Bai S, Kwak-Kim J, Wu L. Anti-Ro/SSA and/or anti-La/SSB antibodies are associated with adverse IVF and pregnancy outcomes. J Reprod Immunol 2021; 149:103459. [PMID: 34929496 DOI: 10.1016/j.jri.2021.103459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/26/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Anti-Ro/SSA and/or anti-La/SSB antibodies (anti-SSA/SSB) were reported to increase the risk of recurrent pregnancy loss. However, the effects of anti-SSA/SSB antibodies on in-vitro fertilization (IVF) and pregnancy outcomes were still unclear. The purpose of the study was to determine whether anti-SSA/SSB antibodies were detrimental to IVF and pregnancy outcomes. This study included 55 anti-SSA/SSB antibodies-positive women and 61 anti-SSA/SSB antibodies-negative control women receiving gonadotropin-releasing hormone (GnRH) agonist long protocol (n = 30 and 39, respectively) or GnRH antagonist protocol (n = 25 and 22, respectively) for in-vitro fertilization and embryo transfer (IVF-ET). The impact of anti-SSA/SSB antibodies on immune-related indicators, fertilization, embryo development and pregnancy outcomes were analyzed. With either GnRH agonist or antagonist protocol, women with anti-SSA/SSB had higher levels of peripheral blood cytokines, including TNF-α and IL-17A, lower levels of peripheral blood Th and NK cells, and poor IVF outcomes, including lower number of retrieved oocytes and embryos, lower M II oocytes rate, blastocyst formation rate, and perfect and available embryo rates. Moreover, clinical pregnancy rate, implantation rate, take-home baby rate, and birth weight were significantly lower in the study group as compared with those of the control group. In conclusion, women with anti-SSA/SSB are associated with adverse IVF and pregnancy outcomes. Screening for these antibodies and proper counselling of couples undergoing IVF-ET should be considered. Underlying immunopathology associated with SSA/SSB antibodies and reproduction should be explored further.
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Affiliation(s)
- Xuhui Fang
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Fangting Lu
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yanshi Wang
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Lan Guo
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yu Zhang
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Shun Bai
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Joanne Kwak-Kim
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, 60061, USA; Center for Cancer Cell Biology, Immunology and Infection Diseases, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA.
| | - Li Wu
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.
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14
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Oliveira FR, Valim V, Pasoto SG, Fernandes MLMS, Lopes MLL, de Magalhães Souza Fialho SC, Pinheiro AC, Dos Santos LC, Appenzeller S, Fidelix T, Ribeiro SLE, de Brito DCSE, Libório T, Santos MCLFS, Tanure L, Gennari JDA, Civile VT, Pinto ACPN, Rocha-Filho CR, Miyamoto ST, Guedes LKN, Pugliesi A, Trevisani VFM. 2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren's syndrome. Adv Rheumatol 2021; 61:54. [PMID: 34479630 DOI: 10.1186/s42358-021-00208-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/03/2021] [Indexed: 12/29/2022] Open
Abstract
Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.
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Affiliation(s)
- Fabiola Reis Oliveira
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP), Av. Bandeirantes, 3900, Vila Monte Alegre, Ribeirão Preto, SP, CEP: 14049-900, Brazil
| | - Valeria Valim
- Serviço de Reumatologia, Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29075-910, Brazil
| | - Sandra Gofinet Pasoto
- Disciplina de Reumatologia, Laboratório de Autoimunidade (DLC + LIM17), Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP), R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, CEP: 05403-010, Brazil
| | | | - Maria Lucia Lemos Lopes
- Disciplina de Reumatologia Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA),, R. Sarmento Leite, 245 - Centro Histórico de Porto Alegre, Porto Alegre, RS, CEP: 90050-170, Brazil
| | | | - Aysa César Pinheiro
- Disciplina de Reumatologia, Departamento de Clínica Médica, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Laura Caldas Dos Santos
- Departamento de Oftalmologia, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 820, Vila Clementino, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Simone Appenzeller
- Departamento de Ortopedia, Reumatologia e Traumatologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, SP, CEP: 13083-887, Brazil
| | - Tania Fidelix
- Departamento de Oftalmologia, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 820, Vila Clementino, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Sandra Lucia Euzébio Ribeiro
- Disciplina de Reumatologia, Universidade Federal do Amazonas, Rua Afonso Pena, 1053, Manaus, AM, CEP: 69020-160, Brazil
| | - Danielle Christinne Soares Egypto de Brito
- Disciplina de Reumatologia, Departamento de Medicina Interna, Centro de Ciências Médicas, Universidade Federal de Paraíba (UFPB), Campus I - Lot. Cidade Universitária, Paraíba, PB, CEP: 58051-900, Brazil
| | - Tatiana Libório
- Disciplina de Reumatologia, Universidade Federal do Amazonas, Rua Afonso Pena, 1053, Manaus, AM, CEP: 69020-160, Brazil
| | - Maria Carmen Lopes Ferreira Silva Santos
- Departamento de Patologia, Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29075-910, Brazil
| | - Leandro Tanure
- Disciplina de Reumatologia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, CEP: 31270-901, Brazil
| | - Juliana DAgostino Gennari
- Serviço de Reumatologia da Santa Casa de São Paulo, R. Dr. Cesário Mota Júnior, 112, Vila Buarque, São Paulo, SP, CEP: 01221-020, Brazil
| | - Vinicius Tassoni Civile
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu 740 Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu 740 Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
| | - César Ramos Rocha-Filho
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu 740 Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
| | - Samira Tatiyama Miyamoto
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil
| | - Lissiane Karine Noronha Guedes
- Disciplina de Reumatologia, Laboratório de Autoimunidade (DLC + LIM17), Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP), R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, CEP: 05403-010, Brazil
| | - Alisson Pugliesi
- Departamento de Ortopedia, Reumatologia e Traumatologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, SP, CEP: 13083-887, Brazil.
