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Cuneo BF, Buyon JP, Sammaritano L, Jaeggi E, Arya B, Behrendt N, Carvalho J, Cohen J, Cumbermack K, DeVore G, Doan T, Donofrio MT, Freud L, Galan HL, Gropler MRF, Haxel C, Hornberger LK, Howley LW, Izmirly P, Killen SS, Kaplinski M, Krishnan A, Lavasseur S, Lindblade C, Matta J, Makhoul M, Miller J, Morris S, Paul E, Perrone E, Phoon C, Pinto N, Rychik J, Satou G, Saxena A, Sklansky M, Stranic J, Strasburger JF, Srivastava S, Srinivasan S, Tacy T, Tworetzky W, Uzun O, Yagel S, Zaretsky MV, Moon-Grady AJ. Knowledge is power: regarding SMFM Consult Series #64: Systemic lupus erythematosus in pregnancy. Am J Obstet Gynecol 2023; 229:361-363. [PMID: 37394327 DOI: 10.1016/j.ajog.2023.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Bettina F Cuneo
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO.
| | - Jill P Buyon
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | | | | | - Bhawna Arya
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Nicholas Behrendt
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO
| | - Julene Carvalho
- Royal College of Obstetrics and Gynecology, Royal Brompton Hospital, London, United Kingdom
| | - Jennifer Cohen
- Icahn School of Medicine, Mt Sinai Hospital, New York, NY
| | - Kristopher Cumbermack
- University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, KY
| | - Greggory DeVore
- David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA
| | - Tam Doan
- Baylor University College of Medicine, Texas Children's Hospital, Houston, TX
| | - Mary T Donofrio
- George Washington School of Medicine, Children's National Hospital, Washington, DC
| | | | - Henry L Galan
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO
| | - Melanie R F Gropler
- Case Western Reserve School of Medicine, University Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Caitlin Haxel
- University of Vermont School of Medicine, University of Vermont Medical Center, Burlington, VT
| | - Lisa K Hornberger
- Stollery Children's Hospital, University of Alberta Medical School, Edmonton, Alberta, Canada
| | | | - Peter Izmirly
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | - Stacy S Killen
- Vanderbilt University Medical School, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Michelle Kaplinski
- Stanford University Medical School, Lucille Packard Children's Hospital, Palo Alto, CA
| | - Anita Krishnan
- George Washington School of Medicine, Children's National Hospital, Washington, DC
| | - Stephanie Lavasseur
- New York-Presbyterian Medical School, Morgan Stanley Children's Hospital, New York, NY
| | | | - Jyothi Matta
- University of Kentucky School of Medicine, Norton Children's Hospital, Louisville, KY
| | | | - Jena Miller
- Johns Hopkins School of Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Shaine Morris
- Baylor University College of Medicine, Texas Children's Hospital, Houston, TX
| | - Erin Paul
- Icahn School of Medicine, Mt Sinai Hospital, New York, NY
| | - Erin Perrone
- University of Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Colin Phoon
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | - Nelangi Pinto
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Jack Rychik
- University of Pennsylvania Medical School, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gary Satou
- David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA
| | - Amit Saxena
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | - Mark Sklansky
- David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA
| | - James Stranic
- Case Western Reserve School of Medicine, University Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | | | - Sharda Srinivasan
- University of Wisconsin School of Medicine, American Children's Hospital, Madison, WI
| | - Theresa Tacy
- Stanford University Medical School, Lucille Packard Children's Hospital, Palo Alto, CA
| | - Wayne Tworetzky
- Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Orhan Uzun
- University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Simcha Yagel
- Hadassah Medical School, Hadassah-Hebrew Medical Center, Jerusalem, Israel
| | - Michael V Zaretsky
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO
| | - Anita J Moon-Grady
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, CA
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Schreiber K, Giles I, Costedoat-Chalumeau N, Nelson-Piercy C, Dolhain RJ, Mosca M, Förger F, Fischer-Betz R, Molto A, Tincani A, Pasquier E, Marin B, Elefant E, Salmon J, Bermas BL, Sammaritano L, Clowse MEB, Chambers C, Buyon J, Inoue SA, Agmon-Levin N, Aguilera S, Emadi SA, Andersen J, Andrade D, Antovic A, Arnaud L, Christiansen AA, Avcin T, Badreh-Wirström S, Bertsias G, Bini I, Bobirca A, Branch W, Brucato A, Bultink I, Capela S, Cecchi I, Cervera R, Chighizola C, Cobilinschi C, Cuadrado MJ, Dey D, Etomi O, Espinosa G, Flint J, Fonseca JE, Fritsch-Stork R, Gerosa M, Glintborg B, Skorpen CG, Goulden B, Graversgaard C, Gunnarsson I, Gupta L, Hetland M, Hodson K, Hunt BJ, Isenberg D, Jacobsen S, Khamashta M, Levy R, Linde L, Lykke J, Meissner Y, Moore L, Morand E, Navarra S, Opris-Belinski D, Østensen M, Ozawa H, Perez-Garcia LF, Petri M, Pons-Estel GJ, Radin M, Raio L, Rottenstreich A, Ruiz-Irastorza G, Tunjić SR, Rygg M, Sciascia S, Strangfeld A, Svenungsson E, Tektonidou M, Troldborg A, Vinet E, Vojinovic J, Voss A, Wallenius M, Andreoli L. Global comment on the use of hydroxychloroquine during the periconception period and pregnancy in women with autoimmune diseases. Lancet Rheumatol 2023; 5:e501-e506. [PMID: 38251494 DOI: 10.1016/s2665-9913(23)00215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Karen Schreiber
- Danish Centre for Expertise in Rheumatology (CeViG), Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark (KS); Institute for Regional Health, Southern Danish University, Odense, Denmark.
| | - Ian Giles
- Centre for Rheumatology, UCL Division of Medicine, London, UK
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France; Université Paris Cité, Paris, France
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK (CN-P, OE)
| | - Radboud Jem Dolhain
- Erasmus MC, University Medical Centre, Department of Rheumatology, Rotterdam, Netherlands
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Frauke Förger
- Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland
| | - Rebecca Fischer-Betz
- Department for Rheumatology and Hiller Research Institute, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Molto
- Rheumatology Department, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University, Brescia, Italy
| | - Elisabeth Pasquier
- Département de Médecine Interne et Pneumologie, CHRU de Brest, Hôpital de la Cavale Blanche, Brest, France; INSERM, Centre d'Investigation Clinique 1412, CHRU de Brest, Brest, France
| | - Benoit Marin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes, F75012, Paris, France
| | - Elisabeth Elefant
- AP-HP, Sorbonne Université, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes, F75012, Paris, France
| | - Jane Salmon
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York, USA
| | | | - Lisa Sammaritano
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Megan E B Clowse
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina Chambers
- Department of Paediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Jill Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Saori Abe Inoue
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Nancy Agmon-Levin
- The Zabludowicz Centre for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Danieli Andrade
- Rheumatology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Aleksandra Antovic
- Department of Medicine, Division of Rheumatology Karolinska Institutet and Rheumatology, Karolinska University Hospital Stockholm, Sweden
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Références Maladies Auto-Immunes, Strasbourg, France
| | - Alice Ashouri Christiansen
- Danish Center for Expertise in Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Badreh-Wirström
- Senior European and Regulatory Affairs Project Manager, EULAR PARE, Brussels, Belgium
| | - George Bertsias
- Rheumatology, University of Crete School of Medicine, Iraklio, Greece; Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Greece
| | | | - Anca Bobirca
- Department of Internal Medicine and Rheumatology, Dr I Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ware Branch
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milano, Fatebenefratelli Hospital, Milano, Italy
| | - Irene Bultink
- Department of Rheumatology, Amsterdam Rheumatology and immunology Centre, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Susanna Capela
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Irene Cecchi
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Cecilia Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Paediatric Rheumatology Unit, ASST Pini, CTO, Milan, Italy
| | - Claudia Cobilinschi
- Department of Internal Medicine and Rheumatology Sânta Maria Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Dzifa Dey
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, University of Ghana Medical School, Accra, Ghana
| | - Oseme Etomi
- Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK (CN-P, OE)
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Julia Flint
- Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - João-Eurico Fonseca
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa and Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ruth Fritsch-Stork
- Health Care Centre Mariahilf, ÖGK and Rheumatology Department at the Sigmund Freud Private University, Vienna, Austria
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Research Centre for Adult and Paediatric Rheumatic Diseases, University of Milan, Milan, Italy; Clinical Rheumatology Unit, ASST G Pini and CTO, Milan, Italy
| | - Bente Glintborg
- DANBIO and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Carina Gøtestam Skorpen
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway; Department of Rheumatology Ålesund, Helse More og Romsdal, Ålesund, Norway
| | - Bethan Goulden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Rheumatology Research, UCL Division of Medicine, University College London, London; Women's Health, University College London Hospital, London, UK
| | - Christine Graversgaard
- Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark; Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Iva Gunnarsson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden; Solna and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Merete Hetland
- DANBIO and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ken Hodson
- UK Teratology Information Service, Newcastle upon Tyne, UK
| | - Beverley J Hunt
- Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Isenberg
- Centre for Rheumatology, UCL Division of Medicine, London, UK
| | - Søren Jacobsen
- Copenhagen Research Centre for Autoimmune Connective Tissue Diseases, COPEACT, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Louise Linde
- Copenhagen Research Centre for Autoimmune Connective Tissue Diseases, Lupus and Vasculitis Clinic, Copenhagen university hospital, Rigshospitalet, Denmark
| | - Jacob Lykke
- Department of Obstetrics, Copenhagen university hospital, Rigshospitalet, Denmark
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
| | - Louise Moore
- Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland
| | - Eric Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Sandra Navarra
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Daniela Opris-Belinski
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines; Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monika Østensen
- Department of Rheumatology, Sorlandet Hospital Kristiansand, Kristiansand, Norway (MØ)
| | - Hiroki Ozawa
- Immuno-Rheumatology Centre, St Luke's International Hospital, Tokyo, Japan
| | | | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Massimo Radin
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Amihai Rottenstreich
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra and Northwell, New York, NY, USA; Laboratory of Blood and Vascular Biology, Rockefeller University, New York, NY, USA; Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, University of the Basque Country, Bizkaia, Spain
| | | | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Savino Sciascia
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Anja Strangfeld
- Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Elisabet Svenungsson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Tektonidou
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Evelyne Vinet
- McGill University, McGill University Health Centre, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jelena Vojinovic
- University of Nis, Faculty of Medicine, Clinic for Pediatrics University Clinical Center Nis, Nis, Serbia
| | - Anne Voss
- Department of Rheumatology C, Odense University Hospital, Odense, Denmark
| | - Marianne Wallenius
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St Olavs Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia, Brescia, Italy
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Lieber SB, Nahid M, Rajan M, Barbhaiya M, Sammaritano L, Lipschultz RA, Lin M, Reid MC, Mandl LA. Association of Baseline Frailty with Patient-Reported Outcomes in Systemic Lupus Erythematosus at 1 Year. J Frailty Aging 2023; 12:247-251. [PMID: 37493387 PMCID: PMC11012234 DOI: 10.14283/jfa.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The relationship of baseline frailty with subsequent patient-reported outcomes in systemic lupus erythematosus (SLE) remains unclear. We assessed these associations in a pilot prospective cohort study. Frailty based on the FRAIL scale and the Fried phenotype and patient-reported outcomes, namely Patient Reported Outcomes Measurement Information System computerized adaptive tests and Valued Life Activities disability, were measured at baseline and 1 year among women aged 18-70 years with SLE enrolled at a single center. Differences in Patient Reported Outcomes Measurement Information System computerized adaptive tests between frail and non-frail participants were evaluated using Wilcoxon rank sum tests, and the association of baseline frailty with self-report disability at 1 year was estimated using linear regression. Of 51 participants, 24% (FRAIL scale) and 16% (Fried phenotype) met criteria for frailty at baseline despite median age of 55.0 and 56.0 years, respectively. Women with (versus without) baseline frailty using either measure had worse 1-year Patient Reported Outcomes Measurement Information System computerized adaptive test scores across multiple domains and greater self-report disability. Baseline frailty was significantly associated with self-report disability at 1 year (FRAIL scale: parameter estimate 0.55, 95% confidence interval (CI) 0.21-0.89, p<0.01; Fried phenotype: parameter estimate 0.61, 95% CI 0.22-1.00, p<0.01), including only slight attenuation after adjustment for SLE cumulative organ damage (FRAIL scale: parameter estimate 0.45, 95% CI 0.09-0.81, p=0.02; Fried phenotype: parameter estimate 0.49, 95% CI 0.09-0.90, p=0.02). These preliminary findings support frailty as an independent risk factor for clinically relevant patient-reported outcomes, including disability onset, among women with SLE.
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Affiliation(s)
- S B Lieber
- Sarah B. Lieber, MD, MS, Division of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, Phone (212)606-1935, Fax (212) 606-1519, , ORCID ID: 0000-0002-6176-9740
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Stamm B, Barbhaiya M, Siegel C, Lieber S, Lockshin M, Sammaritano L. Infertility in systemic lupus erythematosus: what rheumatologists need to know in a new age of assisted reproductive technology. Lupus Sci Med 2022; 9:9/1/e000840. [PMID: 36600642 DOI: 10.1136/lupus-2022-000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
Fertility is often a concern for women with SLE. In addition to known indirect factors that influence the ability of a woman with SLE to become pregnant, such as cytotoxic agents, other medications, advanced age and psychosocial effects of the disease, direct disease-related factors are believed to influence fertility. These include diminished ovarian reserve, menstrual irregularities (a function of disease activity) and the presence of antiphospholipid antibodies. The question of whether SLE intrinsically affects fertility, however, remains unanswered. In this review, we address known factors affecting fertility, assess current data regarding a direct impact of SLE on fertility and evaluate potential disease-related risk factors. We focus primarily on studies measuring anti-Müllerian hormone and antral follicle count, the most widely measured markers of ovarian reserve. Our goal is to provide information to rheumatologists faced with counselling patients with SLE regarding their fertility, family planning and options for assisted reproductive technologies, which now include fertility preservation through oocyte cryopreservation.
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Affiliation(s)
- Bessie Stamm
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA.,Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, New York, NY, USA
| | - Medha Barbhaiya
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA.,Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, New York, NY, USA.,Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Caroline Siegel
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA
| | - Sarah Lieber
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA
| | - Michael Lockshin
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA.,Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, New York, NY, USA
| | - Lisa Sammaritano
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA .,Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, New York, NY, USA