| | - Virginia Fernandes Moça Trevisani
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu 740 Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil.,Disciplina de Reumatologia, Universidade de Santo Amaro, Rua Enéas Siqueira Neto, Jardim das Imbuias, São Paulo, SP, CEP: 04829-300, Brazil
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15
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Barrera MJ, Aguilera S, Castro I, Carvajal P, Jara D, Molina C, González S, González MJ. Dysfunctional mitochondria as critical players in the inflammation of autoimmune diseases: Potential role in Sjögren's syndrome. Autoimmun Rev 2021; 20:102867. [PMID: 34118452 DOI: 10.1016/j.autrev.2021.102867] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Relevant reviews highlight the association between dysfunctional mitochondria and inflammation, but few studies address the contribution of mitochondria and mitochondria-endoplasmic reticulum (ER) contact sites (MERCs) to cellular homeostasis and inflammatory signaling. The present review outlines the important role of mitochondria in cellular homeostasis and how dysfunctional mitochondrion can release and misplace mitochondrial components (cardiolipin, mitochondrial DNA (mtDNA), and mitochondrial formylated peptides) through multiple mechanisms. These components can act as damage-associated molecular patterns (DAMPs) and induce an inflammatory response via pattern recognition receptors (PRRs). Accumulation of damaged ROS-generating mitochondria, accompanied by the release of mitochondrial DAMPs, can activate PRRs such as the NLRP3 inflammasome, TLR9, cGAS/STING, and ZBP1. This process would explain the chronic inflammation that is observed in autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), type I diabetes (T1D), and Sjögren's syndrome. This review also provides a comprehensive overview of the importance of MERCs to mitochondrial function and morphology, cellular homeostasis, and the inflammatory response. MERCs play an important role in calcium homeostasis by mediating the transfer of calcium from the ER to the mitochondria and thereby facilitating the production of ATP. They also contribute to the synthesis and transfer of phospholipids, protein folding in the ER, mitochondrial fission, mitochondrial fusion, initiation of autophagosome formation, regulation of cell death/survival signaling, and regulation of immune responses. Therefore, alterations within MERCs could increase inflammatory signaling, modulate ER stress responses, cell homeostasis, and ultimately, the cell fate. This study shows severe ultrastructural alterations of mitochondria in salivary gland cells from Sjögren's syndrome patients for the first time, which could trigger alterations in cellular bioenergetics. This finding could explain symptoms such as fatigue and malfunction of the salivary glands in Sjögren's syndrome patients, which would contribute to the chronic inflammatory pathology of the disease. However, this is only a first step in solving this complex puzzle, and several other important factors such as changes in mitochondrial morphology, functionality, and their important contacts with other organelles require further in-depth study. Future work should focus on detecting the key milestones that are related to inflammation in patients with autoimmune diseases, such as Sjögren´s syndrome.
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Affiliation(s)
- María-José Barrera
- Facultad de Odontología, Universidad San Sebastián, Bellavista 7, Santiago, 8420524, Chile
| | | | - Isabel Castro
- Departamento de Tecnología Médica, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Patricia Carvajal
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Daniela Jara
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Claudio Molina
- Facultad de Odontología, Universidad San Sebastián, Bellavista 7, Santiago, 8420524, Chile
| | - Sergio González
- Escuela de Odontología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - María-Julieta González
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Meng L, Tan J, Du T, Lin X, Zhang S, Nie X, Xie H, Lin J, Zhang J, Hui C. The Effects of LIT and MLR-Bf on Immune Biomarkers and Pregnancy Outcomes in Women With Previous Early Recurrent Miscarriage: A Retrospective Study. Front Immunol 2021; 12:642120. [PMID: 34017330 PMCID: PMC8129162 DOI: 10.3389/fimmu.2021.642120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/22/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Immunological failure during pregnancy is considered one of the etiologies of recurrent miscarriage (RM). The decreased production of mixed lymphocyte reaction-blocking factors (MLR-Bf) may play a major role in this condition. Lymphocyte immunotherapy (LIT), which induces the production of MLR-Bf, has been used in treating RM patients since 1984. However, the effectiveness of LIT is currently being heatedly debated. In addition to that, possible changes to the maternal immune system upon induced MLR-Bf production by LIT remains unclear. Objectives: To explore the possible impacts that MLR-Bf may have on the expression of immune biomarkers and pregnancy outcomes, and deduce whether the prevention of miscarriages is possible with LIT or MLR-Bf in RM patients. Materials and Methods: Women with previous early RM (eRM) were enrolled in this retrospective study after they got pregnant again. LIT was implemented before pregnancy and during the first trimester. MLR-Bf and immune biomarkers were checked as the clinical routine. Patients were followed up until 12 gestational weeks. Levels of immune biomarkers and successful pregnancy rates were compared between MLR-Bf- group and MLR-Bf+ group stratified by LIT. Independent associations between LIT, or MLR-Bf, and miscarriage were estimated. All data management and analysis were conducted using SPSS 20.0. Results: A total of 1,038 patients, 497 MLR-Bf- (49 cases accepted LIT), and 541 MLR-Bf+(463 cases induced by LIT) were included in the study. Percentage of lymphocytes, the ratio of CD4+ T cells/lymphocytes, and levels of some rheumatoid biomarkers (anti-U1-nRNP, anti-SAA-52kd, and anti-CENOP B) were statistically higher in MLR-Bf+ group than in MLR-Bf- group among women without LIT. With LIT treatment the successful pregnancy rate was statistically higher in MLR-Bf+ group than in MLR-Bf- group (66.7% vs. 51.0%, P = 0.028) among women with LIT. Meanwhile, LIT was estimated to have an independent negative association with miscarriage. Conclusion: Upon LIT treament levels of immune biomarkers were different in women with and without MLR-Bf when stratified by whether they received LIT. Not MLR-Bf, but LIT, has an independent protective effect on miscarriage.
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Affiliation(s)
- Lili Meng
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianping Tan
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tao Du
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xianghua Lin
- Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuning Zhang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaolu Nie
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitian Xie
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jizong Lin
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianping Zhang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Hui
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Eisfeld H, Glimm AM, Burmester GR, Ohrndorf S, Backhaus M. Pregnancy outcome in women with different rheumatic diseases: a retrospective analysis. Scand J Rheumatol 2021; 50:299-306. [PMID: 33622159 DOI: 10.1080/03009742.2020.1849788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Pregnancy may influence the course of inflammatory rheumatic diseases and, conversely, rheumatic and musculoskeletal diseases (RMDs) can affect the outcome of pregnancy. This study aimed to retrospectively analyse the outcome of pregnancy and disease in women with RMDs.Method: Subjects were patients with high-risk pregnancy and connective tissue diseases (CTDs) or inflammatory joint diseases (IJDs) managed at a specialized rheumatology outpatient clinic from 2007 to 2014. Data from conception to 6 months postpartum were collected from medical records and a questionnaire, and analysed regarding clinical symptoms, medications, pregnancy complications, birth outcomes, and infant development. Generalized estimating equations were used to compare the groups (CTD vs IJD).Results: The eligible 66 pregnancies in 57 RMD patients were divided into two groups by RMD type: CTD (n = 48) or IJD (n = 18). The live birth rate was 97% overall. Pregnancy complications (excluding two twin pregnancies) were incurred in 39.1%: miscarriage (n = 2), premature delivery (n = 12), small-for-gestational-age infants (n = 5), and/or pregnancy-related diseases (n = 14). Three children born to women with CTDs had affected development (autism spectrum disorder, congenital heart disease, bronchopulmonary dysplasia). CTD infants had a significantly lower mean gestational age (in weeks) (p = 0.042), weight (p = 0.009), and length (p = 0.016) at birth than IJD infants.Conclusion: Although the live birth rate was high, complications occurred in 39.1% of pregnancies in this cohort. Therefore, interdisciplinary management of pregnant women with RMDs at specialized clinics is strongly recommended.
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Affiliation(s)
- H Eisfeld
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - A M Glimm
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany.,Department of Internal Medicine, Rheumatology and Clinical Immunology, Parkklinik Weißensee, Berlin, Germany
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Blanc J, Bodak N, Saada V, Zavaro A, Bagot M, Petit A, Bourrat E. [Polymorphism and differential diagnosis of neonatal lupus erythematosus]. Ann Dermatol Venereol 2020; 147:258-264. [PMID: 32171550 DOI: 10.1016/j.annder.2019.09.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 09/23/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Neonatal lupus erythematosus (NEL) is a rare condition secondary to transplacental transfer of maternal anti-nuclear antibodies, generally anti-Ro/SSA. The most common signs are dermatological and cardiac. The most frequently reported clinical association is periorbital erythema, known as "owl eye", and bipolar erythematous maculopapular plaques with fine scales. However, many semiological variants can result in diagnostic errors or delays. PATIENTS AND METHODS This was a single-centre retrospective observational study collating all cases of NEL seen at paediatric dermatology consultations between 2010 and 2018. The diagnosis of NEL was confirmed by the presence of specific antinuclear antibodies (ANA) in the mother. The aim was to describe the different clinical forms of NEL and to discuss differential diagnosis. RESULTS AND DISCUSSION We identified ten cases of NEL, all addressed without diagnosis or with misdiagnosis. They were divided into 3 groups based on the semiology of skin lesions: 5 presented inflammatory macular papules on the cephalic extremity and head; 3 presented acquired periorbital depigmentation; 2 presented atrophic and diffuse livedoid lesions. None had heart disease and associated haematological and hepatic damage was mild. Spontaneous remission was seen in all cases before the age of 6 months. The mothers, who were generally symptom-free or paucisymptomatic, presented anti-Ro/SSA NAAs. CONCLUSION Recognition of the different clinical forms of NEL enables early institution of suitable therapy and monitoring of subsequent pregnancies.
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Affiliation(s)
- J Blanc
- Service de dermatologie, hôpital Robert-Debré, 75019 Paris, France.