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Siegel C, Stamm B, Vega J, Sevim E, Lockshin M, Sammaritano L, Barbhaiya M. AB0556 CHARACTERISTICS OF PATIENTS DIAGNOSED WITH UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with undifferentiated connective tissue disease (UCTD) struggle with physical symptoms as well as diagnostic uncertainty.1 UCTD diagnosis requires exclusion of other connective tissue diseases (CTD). Prior studies use variable definitions of UCTD that do not account for updated classification criteria thus limiting generalizability.ObjectivesWe identified characteristics associated with rheumatologist-diagnosed UCTD, applied strict exclusion criteria, and compared UCTD patients to those with criteria-defined CTD.MethodsWe recruited patients ≥18 years old seen between 2018-2022 who had rheumatologist-diagnosed UCTD with positive ANA and ≥1 sign/symptom of a CTD. We reviewed medical records to identify those who fulfilled ACR/EULAR-endorsed classification criteria for SLE, RA, SSc, Primary Sjögren’s, Idiopathic Inflammatory Myopathy, and 2006 Revised Sapporo Criteria for APS. We compared sociodemographic, clinical, serologic, and treatment variables between UCTD and CTD using chi-square, Fisher’s exact, and t-tests.ResultsOf 89 patients with rheumatologist-diagnosed UCTD (mean age 49.0 ± 13.7 years, 97.8% female, 66.3% White), 59 (66.3%) had UCTD and 30 (33.7%) had criteria-defined CTD (27 SLE, 3 SLE and RA, 1 RA, and 1 APS).Patients in both groups had similar non-criteria manifestations, most commonly arthralgia (89.8% UCTD vs. 83.3% CTD, p=0.50) and fatigue (55.9% UCTD vs. 73.3% CTD, p=0.17). Compared to patients with CTD, those with UCTD were less likely to have nonerosive arthritis (27.1% vs. 56.7%, p=0.01) (Table 1).Table 1.Characteristics of Patients with UCTD or Criteria-Defined CTDUCTD1 (n=57), N (%)CTD2 (n=32), N (%)p-valuesClinical3,4•,4nicalN (%))cs of Pa16 (27.1)17 (56.7)0.01•.0156.7) (%))cs of Patients with UCTD or Criteria31 (52.5)18 (60.0)0.65•.6560.0) (%))cs of Patient7 (11.9)4 (13.3)1.0•.013.3)) (%))cs of Patients with UCTD or Criteria-Defined C27 (45.8)14 (46.7)1.0•.0(46.7) (%))cs of Patien24 (40.7)11 (36.7)0.82Serology3•erology) (%))cs of Patients with UCTD or Criteria-Defined CTDth19 (32.2)19 (63.3)<0.01•0.013.3) (%))cs of Patien9 (15.3)13 (4.3)<0.01•0.01.3)) (%))22 (37.3)25 (83.3)<0.01•0.013.3) (%))cs of Patients w10 (16.9)6 (20.0))0.77•.770.0)) (%))cs of Patients with UCTD or Criteria-D6 (10.2)2 (6.7)0.71•.71.7))) (%))cs of Patients with UCTD or Criteria-Defined CTDther CTDs. Our fi18 (30.5)10 (33.3)0.81•.8133.3) (%))cs11 (18.6)6 (20.0)1.01. Do not fulfill ACR/EULAR classification criteria for SLE, RA, SSc, PSS, IIM, APS.2. Diagnosed with UCTD and fulfill ≥1 set of listed CTD classification criteria.3. Defined per listed classification criteria4. Criteria with n≤5: fever, proteinuria/cellular casts, pulmonary hypertension, interstitial lung disease, dysphagia/esophageal dysmotilityPatients with UCTD were less likely than those with CTD to have any hematologic manifestation (lymphopenia, leukopenia, thrombocytopenia, or hemolytic anemia) (p=0.02), anti-dsDNA or anti-Smith antibodies (p<0.01), or hypocomplementemia (p<0.01). The frequency of RA, Sjogren’s, and APS-related serologies did not differ between groups (Table 1).Compared to those with CTD, UCTD patients were less likely to have ever received systemic corticosteroids (71.2% vs. 96.7%, p<0.01); ever use of any disease-modifying antirheumatic drug (DMARD) was similar (35.6% vs. 46.7%, p=0.36).ConclusionAmong patients diagnosed with UCTD, 66.3% met a stringent definition. Compared to those with criteria-defined CTD, UCTD patients had lower frequency of arthritis, hematologic abnormalities, SLE-specific antibodies, and hypocomplementemia. While use of DMARDs did not differ, UCTD patients were less likely to use systemic corticosteroids.Rheumatologists diagnose UCTD even when criteria are met for other CTDs. Our findings suggest UCTD is nonetheless a distinct clinical entity; more rigorous characterization will enable generalizable prognostic and therapy trials.References[1]Siegel CH, et al. J Clin Rheumatol 2021 Mar 5. doi: 0.1097/RHU. 0000000000001714Disclosure of InterestsNone declared
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Mehta B, Glaser KKJ, Jannat-Khah D, Luo Y, Sammaritano L, Salmon JE, Goodman S, Wang F. OP0124 FETAL AND MATERNAL MORBIDITY IN PREGNANT SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS: A 10-YEAR U.S. NATIONAL STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disorder that affects women in their childbearing years. Previously, we demonstrated that fetal and maternal mortality has declined in SLE patients over the years, however little is known about morbidity (1).ObjectivesTo determine the proportion of fetal and maternal morbidity in SLE deliveries compared to non-SLE deliveries in a US nationwide study over a decade.MethodsWe used retrospective data from the National Inpatient Sample database to identify all delivery related hospital admissions of patients with and without SLE from 2008 to 2017 using ICD-9 (710.0) and 10 (M32*) codes. Fetal morbidity indicators included preterm delivery and intrauterine growth restriction. 21 indicators of severe maternal morbidity were identified using the standard CDC definition: these are unexpected outcomes of labor and delivery that result in significant short- or long- term consequences to a woman’s health (2). Descriptive statistics and their 95% confidence intervals were calculated using sample weights from the dataset.ResultsAmong the 40 million delivery-related admissions, 51,161 patients (10,297 unweighted) were reported to have SLE. SLE patients were more likely to be older and have more comorbidities compared to non-SLE patients (Table 1). Patients with SLE had a higher risk of fetal morbidity, including intrauterine growth restriction (8.0% vs 2.7%) and preterm delivery (14.5% vs 7.3%) than patients without SLE. Amongst the CDC maternal morbidity indicators - SLE patients faced a greater risk of blood transfusion, puerperal cerebrovascular disorders, acute renal failure, eclampsia or DIC, cardiovascular and peripheral vascular disorders, and general medical issues than those without SLE (Figure 1).Table 1.Characteristics for deliveries of patients with and without Systemic Lupus ErythematosusSLE deliveriesNon-SLE deliveriesPercent (%)(95 %CI)Percent (%)(95 %CI)N51,161* (10,297 unweighted)(49,419.14, 52,903.37)40,000,000* (8,055,025 unweighted)(39,200,000; 40,700,000)Age (years)30.05(29.92, 30.18)28.19(28.14, 28.24)RaceWhite46.15(44.83, 47.47)52.43(51.74, 53.11)African American24.68(23.55, 25.85)15.01(14.62, 15.42)Hispanic18.48(17.40, 19.60)21.45(20.81, 22.10)Other10.69(9.93, 11.50)11.11(10.76, 11.47)InsuranceMedicare5.32(4.83, 5.86)0.7(0.66, 0.75)Medicaid38.2(37.00, 39.41)43.79(43.20, 44.39)private insurance51.84(50.55, 53.13)49.8(49.15, 50.45)self-pay1.39(1.13, 1.70)2.74(2.57, 2.92)no charge0.04(0.02, 0.12)0.13(0.09, 0.18)other3.21(2.84, 3.63)2.84(2.73, 2.95)Elixhauser00(*no obs)80.56(80.32, 80.80)1 to 497.84(97.50, 98.12)19.4(19.16, 19.64)5+2.16(1.88, 2.50)0.04(0.03, 0.04)*Population weighted values are listed.Figure 1.Fetal and severe maternal morbidity outcomes in Systemic Lupus Erythematosus (SLE) and non-SLE patients. Cardiovascular and peripheral vascular disorders include acute myocardial infarction, aneurysm, amniotic fluid embolism, cardiac arrest/ventricular fibrillation, heart failure, pulmonary edema/acute heart failure, sickle cell disease with crisis, air and thrombotic embolism, and conversion of cardiac rhythm. General medical issues include hysterectomy, shock, sepsis, adult respiratory distress syndrome, and severe anesthesia complications, temporary tracheostomy, and ventilation.ConclusionOur study demonstrates that fetal morbidity and severe maternal morbidity occur at a higher rate in patients with SLE compared to those without, even in this most recent decade. This work can help inform physicians to counsel and manage patients with SLE during pregnancy and its planning.References[1]Mehta B, et al. Trends in Maternal and Fetal Outcomes Among Pregnant Women With Systemic Lupus Erythematosus in the United States: A Cross-sectional Analysis. Ann Intern Med.[2]https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.htmlAcknowledgementsThis work was supported by the Dean’s Diversity Award at Weill Cornell Medicine.Disclosure of InterestsBella Mehta Speakers bureau: Novartis and Jassen, Katharine Kayla J Glaser: None declared, Deanna Jannat-Khah Shareholder of: Cytodyn, AstraZeneca, and Walgreens, Yiming Luo: None declared, Lisa Sammaritano: None declared, Jane E. Salmon: None declared, Susan Goodman Consultant of: UCB, Grant/research support from: Novartis, Employee of: Current Rheumatology Report (section editor), Fei Wang: None declared
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Barbhaiya M, Stamm B, Vitone G, Frey MB, Jannat-Khah D, Levine J, Vega J, Feldman CH, Salmon JE, Crow MK, Bykerk V, Lockshin MD, Sammaritano L, Mandl LA. Pregnancy and Rheumatic Disease: Experience at a Single Center in New York City During the COVID-19 Pandemic. Arthritis Care Res (Hoboken) 2021; 73:1004-1012. [PMID: 33342085 DOI: 10.1002/acr.24547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The present study was undertaken to evaluate the pregnancy experiences of women receiving care in the division of rheumatology at a major academic center in New York City during the COVID-19 pandemic. METHODS A web-based COVID-19 survey was emailed to 26,045 patients who were followed in the division of rheumatology at a single center in New York City. Women ages 18-50 years were asked about their pregnancy. We compared the COVID-19 experience between pregnant and nonpregnant women and also explored the impact of the pandemic on prenatal care and perinatal outcomes. RESULTS Among 7,094 of the 26,045 respondents, 1,547 were women ages 18-50 years, with 61 (4%) reporting being pregnant during the pandemic. The prevalence of self-reported COVID-19 was similar in pregnant and nonpregnant women (8% versus 9%, respectively; P = 0.76). Among women with COVID-19, pregnant women had a shorter duration of symptoms (P < 0.01) and were more likely to experience loss of smell or taste (P = 0.02) than nonpregnant women. Approximately three-fourths of women had a systemic rheumatic disease, with no differences when stratified by pregnancy or COVID-19 status. In all, 67% of pregnant women noted changes to prenatal care during the pandemic, and 23% of postpartum women stated that the pandemic affected delivery. CONCLUSION Among women followed in the division of rheumatology at a major center in New York City, pregnancy was not associated with increased self-reported COVID-19. Pregnancy was associated with a shorter duration of COVID-19 symptoms and a higher prevalence of loss of smell or taste. The COVID-19 pandemic impacted prenatal care for the majority of pregnant patients.