| | - N Bodak
- Service de dermatologie, hôpital Trousseau, 75012 Paris, France
| | - V Saada
- Service de dermatologie, hôpital St Louis, 75010 Paris, France
| | - A Zavaro
- Cabinet médical, 94170 Le-Perreux-sur-Marne, France
| | - M Bagot
- Service de dermatologie, hôpital St Louis, 75010 Paris, France
| | - A Petit
- Service de dermatologie, hôpital St Louis, 75010 Paris, France
| | - E Bourrat
- Service de dermatologie, hôpital Robert-Debré, 75019 Paris, France
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Sugawara E, Kato M, Fujieda Y, Oku K, Bohgaki T, Yasuda S, Umazume T, Morikawa M, Watari H, Atsumi T. Pregnancy outcomes in women with rheumatic diseases: a real-world observational study in Japan. Lupus 2019; 28:1407-1416. [PMID: 31551035 DOI: 10.1177/0961203319877258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We aimed to evaluate the obstetric complications and the risk factors for these events in pregnant women with rheumatic diseases (RDs). METHODS A single-center retrospective study of women with RDs at Hokkaido University Hospital between 2007 and 2016 was conducted. Clinical features and maternal and fetal outcomes were retrospectively collected. The rate of pregnancy complications was compared with the general obstetric population (GOP) in Japan. RESULTS Overall, 132 pregnancies in 95 women with RDs were recorded. Underlying RDs were systemic erythematosus (SLE) (n = 57), antiphospholipid syndrome (APS) (n = 35), rheumatoid arthritis (n = 9), and other RDs (n = 31). Antiphospholipid antibodies (aPL) were detected in 44 pregnancies (32%). Glucocorticoid was used in 82 pregnancies (62%), and tacrolimus in 20 pregnancies (15%). There were 24 disease flares (18%), but no RD-related death was documented. We recorded 112 live births, 6 abortions, 8 miscarriages, and 6 stillbirths. Pregnancies with RDs appeared to have frequent, emergency cesarean sections and preterm deliveries compared with GOP (30% vs 15% and 21% vs 14%, respectively). The median [interquartile range] birthweight in SLE and APS was lower than GOP (2591 [2231-2958] g and 2600 [2276-2920] g vs 2950 [2650-3250] g, respectively). In pregnancies with SLE, low complement levels presented the risk of maternal complications (odds ratio [95% CI]; 3.9 [1.0-14.9], p = 0.046) and anti-DNA antibody positivity was significantly correlated with the risk of fetal complications (3.5 [1.1-11.2], p = 0.036). In pregnancies with APS, maternal age over 35 years and duration of disease longer than 9 years (7.4 [1.3-40.8], p = 0.021, and 11.16 [1.1-118.8], p = 0.046, respectively) were significantly correlated with the risk of fetal complications. CONCLUSION Pregnancies with RDs were at increased risk of having both maternal complications and adverse neonatal outcomes, indicating these pregnancies should be closely monitored.
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Affiliation(s)
- E Sugawara
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - M Kato
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - Y Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - T Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - T Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
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20
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Elliott B, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Effect of Sjögren's syndrome on maternal and neonatal outcomes of pregnancy. J Perinat Med 2019; 47:637-642. [PMID: 31287800 DOI: 10.1515/jpm-2019-0034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022]
Abstract
Background Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34-1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04-1.57); preterm delivery (OR 1.56, 95% CI 1.34-1.81); cesarean delivery (OR 1.29, 95% CI 1.17-1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57-5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46-3.65); and congenital malformations (OR 3.26, 95% CI 2.30-4.62). Conclusion SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies.
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Affiliation(s)
- Brittney Elliott
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
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De Carolis S, Moresi S, Rizzo F, Monteleone G, Tabacco S, Salvi S, Garufi C, Lanzone A. Autoimmunity in obstetrics and autoimmune diseases in pregnancy. Best Pract Res Clin Obstet Gynaecol 2019; 60:66-76. [PMID: 31133364 DOI: 10.1016/j.bpobgyn.2019.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/01/2019] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases (AIDs) are associated with strong female preponderance and often present before or during the reproductive years; consequently, pregnancy and breastfeeding are topics of major interest for these patients. AIDs show different responses to pregnancy: some ameliorate, while others remain unchanged, and several AIDs aggravate. The response of the AIDs to the hormonal and immunological alterations of pregnancy reflects the different pathophysiology of each disease. Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are associated with multiple autoantibodies, multiorgan involvement, more aggressive therapy, and increased impact on pregnancy outcome. For the management of pregnancy in patients with SLE and/or APS, it is important to individuate the correct risk profile for each woman and timing for treatment. The optimal timing for starting or modulating treatment is at preconception assessment to influence the placentation. In this chapter, we discuss the management of pregnancy in patients with AIDs.
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Affiliation(s)
- Sara De Carolis
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sascia Moresi
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesca Rizzo
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppina Monteleone
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Sara Tabacco
- Department of Gynecological and Obstetric Sciences and Urological Sciences, Sapienza Università di Roma, Umberto I Hospital, Rome, Italy
| | - Silvia Salvi
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - Cristina Garufi
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Umberto I Hospital, Rome, Italy
| | - Antonio Lanzone
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy
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23
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Arese V, Murabito P, Ribero S, Panzone M, Tonella L, Fierro MT, Papini M, Quaglino P. Autoimmune connective tissue diseases and pregnancy. GIORN ITAL DERMAT V 2019; 154:263-276. [PMID: 30650958 DOI: 10.23736/s0392-0488.18.06252-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autoimmune connective tissue-diseases are more frequent in women and deserve a multidisciplinary approach in which the dermatologist play a major role together with other physicians. Pregnancy in these patients has to be considered a high-risk situation, because of possible worsening of the mother's disease and increased morbility and mortality for the fetus; also, therapies have to be chosen carefully because some drugs cannot be used during pregnancy. For all these reasons, the decision to become pregnant needs to consider the type of disease, stage of disease, age and clinical condition, and requires a multidisciplinary approach. A correct counselling, a close monitoring, a specific approach based on the risks involved and the use of appropriate therapies are the keys to obtain optimal pregnancy outcomes.
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Affiliation(s)
- Veronica Arese
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Pierangela Murabito
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Michele Panzone
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Luca Tonella
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Maria T Fierro
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Manuela Papini
- Department of Surgical and Biomedical Sciences, Dermatologic Clinic of Terni, University of Perugia, Perugia, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy -
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Demarchi J, Papasidero SB, Klajn D, Alba P, Babini AM, Durigan V, Gobbi C, Raiti L. Primary Sjögren's syndrome and pregnancy: A report of 18 cases. ACTA ACUST UNITED AC 2017; 15:109-112. [PMID: 28844688 DOI: 10.1016/j.reuma.2017.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/06/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Abstract
Primary Sjögren's syndrome (pSS) is a condition that predominantly affects women. Reports of pregnancy outcome in these patients are limited and contradictory. OBJECTIVE To describe pregnancy characteristics and outcomes and newborn morbidity in women with pSS. MATERIAL AND METHODS We included women with pSS who became pregnant after the onset of the symptoms of the disease. Clinical and serological characteristics, risk factors and previous maternal comorbidities are described. For each pregnancy in a woman with pSS, we recorded pregnancy course and outcome and newborn condition. RESULTS We assessed 11 patients with 18 pregnancies after the onset of pSS symptoms. All of them presented FAN +; 10 anti-Ro / SSA + and 7 anti-La / SSB +. The mean age in years at the onset of symptoms was 24.9 (SD 6.9) and at the time of pregnancy was 30.3 (SD 5.4). Thirteen pregnancies happened before the diagnosis, reporting only one miscarriage. Two preterm births, 1 case of oligohydramnios, 2 of premature membrane rupture and 2 low birthweight babies were reported after the onset of pSS symptoms. There was 1 newborn with congenital atrioventricular block and another with neonatal cutaneous lupus. All the women with pregnancy complications (n=6) had anti-Ro/SSA antibodies. CONCLUSIONS Almost half of the pregnancies assessed in women with pSS were associated with complications not attributable to factors other than the disease.
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Affiliation(s)
- Julia Demarchi
- Servicio de Reumatología, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Silvia B Papasidero
- Servicio de Reumatología, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Diana Klajn
- Servicio de Reumatología, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Paula Alba
- Hospital Córdoba, Hospital Materno Neonatal Córdoba, Cátedra de Medicina I UHMN 3 UNC, Córdoba, Argentina
| | | | - Virginia Durigan
- Hospital Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
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Neonatal lupus: Follow-up in infants with anti -SSA/Ro antibodies and review of the literature. Autoimmun Rev 2017; 16:427-432. [DOI: 10.1016/j.autrev.2017.02.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/12/2017] [Indexed: 11/20/2022]
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Martínez-Sánchez N, Pérez-Pinto S, Robles-Marhuenda Á, Arnalich-Fernández F, Martín Cameán M, Hueso Zalvide E, Bartha JL. Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women: a prospective cohort study. Immunol Res 2017; 65:487-494. [DOI: 10.1007/s12026-016-8888-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
OBJECTIVES Autoimmune diseases do not impair fertility, and women with autoimmune diseases who become pregnant are likely to experience more complicated pregnancies than are women without the disease. Pregnancies complicated by these disorders have a high clinical impact on both the pregnancy and the disease. The effect of autoimmune disease on pregnancy differs according to the type of maternal disease, disease activity, severity of organ damage, antibody profile, and drug treatment. Sjögren syndrome is an autoimmune disease with a high prevalence of anti-SS-A (anti-Ro) and anti-SS-B (anti-La) antibodies. Anti-SS-A antibodies are associated with congenital heart block. Data on pregnancy outcomes in primary Sjögren syndrome are scarce. METHODS We performed a review of the literature regarding pregnancy outcomes in women with Sjögren syndrome. RESULTS Women with Sjögren syndrome are likely to experience more complications during pregnancy than women without an autoimmune disease. Studies show a high incidence of poor fetal outcomes for these patients. CONCLUSION Women with Sjögren syndrome require prenatal counseling explaining the risks involved and the need to control the disease well before conception. High-risk pregnancies can be optimally managed by a multidisciplinary team.
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Affiliation(s)
- Suruchi Gupta
- Medical Officer in the Department of Obstetrics and Gynecology at the Vardhman Mahavir Medical College and Safdarjung Hospital in Delhi, New Delhi, India.
| | - Nikhil Gupta
- Fellow in Clinical Immunology & Rheumatology at the Christian Medical College in Vellore, India.
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Sung N, Byeon H, Garcia MS, Skariah A, Wu L, Dambaeva S, Beaman K, Gilman-Sachs A, Kwak-Kim J. Deficiency in memory B cell compartment in a patient with infertility and recurrent pregnancy losses. J Reprod Immunol 2016; 118:70-75. [DOI: 10.1016/j.jri.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 01/08/2023]
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Huang N, Yu Y, Qiao J. Dual role for the unfolded protein response in the ovary: adaption and apoptosis. Protein Cell 2016; 8:14-24. [PMID: 27638465 PMCID: PMC5233609 DOI: 10.1007/s13238-016-0312-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
The endoplasmic reticulum (ER) is the principal organelle responsible for several specific cellular functions including synthesis and folding of secretory or membrane proteins, lipid metabolism, and Ca2+ storage. Different physiological as well as pathological stress conditions can, however, perturb ER homeostasis, giving rise to an accumulation of unfolded or misfolded proteins in the ER lumen, a condition termed ER stress. To deal with an increased folding demand, cells activate the unfolded protein response (UPR), which is initially protective but can become detrimental if ER stress is severe and prolonged. Accumulating evidence demonstrates a link between the UPR and ovarian development and function, including follicular growth and maturation, follicular atresia, and corpus luteum biogenesis. Additionally, ER stress and the UPR may also play an important role in the ovary under pathological conditions. Understanding the molecular mechanisms related to the dual role of unfolded protein response in the ovarian physiology and pathology may reveal the pathogenesis of some reproductive endocrine diseases and provide a new guidance to improve the assisted reproductive technology. Here we review the current literature and discuss concepts and progress in understanding the UPR, and we also analyze the role of ER stress and the UPR in the ovary.