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Affiliation(s)
- Medha Barbhaiya
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Bessie Stamm
- Hospital for Special Surgery, New York, New York
| | | | | | - Deanna Jannat-Khah
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Jonah Levine
- Hospital for Special Surgery, New York, New York
| | - JoAnn Vega
- Hospital for Special Surgery, New York, New York
| | - Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jane E Salmon
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Mary K Crow
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Vivian Bykerk
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael D Lockshin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Lisa Sammaritano
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Lisa A Mandl
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
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Siegel C, Sevim E, Stamm B, Vega J, Kleinman J, Barnhill J, Lockshin M, Sammaritano L, Barbhaiya M. POS0715 QUANTIFYING THE PSYCHOSOCIAL IMPACT OF UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE (UCTD). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Only half of patients diagnosed with SLE fulfill classification criteria; the rest have “SLE-like” illnesses such as UCTD. SLE patients are known to experience impaired health-related quality of life (HRQoL) and significant anxiety, depression, and fatigue,1 yet the psychosocial aspects of UCTD are less established. In a qualitative study, we found that most UCTD patients had engaged in psychotherapy and felt additional support was needed.2Objectives:Using multiple validated instruments, this study aims to quantify the psychosocial impact of UCTD.Methods:The Hospital for Special Surgery UCTD and Overlap Registry includes UCTD patients aged ≥ 18 years with ANA ≥ 1:80 and ≥ 1 sign or symptom of rheumatic disease who do not fulfill classification criteria for a defined CTD. We administered the 36-Item Short Form Health Survey (SF-36), General Anxiety Disorder-7 (GAD-7), Beck Depression Inventory (BDI), and Fatigue Severity Scale (FSS) to all patients to assess HRQoL, anxiety, depression, and fatigue. Instruments were scored based on established algorithms and results were summarized using predefined scales and severity thresholds.Results:The composite questionnaire was administered to 85 UCTD patients and completed by 75 (97.3% female, 60% white, mean age ± SD 48.8 ± 13.6 years). The SF-36 Physical Component Summary mean score was 37.8 and Mental Component Summary mean score was 41.1. Across the 8 SF-36 subscales, mean scores were lowest for role limitations due to physical health (39.3) and vitality (39.7) and highest for physical functioning (67.2), role limitations due to emotional health (67.1), and mental health (67.1). Approximately half of UCTD patients reported anxiety (GAD-7 ≥ 6); 20% had moderate/severe anxiety (GAD-7 ≥ 10). The prevalence of depression (BDI ≥ 14) was 26.7%; 13.3% had moderate/severe depression (BDI ≥ 20). Fatigue (FSS ≥ 3) was reported by 82.8% of patients (median FSS score of 4.7) [Table 1].Table 1.Psychosocial Survey Scores of Patients with Undifferentiated
Connective Tissue Disease (n=75)36-Item Short Form Health Survey (SF-36)Range 1-100 – Mean (SD)*Physical Component Summary∘Physical functioning∘Role-Physical∘Bodily PainoGeneral Health38.2 (11.2)67.2 (26.3)39.3 (46.3)49.5 (22.1)42.9 (21.5)Mental Component Summary∘Vitality∘Social Functioning∘Role-EmotionaloMental Health41.3 (10.7)39.7 (21.7)59.3 (25.9)67.1 (41.9)67.1 (18.3)Generalized Anxiety Disorder-7 (GAD-7)Range 0-21 – N (%)**None [0-5]Mild [6-10]Moderate [11-15]Severe [16-21]38 (50.7)22 (29.3)14 (18.7)1 (1.3)Beck Depression Inventory (BDI)Range 0-63 – N (%)**Minimal [0-13]Mild [14-19]Moderate [20-28]Severe [29-63]55 (73.3)10 (13.3)7 (9.3)3 (4.0)Fatigue Severity Scale (FSS) Range 1-7 – Median (IQR)**4.7 (1.5)*Higher number indicates better health state. **Higher number indicates greater severity.Conclusion:UCTD patients have significantly impaired HRQoL and a high prevalence of anxiety, depression, and fatigue, suggesting substantial psychosocial impact of UCTD comparable to that reported in SLE.3,4 Impaired HRQoL in UCTD is driven to similar degrees by aspects of physical and mental health. In future studies, we will compare age- and sex- matched UCTD to SLE patients and longitudinally evaluate psychosocial metrics alongside clinical trajectories.References:[1]Dietz B, Katz P, Dall’Era M, et al. Major depression and adverse patient-reported outcomes in systemic lupus erythematosus: Results from a prospective longitudinal cohort. Arthritis Care Res. 2021;73(1):48-54.[2]Siegel CH, Kleinman J, Barbhaiya M, et al. The psychosocial impact of undifferentiated connective tissue disease on patient health and well-being: A qualitative study. J Clin Rheumatol. In press.[3]Gu M, Cheng Q, Wang X, et al. The impact of SLE on health-related quality of life assessed with SF-36: A systemic review and meta-analysis. Lupus. 2019;28(3):371-382.[4]Zhang L, Fu T, Yin R, Zhang Q, Shen B. Prevalence of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. BMC Psychiatry. 2017;17(1).Acknowledgements:This project was supported by the Barbara Volcker Center for Women and Rheumatic Diseases and the Robin J. Sillau Memorial Research Fund for Connective Tissue Disease. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award.Disclosure of Interests:None declared
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Odendaal J, Quenby S, Sammaritano L, Macklon N, Branch DW, Rosenwaks Z. Immunologic and rheumatologic causes and treatment of recurrent pregnancy loss: what is the evidence? Fertil Steril 2020; 112:1002-1012. [PMID: 31843070 DOI: 10.1016/j.fertnstert.2019.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Joshua Odendaal
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
| | - Siobhan Quenby
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
| | - Lisa Sammaritano
- Hospital for Special Surgery, New York, New York; Weill Cornell Medicine, New York, New York
| | - Nick Macklon
- London Womens Clinic, London, United Kingdom; ReproHealth Consortium, Zealand University Hospital, Koege, Denmark
| | | | - Zev Rosenwaks
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
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Mehta B, Luo Y, Xu J, Sammaritano L, Salmon J, Lockshin M, Goodman S, Ibrahim S. Trends in Maternal and Fetal Outcomes Among Pregnant Women With Systemic Lupus Erythematosus in the United States: A Cross-sectional Analysis. Ann Intern Med 2019; 171:164-171. [PMID: 31284305 DOI: 10.7326/m19-0120] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although pregnancy in systemic lupus erythematosus (SLE) carries a high risk for mother and fetus, outcomes may be improving. OBJECTIVE To assess nationwide trends and disparities in maternal and fetal complications among pregnant women with SLE. DESIGN Retrospective cohort study. SETTING United States, 1998 to 2015. PATIENTS Adult pregnant women with and without SLE who had hospitalizations recorded in the National Inpatient Sample (NIS) database. MEASUREMENTS Outcome measures were in-hospital maternal mortality, fetal mortality, preeclampsia or eclampsia, caesarean sections, non-delivery-related admissions, and length of stay. To assess whether trends in outcomes over time differed between patients with SLE and those without SLE, logistic or linear regression with an interaction term between year and SLE (yes or no) was used. Nationwide population estimates incorporating sampling and poststratification weights were obtained. RESULTS An estimated 93 820 pregnant women with SLE and 78 045 054 without SLE were hospitalized in the United States from 1998 through 2015. Outcomes improved during those 18 years. In-hospital maternal deaths (per 100 000 admissions) declined among patients with as well as those without SLE (442 vs. 13 for 1998 to 2000 and <50 vs. 10 for 2013 to 2015), although the decrease was greater in women with SLE (difference in trends, P < 0.002). The percentage of patients with SLE in all pregnancy-related, as well as delivery-related, admissions increased significantly. LIMITATIONS The sample for this analysis was identified by using diagnostic codes; detailed information on hospital-specific trends, SLE disease activity, and medications was not available. Race trends could not be analyzed. Given that NIS uses weighted estimates, the incidence of outcomes reported may not be exact. CONCLUSION In this large study examining SLE and non-SLE pregnancies over 18 years, in-hospital maternal mortality and overall outcomes improved markedly, particularly among women with SLE. However, improvement is still needed, because SLE pregnancy risks remain high. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (B.M., L.S., J.S., M.L., S.G.)
| | - Yiming Luo
- Mount Sinai St. Luke's, Mount Sinai West, and Icahn School of Medicine, New York, New York (Y.L.)
| | - Jiehui Xu
- Weill Cornell Medicine, New York, New York (J.X.)
| | - Lisa Sammaritano
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (B.M., L.S., J.S., M.L., S.G.)
| | - Jane Salmon
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (B.M., L.S., J.S., M.L., S.G.)
| | - Michael Lockshin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (B.M., L.S., J.S., M.L., S.G.)
| | - Susan Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (B.M., L.S., J.S., M.L., S.G.)
| | - Said Ibrahim
- Weill Cornell Health Policy and Research, New York, New York (S.I.)