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Affiliation(s)
- Ning Huang
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Yang Yu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
| | - Jie Qiao
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
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Abstract
Our PubMed search for peer-reviewed articles published in the 2014 solar year retrieved a significantly higher number of hits compared to 2013 with a net 28 % increase. Importantly, full articles related to autoimmunity constitute approximately 5 % of immunology articles. We confirm that our understanding of autoimmunity is becoming a translational paradigm with pathogenetic elements rapidly followed by new treatment options. Furthermore, numerous clinical and pathogenetic elements and features are shared among autoimmune diseases, and this is well illustrated in the recent literature. More specifically, the past year witnessed critical revisions of our understanding and management of antiphospholipid syndrome with new exciting data on the pathogenicity of the serum anti-beta2 glycoprotein autoantibody, a better understanding of the current and new treatments for rheumatoid arthritis, and new position papers on important clinical questions such as vaccinations in patients with autoimmune disease, comorbidities, or new classification criteria. Furthermore, data confirming the important connections between innate immunity and autoimmunity via toll-like receptors or the critical role of T regulatory cells in tolerance breakdown and autoimmunity perpetuation were also reported. Lastly, genetic and epigenetic data were provided to confirm that the mosaic of autoimmunity warrants a susceptible individual background which may be geographically determined and contribute to the geoepidemiology of diseases. The 2014 literature in the autoimmunity world should be cumulatively regarded as part of an annus mirabilis in which, on a different level, the 2014 Annual Meeting of the American College of Rheumatology in Boston was attended by over 16,000 participants with over selected 3000 abstracts.
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Affiliation(s)
- Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, via A. Manzoni 56, 20089 Rozzano, Milan, Italy. .,BIOMETRA Department, University of Milan, Milan, Italy.
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31
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Kim NE, Lee JH, Chung IS, Lee JY. Anesthetic management of patient with Sjogren's syndrome who underwent cesarean section: a case report. Korean J Anesthesiol 2016; 69:283-6. [PMID: 27274376 PMCID: PMC4891543 DOI: 10.4097/kjae.2016.69.3.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/23/2015] [Accepted: 03/16/2015] [Indexed: 11/29/2022] Open
Abstract
Sjogren's syndrome is one of the most common autoimmune disorders and has a female predominance. Maternal circulating autoantibodies such as anti-Ro/SSA and anti-La/SSB antibodies can cause congenital heart block of fetus, and in severe case, emergency pacemaker implantation may be needed for neonate. Therefore, it is very important to understand maternal and fetal condition and pay attention to the status of the neonate during delivery. In this paper, we present a case of patient with Sjogren's syndrome who underwent cesarean section under spinal anesthesia.
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Affiliation(s)
- Na Eun Kim
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea
| | - Jae Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea
| | - Jun Yong Lee
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea
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32
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Upala S, Yong WC, Sanguankeo A. Association between primary Sjögren’s syndrome and pregnancy complications: a systematic review and meta-analysis. Clin Rheumatol 2016; 35:1949-1955. [DOI: 10.1007/s10067-016-3323-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 01/11/2023]
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33
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Ballester C, Grobost V, Roblot P, Pourrat O, Pierre F, Laurichesse-Delmas H, Gallot D, Aubard Y, Bezanahary H, Fauchais AL. Pregnancy and primary Sjögren’s syndrome: management and outcomes in a multicentre retrospective study of 54 pregnancies. Scand J Rheumatol 2016; 46:56-63. [DOI: 10.3109/03009742.2016.1158312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- C Ballester
- Department of Obstetrics, Limoges University Hospital, Limoges, France
| | - V Grobost
- Department of Internal Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - P Roblot
- Department of Internal Medicine, Poitiers University Hospital, Poitiers, France
| | - O Pourrat
- Department of Internal Medicine, Poitiers University Hospital, Poitiers, France
| | - F Pierre
- Department of Obstetrics, Poitiers University Hospital, Poitiers, France
| | - H Laurichesse-Delmas
- Department of Obstetrics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - D Gallot
- Department of Obstetrics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Y Aubard
- Department of Obstetrics, Limoges University Hospital, Limoges, France
| | - H Bezanahary
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - A-L Fauchais
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
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34
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Mekinian A, Cohen J, Alijotas-Reig J, Carbillon L, Nicaise-Roland P, Kayem G, Daraï E, Fain O, Bornes M. Unexplained Recurrent Miscarriage and Recurrent Implantation Failure: Is There a Place for Immunomodulation? Am J Reprod Immunol 2016; 76:8-28. [DOI: 10.1111/aji.12493] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/02/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Arsène Mekinian
- AP-HP; Hôpital Saint-Antoine; Service de Médecine Interne and Inflammation-(DHU i2B); Paris France
| | - Jonathan Cohen
- AP-HP; Hôpital Tenon; Service d'Obstétrique et de Procréation Médicalement Assistée; Paris France
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit; Department of Internal Medicine I; Vall d'Hebrón University Hospital; Universitat Autonoma de Barcelona; Barcelona Spain
| | - Lionel Carbillon
- AP-HP; Hôpital Jean Verdier; Service d'Obstétrique; Bondy France
| | | | - Gilles Kayem
- AP-HP; Hôpital Trousseau; Service d'Obstétrique; Paris France
| | - Emile Daraï
- AP-HP; Hôpital Tenon; Service d'Obstétrique et de Procréation Médicalement Assistée; Paris France
| | - Olivier Fain
- AP-HP; Hôpital Saint-Antoine; Service de Médecine Interne and Inflammation-(DHU i2B); Paris France
| | - Marie Bornes
- AP-HP; Hôpital Tenon; Service d'Obstétrique et de Procréation Médicalement Assistée; Paris France
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35
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Sun Y, Haapanen K, Li B, Zhang W, Van de Water J, Gershwin ME. Women and primary biliary cirrhosis. Clin Rev Allergy Immunol 2016; 48:285-300. [PMID: 25241227 DOI: 10.1007/s12016-014-8449-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary biliary cirrhosis occurs more frequently in women, and previous studies indicated that the average age of primary biliary cirrhosis (PBC) onset makes pregnancy in PBC patients uncommon. However, more recently, improved diagnostic testing has enabled detection of PBC in younger women, including those of childbearing age. This has led investigators to become increasingly interested in the relationship between the ontogeny of PBC and pregnancy. Published cases indicate that the typical age for pregnant women to be diagnosed with PBC is in the early 30s, and that during gestation, pruritus and jaundice are the most common symptoms. During gestation, susceptible women may experience onset of PBC resulting from the drastic changes in female hormones; this would include not only the mitochondrial damage due to accumulation of bile acids but also changes in the immune response during the different stages of pregnancy that might play an important role in the breakdown of self-tolerance. The mechanisms underlying the potential relationship between PBC and pregnancy warrant further investigation. For women first diagnosed with PBC during gestation, or those for whom first appearance of a flare up occurs during and postpartum, investigation of the immune response throughout gestation could provide new avenues for immunologic therapeutic intervention and the discovery of new treatment strategies for PBC.
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Affiliation(s)
- Ying Sun
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
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36
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Chen JS, Roberts CL, Simpson JM, March LM. Pregnancy Outcomes in Women With Rare Autoimmune Diseases. Arthritis Rheumatol 2015; 67:3314-23. [DOI: 10.1002/art.39311] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Christine L. Roberts
- Kolling Institute of Medical Research and The University of Sydney, Sydney; New South Wales Australia
| | | | - Lyn M. March
- Kolling Institute of Medical Research and The University of Sydney, Sydney; New South Wales Australia
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37
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Skog A, Lagnefeldt L, Conner P, Wahren-Herlenius M, Sonesson SE. Outcome in 212 anti-Ro/SSA-positive pregnancies and population-based incidence of congenital heart block. Acta Obstet Gynecol Scand 2015; 95:98-105. [DOI: 10.1111/aogs.12785] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/17/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Amanda Skog
- Unit of Experimental Rheumatology; Department of Medicine; Karolinska Institute; Stockholm Sweden
| | - Linda Lagnefeldt
- Pediatric Cardiology Unit; Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Peter Conner
- Division of Obstetrics and Gynecology; Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Marie Wahren-Herlenius
- Unit of Experimental Rheumatology; Department of Medicine; Karolinska Institute; Stockholm Sweden
| | - Sven-Erik Sonesson
- Pediatric Cardiology Unit; Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
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38
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The 2014 ACR annual meeting: a bird’s eye view of autoimmunity in 2015. Autoimmun Rev 2015; 14:622-32. [DOI: 10.1016/j.autrev.2015.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/12/2015] [Indexed: 12/14/2022]
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39
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Rival C, Setiady Y, Samy ET, Harakal J, Tung KSK. The unique neonatal NK cells: a critical component required for neonatal autoimmune disease induction by maternal autoantibody. Front Immunol 2014; 5:242. [PMID: 24904590 PMCID: PMC4035566 DOI: 10.3389/fimmu.2014.00242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/09/2014] [Indexed: 11/13/2022] Open
Abstract
Human maternal autoantibodies can trigger autoimmune diseases such as congenital heart block (CHB) in the progeny of women with lupus or Sjogren’s disease. The pathogenic effect of early autoantibody (autoAb) exposure has been investigated in a murine neonatal autoimmune ovarian disease (nAOD) model triggered by a unique ZP3 antibody. Although immune complexes (IC) are formed in adult and neonatal ovaries, ZP3 antibody triggers severe nAOD only in <7-day-old neonatal mice. Propensity to nAOD is due to the uniquely hyper-responsive neonatal natural killer (NK) cells that lack the inhibitory Ly49C/I receptors. In nAOD, the neonatal NK cells directly mediate ovarian inflammation and oocyte depletion while simultaneously promoting de novo pathogenic ovarian-specific T cell responses. Resistance to nAOD in older mice results from the emergence of the Ly49C/I+ NK cells that regulate effector NK cells and from CD25+ regulatory T cell control. In preliminary studies, FcγRIII+ NK cells as well as the ovarian resident FcγRIII+ macrophages and/or dendritic cells were found to be as indispensable players. Activated by ovarian IC, they migrate to lymphoid organs where NK cell priming occurs. Remarkably, the findings in nAOD are very similar to those reported for neonatal responses to a retrovirus and its cognate antibody that lead to long-lasting immunity. Studies on nAOD therefore provide insights into maternal autoAb-mediated neonatal autoimmunity, including CHB, while simultaneously uncovering new properties of the neonatal innate and adaptive responses, lethality of premature infant infection, and novel neonatal antiviral vaccine design.