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Schlame M, Haller I, Sammaritano L, Blanck T. Effect of Cardiolipin Oxidation on Solid-Phase Immunoassay for Antiphospholipid Antibodies. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616751] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryDiagnostic assays for antiphospholipid antibodies are routinely performed on microtitre plates coated with cardiolipin. Here we show that contact between cardiolipin and NUNC-Immuno® plates leads to extensive oxidation, generating a series of peroxy-cardiolipins which were identified by electrospray ionization mass spectrometry. To investigate the impact of oxidation on the antibody assay, cardiolipin was resolved into 12 molecular species, including oxidized species and non-oxidized species with different degrees of unsaturation. All 12 species reacted under anaerobic conditions with serum from patients with primary antiphospholipid syndrome. Immune reactivity was similar for tetralinoleoyl-cardiolipin, trilinoleoyl-oleoyl-cardiolipin, and peroxycardiolipins, but somewhat lower for tristearoyl-oleoyl-cardiolipin. Oxidative treatment of cardiolipin with air, cytochrome c, or Cu2+/tert-butylhydroperoxide, either before or during the assay, did not enhance immune reactivity. Similar results were obtained with a monoclonal IgM from lupus-prone mice, that binds cardiolipin in the absence of protein cofactors. We conclude that the solid-phase assay for antiphospholipid antibodies can be supported by various oxidized and nonoxididized molecular species of cardiolipin.
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Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, Sammaritano L, Branch DW, Porter TF, Sawitzke A, Merrill JT, Stephenson MD, Cohn E, Garabet L, Salmon JE. Predictors of Pregnancy Outcomes in Patients With Lupus: A Cohort Study. Ann Intern Med 2015; 163:153-63. [PMID: 26098843 PMCID: PMC5113288 DOI: 10.7326/m14-2235] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Because systemic lupus erythematosus (SLE) affects women of reproductive age, pregnancy is a major concern. OBJECTIVE To identify predictors of adverse pregnancy outcomes (APOs) in patients with inactive or stable active SLE. DESIGN Prospective cohort. SETTING Multicenter. PATIENTS 385 patients (49% non-Hispanic white; 31% with prior nephritis) with SLE in the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study. Exclusion criteria were urinary protein-creatinine ratio greater than 1000 mg/g, creatinine level greater than 1.2 mg/dL, prednisone use greater than 20 mg/d, and multifetal pregnancy. MEASUREMENTS APOs included fetal or neonatal death; birth before 36 weeks due to placental insufficiency, hypertension, or preeclampsia; and small-for-gestational-age (SGA) neonate (birthweight below the fifth percentile). Disease activity was assessed with the Systemic Lupus Erythematosus Pregnancy Disease Activity Index and the Physician's Global Assessment (PGA). RESULTS APOs occurred in 19.0% (95% CI, 15.2% to 23.2%) of pregnancies; fetal death occurred in 4%, neonatal death occurred in 1%, preterm delivery occurred in 9%, and SGA neonate occurred in 10%. Severe flares in the second and third trimesters occurred in 2.5% and 3.0%, respectively. Baseline predictors of APOs included presence of lupus anticoagulant (LAC) (odds ratio [OR], 8.32 [CI, 3.59 to 19.26]), antihypertensive use (OR, 7.05 [CI, 3.05 to 16.31]), PGA score greater than 1 (OR, 4.02 [CI, 1.84 to 8.82]), and low platelet count (OR, 1.33 [CI, 1.09 to 1.63] per decrease of 50 × 109 cells/L). Non-Hispanic white race was protective (OR, 0.45 [CI, 0.24 to 0.84]). Maternal flares, higher disease activity, and smaller increases in C3 level later in pregnancy also predicted APOs. Among women without baseline risk factors, the APO rate was 7.8%. For those who either were LAC-positive or were LAC-negative but nonwhite or Hispanic and using antihypertensives, the APO rate was 58.0% and fetal or neonatal mortality was 22.0%. LIMITATION Patients with high disease activity were excluded. CONCLUSION In pregnant patients with inactive or stable mild/moderate SLE, severe flares are infrequent and, absent specific risk factors, outcomes are favorable. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Jill P. Buyon
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Mimi Y. Kim
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Marta M. Guerra
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Carl A. Laskin
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Michelle Petri
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Michael D. Lockshin
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Sammaritano
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - D. Ware Branch
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - T. Flint Porter
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Allen Sawitzke
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Joan T. Merrill
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Mary D. Stephenson
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Elisabeth Cohn
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Lamya Garabet
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
| | - Jane E. Salmon
- From New York University School of Medicine, Hospital for Special Surgery, Albert Einstein College of Medicine, and Weill Cornell Medical College, New York, New York; University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah; Oestfold Hospital Trust, Fredrikstad, Norway; University of Toronto, Toronto, Ontario, Canada; Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and University of Illinois at Chicago, Chicago, Illinois
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13
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Lockshin MD, Kim M, Laskin CA, Guerra M, Branch DW, Merrill J, Petri M, Porter TF, Sammaritano L, Stephenson MD, Buyon J, Salmon JE. Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies. ACTA ACUST UNITED AC 2012; 64:2311-8. [PMID: 22275304 DOI: 10.1002/art.34402] [Citation(s) in RCA: 243] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate which serologic and clinical findings predict adverse pregnancy outcome in patients with antiphospholipid antibody (aPL) and to test the hypothesis that a pattern of clinical and serologic variables can identify women at highest risk of adverse pregnancy outcome. METHODS Women enrolled in a multicenter prospective observational study of risk factors for adverse pregnancy outcome in patients with aPL (lupus anticoagulant [LAC], anticardiolipin antibody [aCL], and/or antibody to β2-glycoprotein I [anti-β2 GPI]) and/or systemic lupus erythematosus (SLE) were recruited for the present prospective study. Demographic, clinical, serologic, and treatment data were recorded at the time of the first study visit. The relationship between individual and combined variables and adverse pregnancy outcome was assessed by bivariate and multivariate analysis. RESULTS Between 2003 and 2011 we enrolled 144 pregnant patients, of whom 28 had adverse pregnancy outcome. Thirty-nine percent of the patients with LAC had adverse pregnancy outcome, compared to 3% of those who did not have LAC (P<0.0001). Among women with IgG aCL at a level of ≥40 units/ml, only 8% of those who were LAC negative had adverse pregnancy outcome, compared to 43% of those who were LAC positive (P=0.002). IgM aCL, IgG anti-β2 GPI, and IgM anti-β2 GPI did not predict adverse pregnancy outcome. In bivariate analysis, adverse pregnancy outcome occurred in 52% of patients with and 13% of patients without prior thrombosis (P=0.00005), and in 23% with SLE versus 17% without SLE (not significant); SLE was a predictor in multivariate analysis. Prior pregnancy loss did not predict adverse pregnancy outcome. Simultaneous positivity for aCL, anti-β2 GPI, and LAC did not predict adverse pregnancy outcome better than did positivity for LAC alone. CONCLUSION LAC is the primary predictor of adverse pregnancy outcome after 12 weeks' gestation in aPL-associated pregnancies. Anticardiolipin antibody and anti-β2 GPI, if LAC is not also present, do not predict adverse pregnancy outcome.
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Affiliation(s)
- Michael D Lockshin
- Hospital for Special Surgery and Weill Cornell Medical College, New York, New York.
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Ruperto N, Hanrahan LM, Alarcón GS, Belmont HM, Brey RL, Brunetta P, Buyon JP, Costner MI, Cronin ME, Dooley MA, Filocamo G, Fiorentino D, Fortin PR, Franks AG, Gilkeson G, Ginzler E, Gordon C, Grossman J, Hahn B, Isenberg DA, Kalunian KC, Petri M, Sammaritano L, Sánchez-Guerrero J, Sontheimer RD, Strand V, Urowitz M, von Feldt JM, Werth VP, Merrill JT. International consensus for a definition of disease flare in lupus. Lupus 2010; 20:453-62. [PMID: 21148601 DOI: 10.1177/0961203310388445] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Lupus Foundation of America (LFA) convened an international working group to obtain a consensus definition of disease flare in lupus. With help from the Paediatric Rheumatology International Trials Organization (PRINTO), two web-based Delphi surveys of physicians were conducted. Subsequently, the LFA held a second consensus conference followed by a third Delphi survey to reach a community-wide agreement for flare definition. Sixty-nine of the 120 (57.5%) polled physicians responded to the first survey. Fifty-nine of the responses were available to draft 12 preliminary statements, which were circulated in the second survey. Eighty-seven of 118 (74%) physicians completed the second survey, with an agreement of 70% for 9/12 (75%) statements. During the second conference, three alternative flare definitions were consolidated and sent back to the international community. One hundred and sixteen of 146 (79.5%) responded, with agreement by 71/116 (61%) for the following definition: "A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment." The LFA proposes this definition for lupus flare on the basis of its high face validity.