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Affiliation(s)
- Claudia Rival
- Departments of Pathology and Microbiology, Beirne Carter Center for Immunology Research, University of Virginia , Charlottesville, VA , USA
| | | | - Eileen T Samy
- EMD Serono Research Institute, Inc. , Billerica, MA , USA
| | - Jessica Harakal
- Departments of Pathology and Microbiology, Beirne Carter Center for Immunology Research, University of Virginia , Charlottesville, VA , USA
| | - Kenneth S K Tung
- Departments of Pathology and Microbiology, Beirne Carter Center for Immunology Research, University of Virginia , Charlottesville, VA , USA
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40
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Efe C, Kahramanoğlu-Aksoy E, Yilmaz B, Ozseker B, Takci S, Roach EC, Purnak T, Kav T, Ozaslan E, Wahlin S. Pregnancy in women with primary biliary cirrhosis. Autoimmun Rev 2014; 13:931-5. [PMID: 24879082 DOI: 10.1016/j.autrev.2014.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Primary biliary cirrhosis (PBC) may present in all decades of life, also in childbearing age. Data on maternal and fetal outcome is limited. We aimed to investigate the impact of pregnancy and childbirth on the disease course and possible effects of PBC on fetal outcome. METHODS Retrospective study of local cases and a compact review of published reports between 1950 and 2014. RESULTS Our cases along with literature review provided 98 pregnancies in 72 PBC patients. PBC was diagnosed during pregnancy in 26 (36%) patients and 46 (64%) had the diagnosis before conception. Twenty-four (30%) of the pregnancies were associated with biochemical flares and 55 (70%) with clinical improvement or stabilization. De novo onset or worsening of pruritus was seen in 49% (45/92). No maternal deaths were reported. Post-partum disease activation was observed in 60% (53/88). One patient was referred for liver transplantation after delivery. A miscarriage rate of 24% and three stillbirths were reported. Most patients were treated with ursodeoxycholic acid (UDCA) during breastfeeding and 12 patients also received UDCA during the first trimester without any identified side effects. CONCLUSION Most women with PBC maintain a stable disease during pregnancy, but post-partum biochemical flares are common. Symptomatic pruritus may be challenging in pregnant PBC patients. UDCA appears to be safe during pregnancy and breastfeeding. A successful pregnancy outcome is a realistic expectation for women with PBC.
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Affiliation(s)
- Cumali Efe
- Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
| | | | - Bülent Yilmaz
- Department of Gastroenterology, Hacettepe University, Ankara, Turkey
| | - Burak Ozseker
- Department of Gastroenterology, Hacettepe University, Ankara, Turkey
| | - Sahin Takci
- Department of Neonatology, Gaziosmanpaşa University, Tokat, Turkey
| | | | - Tugrul Purnak
- Department of Gastroenterology, Hacettepe University, Ankara, Turkey
| | - Taylan Kav
- Department of Gastroenterology, Hacettepe University, Ankara, Turkey
| | - Ersan Ozaslan
- Department of Gastroenterology, Numune Research and Education Hospital, Ankara, Turkey
| | - Staffan Wahlin
- Department of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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41
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Burbelo PD, Ambatipudi K, Alevizos I. Genome-wide association studies in Sjögren's syndrome: What do the genes tell us about disease pathogenesis? Autoimmun Rev 2014; 13:756-61. [PMID: 24657515 DOI: 10.1016/j.autrev.2014.02.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 12/14/2022]
Abstract
The pathogenesis of Sjögren's syndrome (SS) likely involves complex interactions between genes and the environment. While the candidate gene approach has been previously used to identify several genes associated with SS, two recent large-scale genome-wide association studies (GWAS) have implicated many more loci as genetic risk factors. Of particular relevance, was the significant association of SS with additional immune-related genes including IL12A, BLK, and CXCR5. GWAS has also uncovered other loci and suggestive gene associations in SS, but none are related to genes encoding salivary or lacrimal components, secretion machinery and neuronal proteins involved in innervations of the glands, respectively. In this review, we discuss these genetic findings with particular attention paid to the genes identified, the strength of associations, and how the SS-associated genes compare to what has been discovered previously in systemic lupus erythematosus (SLE). We also summarize the potential impact of these associated gene products on NFκB and immune pathways and describe how this new information might be integrated further for identifying clinical subsets and understanding the pathogenesis of SS.
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Affiliation(s)
- Peter D Burbelo
- Dental Clinical Research Core, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
| | - Kiran Ambatipudi
- Secretory Mechanisms and Dysfunction Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Ilias Alevizos
- Sjögren Syndrome Clinic, Molecular Physiology and Therapeutics Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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42
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Goules AV, Tzioufas AG, Moutsopoulos HM. Classification criteria of Sjögren's syndrome. J Autoimmun 2014; 48-49:42-5. [PMID: 24456935 DOI: 10.1016/j.jaut.2014.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 11/15/2022]
Abstract
Sjögren's syndrome (SS) is a chronic, systemic autoimmune disease that affects typically the exocrine glands causing mucosal dryness. Dry eyes and mouth are considered by far the most common and early symptoms of the disease but systemic complications may also occur. In 1993, the preliminary European criteria were proposed and widely accepted, consisting of both subjective and objective criteria. Almost ten years later, these classification criteria were revised by introducing more stringent rules and precise diagnostic procedures leading to the currently used American-European Consensus Group (AECG) criteria. The AECG criteria have been largely employed to conduct epidemiologic and clinical studies of patients with SS and proved to be more specific compared to the preliminary European criteria. The recent American College of Rheumatology/Sjögren's International Collaborative Clinical Alliance (ACR/SICCA) criteria that are based exclusively on objective tests, the stringency of the AECG criteria and the potential therapeutic use of biologic agents in SS clearly set the need for new classification criteria. Whether the new diagnostic approach will further encompass subclinical and early forms of the disease remains to be addressed by the scientific community.
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Affiliation(s)
- Andreas V Goules
- Department of Pathophysiology, School of Medicine, University of Athens, Mikras Asias Str 75, 115 27 Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, University of Athens, Mikras Asias Str 75, 115 27 Athens, Greece
| | - Haralampos M Moutsopoulos
- Department of Pathophysiology, School of Medicine, University of Athens, Mikras Asias Str 75, 115 27 Athens, Greece.
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