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Affiliation(s)
- N Ruperto
- Gaslini Pediatria II, Reumatologia, PRINTO, Genova, Italy
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15
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Perna M, Roman MJ, Alpert DR, Crow MK, Lockshin MD, Sammaritano L, Devereux RB, Cooke JP, Salmon JE. Relationship of asymmetric dimethylarginine and homocysteine to vascular aging in systemic lupus erythematosus patients. ACTA ACUST UNITED AC 2010; 62:1718-22. [PMID: 20155836 DOI: 10.1002/art.27392] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is independently associated with accelerated atherosclerosis and premature arterial stiffening. Asymmetric dimethylarginine (ADMA) and homocysteine are mechanistically interrelated mediators of endothelial dysfunction and correlates of atherosclerosis in the general population. The aim of this study was to assess the relationship of ADMA and homocysteine to subclinical vascular disease in patients with SLE. METHODS One hundred twenty-five patients with SLE who were participating in a study of cardiovascular disease underwent clinical and laboratory assessment, carotid artery ultrasonography to detect atherosclerosis, and radial artery applanation tonometry to measure arterial stiffness. RESULTS Neither ADMA nor homocysteine correlated with the presence or extent of carotid atherosclerosis. In contrast, ADMA was significantly related to the arterial stiffness index. Independent correlates of arterial stiffening included the ADMA concentration, the presence of diabetes mellitus, older age at the time of diagnosis, longer disease duration, and the absence of anti-Sm or anti-RNP antibodies. A secondary multivariable analysis substituting homocysteine for ADMA demonstrated comparable relationships with arterial stiffness (r(2) = 0.616 for homocysteine and r(2) = 0.595 for ADMA). CONCLUSION ADMA and homocysteine are biomarkers for and may be mediators of premature arterial stiffening in patients with SLE. Because arterial stiffness has independent prognostic value for cardiovascular morbidity and mortality, its predictors may identify patients who are at increased risk of cardiovascular disease.
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Affiliation(s)
- Michelle Perna
- Weill Cornell Medical College and Hospital for Special Surgery, New York, New York 10021, USA
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Erkan D, Barbhaiya M, George D, Sammaritano L, Lockshin M. Moderate versus high-titer persistently anticardiolipin antibody positive patients: are they clinically different and does high-titer anti-beta 2-glycoprotein-I antibody positivity offer additional predictive information? Lupus 2009; 19:613-9. [PMID: 19934177 DOI: 10.1177/0961203309355300] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The association between antiphospholipid antibodies (aPL) and clinical events is stronger with a positive lupus anticoagulant (LA) test, higher anticardiolipin antibody (aCL) titers, and/or higher anti-beta(2)-glycoprotein-I antibody (abeta( 2)GPI) titers. The objective of this study was to determine the clinical characteristics of persistently high-titer (> or =80 U) aCL-positive patients compared with those with persistent moderate aCL titers (40-79 U). Second, we analyzed whether high-titer abeta(2)GPI test adds predictive information in persistently moderate-to-high titer aCL-positive patients. In this cross-sectional study, the primary analysis compared the clinical and aPL characteristics of 58 patients with at least two moderate-titer aCL results to another 85 patients with at least two high-titer aCL results. In the secondary analysis of patients with at least two abeta(2)GPI test results, we compared 29 patients with 'aCL 40-79 U and abeta( 2)GPI < 80 U' profiles with 8 patients with 'aCL 40-79U and abeta(2)GPI > or = 80 U', and also compared 27 patients with 'aCL > 80 U and abeta(2)GPI < 80 U' with 32 patients with 'aCL > 80 U and abeta(2)GPI > or = 80 U'. Although aPL-related vascular and pregnancy events were similar between the moderate- and high-titer aCL groups, the number of patients with positive LA tests (RR 2.06, CI 1.38-3.08, p < 0.01) and with at least one non-criteria aPL manifestation (RR 1.66, CI 1.20-2.30, p = 0.0005) were significantly higher in the high-titer aCL group. While magnetic resonance imaging (MRI) white matter changes were statistically more common in the high-titer aCL group (RR 2.03, CI 1.04-3.94, p = 0.02), there was a trend towards increased prevalence of livedo reticularis, cardiac valve disease, and cognitive dysfunction occurring in the high-titer aCL group. The secondary analysis showed that MRI white matter changes, cardiac valve disease, and cognitive dysfunction were proportionally more common in the high-titer abeta( 2)GPI groups, suggesting a linear relationship between non-criteria aPL manifestations and aPL titers. Our results suggest that patients with high aCL titers, compared with those with moderate titers, are more likely to have a positive LA test and a higher prevalence of non-criteria aPL manifestations. Furthermore, high-titer abeta(2)GPI positivity may further increase the prevalence of non-criteria aPL manifestations in moderate- or high-titer aCL-positive patients.
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Affiliation(s)
- D Erkan
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA.
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Rudominer RL, Roman MJ, Devereux RB, Paget SA, Schwartz JE, Lockshin MD, Crow MK, Sammaritano L, Levine DM, Salmon JE. Independent association of rheumatoid arthritis with increased left ventricular mass but not with reduced ejection fraction. ACTA ACUST UNITED AC 2009; 60:22-9. [PMID: 19116901 DOI: 10.1002/art.24148] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with premature atherosclerosis, vascular stiffening, and heart failure. This study was undertaken to investigate whether RA is associated with underlying structural and functional abnormalities of the left ventricle (LV). METHODS Eighty-nine RA patients without clinical cardiovascular disease and 89 healthy matched controls underwent echocardiography, carotid ultrasonography, and radial tonometry to measure arterial stiffness. RA patients and controls were similar in body size, hypertension and diabetes status, and cholesterol level. RESULTS LV diastolic diameter (4.92 cm versus 4.64 cm; P<0.001), mass (136.9 gm versus 121.7 gm; P=0.004 or 36.5 versus 32.9 gm/m2.7; P=0.01), ejection fraction (71% versus 67%; P<0.001), and prevalence of LV hypertrophy (18% versus 6.7%; P=0.023) were all higher among RA patients versus controls. In multivariate analysis, presence of RA was an independent correlate of LV mass (P=0.004). Furthermore, RA was independently associated with presence of LV hypertrophy (odds ratio 4.14 [95% confidence interval 1.24, 13.80], P=0.021). Among RA patients, age at diagnosis and disease duration were independently related to LV mass. RA patients with LV hypertrophy were older and had higher systolic pressure, damage index scores, C-reactive protein levels, homocysteine levels, and arterial stiffness compared with those without LV hypertrophy. CONCLUSION The present results demonstrate that RA is associated with increased LV mass. Disease duration is independently related to increased LV mass, suggesting a pathophysiologic link between chronic inflammation and LV hypertrophy. In contrast, LV systolic function is preserved in RA patients, indicating that systolic dysfunction is not an intrinsic feature of RA.
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Roman MJ, Crow MK, Lockshin MD, Devereux RB, Paget SA, Sammaritano L, Levine DM, Davis A, Salmon JE. Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus. ACTA ACUST UNITED AC 2007; 56:3412-9. [PMID: 17907140 DOI: 10.1002/art.22924] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the rate of atherosclerosis progression as well as the relationship of traditional risk factors, systemic lupus erythematosus (SLE)-related factors, and treatment to atherosis progression in SLE patients. METHODS Outpatients in the Hospital for Special Surgery SLE Registry underwent serial carotid ultrasound and clinical assessment in a longitudinal study. RESULTS Among 158 patients, 77 (49%) had persistent absence of atherosclerosis (carotid plaque), 36 (23%) had unchanged atherosclerosis, and 45 (28%) had progressive atherosclerosis, defined as a higher plaque score (new plaque in 25 patients and more extensive plaque in 20 patients) after a mean +/- SD interval of 34 +/- 9 months. Multivariate determinants of atherosclerosis progression were age at diagnosis (odds ratio [OR] 2.75, 95% confidence interval [95% CI] 1.67-4.54 per 10 years, P < 0.001), duration of SLE (OR 3.16, 95% CI 1.64-6.07 per 10 years, P < 0.001), and baseline homocysteine concentration (OR 1.24, 95% CI 1.06-1.44 per mumoles/liter, P = 0.006). SLE patients with stable plaque and progressive plaque differed only in baseline homocysteine concentration. Atherosclerosis progression was increased across tertiles of homocysteine concentration (16.2%, 36.4%, and 56.1%; P = 0.001), and homocysteine tertile was independently related to progression of atherosclerosis (OR 3.14, 95% CI 1.65-5.95 per tertile, P < 0.001). Less aggressive immunosuppressive therapy and lower average prednisone dose were associated with progression of atherosclerosis in univariate, but not multivariate, analyses. Inflammatory markers and lipids were not related to atherosclerosis progression. CONCLUSION Atherosclerosis develops or progresses in a substantial minority of SLE patients during short-term followup (10% per year on average). Older age at diagnosis, longer duration of SLE, and higher homocysteine concentration are independently related to progression of atherosclerosis. These findings show that aggressive control of SLE and lowering of homocysteine concentrations are potential means to retard the development and progression of atherosclerosis in SLE.
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Affiliation(s)
- Mary J Roman
- Weill Medical College of Cornell University, and the Hospital for Special Surgery, New York, New York 10021, USA.
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Pieretti J, Roman MJ, Devereux RB, Lockshin MD, Crow MK, Paget SA, Schwartz JE, Sammaritano L, Levine DM, Salmon JE. Systemic Lupus Erythematosus Predicts Increased Left Ventricular Mass. Circulation 2007; 116:419-26. [PMID: 17620509 DOI: 10.1161/circulationaha.106.673319] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis and vascular stiffening. Whether SLE alters left ventricular (LV) structure and function in the absence of valvular and clinical coronary artery disease is unknown. METHODS AND RESULTS SLE patients without clinical or echocardiographic evidence of valvular or coronary disease were age and gender matched to a reference group (n=173 in both groups). Subjects underwent echocardiography to quantify LV structure and function and carotid ultrasonography to detect atherosclerosis. Disease characteristics and radial applanation tonometry to measure arterial stiffness were evaluated in SLE patients. The 2 groups were similar in subjects' body size, hypertension and diabetes status, smoking status, and cholesterol levels. LV mass (38.3 versus 32.8 g/m(2.7)), ejection fraction (71% versus 67%), and prevalence of LV hypertrophy (17.9% versus 6.4%) were higher in SLE patients than in referent subjects (all P<0.001). The combination of SLE and hypertension further increased LV mass. In multivariable analysis, LV mass was associated with SLE (P<0.001) in addition to body mass index, diabetes mellitus, and hypertension. Among SLE patients, LV mass was associated with arterial stiffness (P<0.001). Carotid atherosclerosis, SLE duration, damage index, serum creatinine, and homocysteine were significantly related to LV mass in univariate but not multivariable analyses. CONCLUSIONS SLE predicts increased LV mass, possibly because of inflammation-related arterial stiffening. Excess LV hypertrophy may contribute to the increased cardiac morbidity and mortality observed in SLE patients.
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Affiliation(s)
- Janice Pieretti
- Division of Cardiology, Weill Medical College of Cornell University and the Hospital for Special Surgery, New York, NY 10021, USA
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Abstract
OBJECTIVE To analyse antiphospholipid (aPL) antibody-positive patients using the 2006 revised antiphospholipid syndrome (APS) classification criteria. METHODS A descriptive study of 200 aPL-positive patients identified in a local, hospital-based registry, analysing demographic, clinical and aPL characteristics. Patients were analysed for (1) fulfillment of the 1999 original (Sapporo) and 2006 revised APS classification criteria; (2) non-criteria aPL features (for all aPL-positive patients, based on the 2006 revised criteria definitions); and (3) non-aPL thrombosis risk factors at the time of the clinical events (for patients with APS, based on the 2006 revised criteria stratifications). RESULTS Of the 200 patients, 183 patients had sufficient data for analysis. Of these, 39 (21%) patients did not meet the laboratory requirement of the original 1999 criteria. Of 81 patients with APS who met the 1999 classification criteria, 47 (58%) also met the 2006 revised criteria. Of 63 asymptomatic (no vascular or pregnancy events) aPL-positive patients who met the laboratory requirement of the 1999 classification criteria, 38 (60%) also met the laboratory requirement of the 2006 revised criteria. More than 50% of the patients with APS with vascular events had identifiable non-aPL thrombosis risk factors at the time of clinical events. CONCLUSIONS Only 59% of the patients meeting the 1999 APS Sapporo classification criteria met the 2006 APS classification criteria. The revised criteria will have positive implications in APS research by way of limiting the inclusion of a heterogeneous group of patients and also by way of providing a risk-stratified approach.
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Affiliation(s)
- Mala Kaul
- Weill Medical College of Cornell University, New York, NY, USA.
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Erkan D, Harrison MJ, Levy R, Peterson M, Petri M, Sammaritano L, Unalp-Arida A, Vilela V, Yazici Y, Lockshin MD. Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: A randomized, double-blind, placebo-controlled trial in asymptomatic antiphospholipid antibody–positive individuals. ACTA ACUST UNITED AC 2007; 56:2382-91. [PMID: 17599766 DOI: 10.1002/art.22663] [Citation(s) in RCA: 234] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine the efficacy of a daily dose of 81 mg aspirin in primary thrombosis prevention in asymptomatic, persistently antiphospholipid antibody (aPL)-positive individuals (those with positive aPL but no vascular and/or pregnancy events). METHODS The Antiphospholipid Antibody Acetylsalicylic Acid (APLASA) study was a multicenter, randomized, double-blind, placebo-controlled clinical trial in which asymptomatic, persistently aPL-positive individuals were randomized to receive a daily dose of 81 mg of aspirin or placebo. In a separate observational and parallel study, asymptomatic, persistently aPL-positive individuals who were taking aspirin or declined randomization were followed up prospectively. RESULTS In the APLASA study, 98 individuals were randomized to receive aspirin or placebo (mean +/- SD followup period 2.30 +/- 0.95 years), of whom 48 received aspirin and 50 received placebo. In the observational study, 74 nonrandomized individuals were followed up prospectively (mean +/- SD followup period 2.46 +/- 0.76 years); 61 received aspirin and 13 did not. In the APLASA study, the acute thrombosis incidence rates were 2.75 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for the placebo-treated subjects (hazard ratio 1.04, 95% confidence interval 0.69-1.56) (P = 0.83). Similarly, in the observational study, the acute thrombosis incidence rates were 2.70 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for those not treated with aspirin. All but 1 patient with thrombosis in either study had concomitant thrombosis risk factors and/or systemic autoimmune disease at the time of thrombosis. CONCLUSION Our results suggest that asymptomatic, persistently aPL-positive individuals do not benefit from low-dose aspirin for primary thrombosis prophylaxis, have a low overall annual incidence rate of acute thrombosis, and develop vascular events when additional thrombosis risk factors are present.
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Affiliation(s)
- Doruk Erkan
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA.
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Roman MJ, Moeller E, Davis A, Paget SA, Crow MK, Lockshin MD, Sammaritano L, Devereux RB, Schwartz JE, Levine DM, Salmon JE. Preclinical carotid atherosclerosis in patients with rheumatoid arthritis. Ann Intern Med 2006; 144:249-56. [PMID: 16490910 DOI: 10.7326/0003-4819-144-4-200602210-00006] [Citation(s) in RCA: 220] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors. OBJECTIVE To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for atherosclerotic disease in this patient population. DESIGN Matched, cross-sectional study. SETTING Hospital for Special Surgery in New York City. PATIENTS 98 consecutive outpatients with rheumatoid arthritis who were followed by rheumatologists and 98 controls matched on age, sex, and ethnicity. MEASUREMENTS Cardiovascular risk factor ascertainment and carotid ultrasonography in all participants; disease severity, disease treatment, and inflammatory markers in patients with rheumatoid arthritis. RESULTS Despite a more favorable risk factor profile, patients with rheumatoid arthritis had a 3-fold increase in carotid atherosclerotic plaque (44% vs. 15%; P < 0.001). The relationship between rheumatoid arthritis and carotid atherosclerotic plaque remained after accounting for age, serum cholesterol levels, smoking history, and hypertensive status; adjusted predicted prevalence was 7.4% (95% CI, 3.4% to 15.2%) for the control group and 38.5% (CI, 25.4% to 53.5%) for patients with rheumatoid arthritis. Age (P < 0.001) and current cigarette use (P < 0.014) were also significantly associated with carotid atherosclerotic plaque. Among patients with rheumatoid arthritis, atherosclerosis was related to age, hypertension status, and use of tumor necrosis factor-alpha inhibitors (a possible marker of disease severity). LIMITATIONS The study had a cross-sectional design, and inflammatory markers were determined only once. CONCLUSIONS Patients with rheumatoid arthritis have a high prevalence of preclinical atherosclerosis independent of traditional risk factors, suggesting that chronic inflammation and, possibly, disease severity are atherogenic in this population.
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Affiliation(s)
- Mary J Roman
- Division of Cardiology, Weill Medical College of Cornell University, Hospital for Special Surgery, and The Rogosin Institute, New York, New York 10021, USA.
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Farzaneh-Far A, Roman MJ, Lockshin MD, Devereux RB, Paget SA, Crow MK, Davis A, Sammaritano L, Levine DM, Salmon JE. Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. ACTA ACUST UNITED AC 2006; 54:3918-25. [PMID: 17133599 DOI: 10.1002/art.22265] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although antiphospholipid antibodies (aPL) are associated with arterial and venous thrombosis in systemic lupus erythematosus (SLE), the extent to which they influence other cardiovascular manifestations is either controversial or uncertain. We undertook this study to examine the relationships of aPL with valvular, myocardial, and arterial disease in SLE. METHODS Two hundred patients in an SLE registry, recruited at the time of outpatient visits, underwent comprehensive interviews, physical examinations, laboratory assessments, echocardiography to assess left ventricular (LV) and valvular status, carotid ultrasonography to detect atherosclerosis (discrete plaque), and radial applanation tonometry to measure arterial stiffness. RESULTS Antiphospholipid antibodies were present(defined as IgG or IgM anticardiolipin > or =40 IU/ml or the presence of lupus anticoagulant) in 42 patients (21%). Mitral valve nodules and moderate-to-severe mitral regurgitation were more common in aPL-positive patients (both 14.3% versus 4.4%; P = 0.02). Thirty-one percent of patients with high titers of IgG aPL (>80 IU/ml) had mitral valve nodules, compared with 20% of patients with mildly to moderately elevated levels of IgG aPL (16-80 IU/ml) and 4% of patients without IgG aPL (overall P < 0.001). Levels of soluble tumor necrosis factor receptors were higher in the presence of both aPL and mitral valve nodules. LV dimensions, systolic function, and carotid artery stiffness as well as prevalences of Raynaud's phenomenon, pulmonary hypertension, and atherosclerosis were similar in aPL-positive and aPL-negative patients. CONCLUSION Antiphospholipid antibodies in SLE are associated with mitral valve nodules and significant mitral regurgitation, possibly due to valvular endothelial cell activation. However, in this population, they are not associated with evidence of myocardial hypertrophy, systolic dysfunction, coronary or carotid atherosclerosis, or other vascular abnormalities.
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Affiliation(s)
- Afshin Farzaneh-Far
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA
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Buyon JP, Petri MA, Kim MY, Kalunian KC, Grossman J, Hahn BH, Merrill JT, Sammaritano L, Lockshin M, Alarcón GS, Manzi S, Belmont HM, Askanase AD, Sigler L, Dooley MA, Von Feldt J, McCune WJ, Friedman A, Wachs J, Cronin M, Hearth-Holmes M, Tan M, Licciardi F. The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: a randomized trial. Ann Intern Med 2005; 142:953-62. [PMID: 15968009 DOI: 10.7326/0003-4819-142-12_part_1-200506210-00004] [Citation(s) in RCA: 416] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is concern that exogenous female hormones may worsen disease activity in women with systemic lupus erythematosus (SLE). OBJECTIVE To evaluate the effect of hormone replacement therapy (HRT) on disease activity in postmenopausal women with SLE. DESIGN Randomized, double-blind, placebo-controlled noninferiority trial conducted from March 1996 to June 2002. SETTING 16 university-affiliated rheumatology clinics or practices in 11 U.S. states. PATIENTS 351 menopausal patients (mean age, 50 years) with inactive (81.5%) or stable-active (18.5%) SLE. INTERVENTIONS 12 months of treatment with active drug (0.625 mg of conjugated estrogen daily, plus 5 mg of medroxyprogesterone for 12 days per month) or placebo. The 12-month follow-up rate was 82% for the HRT group and 87% for the placebo group. MEASUREMENTS The primary end point was occurrence of a severe flare as defined by Safety of Estrogens in Lupus Erythematosus, National Assessment-Systemic Lupus Erythematosus Disease Activity Index composite. RESULTS Severe flare was rare in both treatment groups: The 12-month severe flare rate was 0.081 for the HRT group and 0.049 for the placebo group, yielding an estimated difference of 0.033 (P = 0.23). The upper limit of the 1-sided 95% CI for the treatment difference was 0.078, within the prespecified margin of 9% for noninferiority. Mild to moderate flares were significantly increased in the HRT group: 1.14 flares/person-year for HRT and 0.86 flare/person-year for placebo (relative risk, 1.34; P = 0.01). The probability of any type of flare by 12 months was 0.64 for the HRT group and 0.51 for the placebo group (P = 0.01). In the HRT group, there were 1 death, 1 stroke, 2 cases of deep venous thrombosis, and 1 case of thrombosis in an arteriovenous graft; in the placebo group, 1 patient developed deep venous thrombosis. LIMITATIONS Findings are not generalizable to women with high-titer anticardiolipin antibodies, lupus anticoagulant, or previous thrombosis. CONCLUSIONS Adding a short course of HRT is associated with a small risk for increasing the natural flare rate of lupus. Most of these flares are mild to moderate. The benefits of HRT can be balanced against the risk for flare because HRT did not significantly increase the risk for severe flare compared with placebo.
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Affiliation(s)
- Jill P Buyon
- Hospital for Joint Diseases, New York University School of Medicine, New York, New York, USA.
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Roman MJ, Devereux RB, Schwartz JE, Lockshin MD, Paget SA, Davis A, Crow MK, Sammaritano L, Levine DM, Shankar BA, Moeller E, Salmon JE. Arterial stiffness in chronic inflammatory diseases. Hypertension 2005; 46:194-9. [PMID: 15911740 DOI: 10.1161/01.hyp.0000168055.89955.db] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic inflammatory diseases are associated with premature atherosclerosis; however, it is unknown whether arterial stiffness is increased in this setting, possibly as a manifestation of vascular disease preceding and/or independent of atherosclerosis. Carotid ultrasonography and radial applanation tonometry were performed in 101 patients with systemic lupus erythematosus, 80 patients with rheumatoid arthritis, and 105 healthy control subjects. The 3 groups were comparable in age, gender, and carotid artery absolute and relative wall thickness. Atherosclerotic plaque was more common in lupus (46%) and rheumatoid arthritis (38%) patients than in controls (23%) (P<0.003). Although control subjects had higher central and peripheral blood pressures, arterial stiffness was increased in patient groups compared with controls (lupus, rheumatoid arthritis, controls, respectively: beta: 3.36 versus 3.22 versus 2.60, P<0.001; Young's modulus: 441 versus 452 versus 366 mm Hg/cm, P=0.004; Peterson's elastic modulus: 278 versus 273 versus 216 mm Hg, P<0.001) after adjustment for differences in mean brachial pressure. In multivariate analysis involving the entire population, arterial stiffness was independently related to age, serum glucose, and the presence of chronic inflammatory disease. In multivariate analysis restricted to the patients, arterial stiffness was independently related to age at diagnosis, disease duration, serum cholesterol, and C-reactive protein (and IL-6, when substituted for C-reactive protein). When analyses were repeated in the 186 study subjects without carotid plaque, arterial stiffness remained significantly elevated in patient groups after adjustment for differences in age and mean brachial pressure. In conclusion, arterial stiffness is increased in chronic inflammatory disorders independent of the presence of atherosclerosis and is related to disease duration, cholesterol, and the inflammatory mediator C-reactive protein and the cytokine that stimulates its production, IL-6.
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Affiliation(s)
- Mary J Roman
- Division of Cardiology, Weill Medical College, Cornell University, 525 East 68th St, New York, NY 10021, USA.
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Erkan D, Derksen WJM, Kaplan V, Sammaritano L, Pierangeli SS, Roubey R, Lockshin MD. Real world experience with antiphospholipid antibody tests: how stable are results over time? Ann Rheum Dis 2005; 64:1321-5. [PMID: 15731290 PMCID: PMC1755632 DOI: 10.1136/ard.2004.031856] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the stability and the degree of variation of antiphospholipid antibody (aPL) results over time in a large cohort of well evaluated aPL positive patients; and to analyse factors contributing to aPL variation and the validity of aPL in a real world setting in which aPL tests are done in multiple laboratories. METHODS The clinical characteristics, drug treatment, and 1652 data points for lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and anti-beta2 glycoprotein I antibodies (anti-beta2GPI) were examined in 204 aPL positive patients; 81 of these met the Sapporo criteria for antiphospholipid syndrome (APS) and 123 were asymptomatic bearers of aPL. RESULTS 87% of initially positive LA results, 88% of initially negative to low positive aCL results, 75% of initially moderate to high positive aCL results, 96% of initially negative to low positive anti-beta2GPI results, and 76% of initially moderate to high positive anti-beta2GPI results subsequently remained in the same range regardless of the laboratory performing the test. Aspirin, warfarin, and hydroxychloroquine use did not differ among patients whose aCL titres significantly decreased or increased or remained stable. On same day specimens, the consistency of aCL results among suppliers ranged from 64% to 88% and the correlation ranged from 0.5 to 0.8. Agreement was moderate for aCL IgG and aCL IgM; however, for aCL IgA agreement was marginal. CONCLUSIONS aPL results remained stable for at least three quarters of subsequent tests, regardless of the laboratory performing the test; the small amount of variation that occurred did not appear to be caused by aspirin, warfarin, or hydroxychloroquine use.
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Affiliation(s)
- D Erkan
- Department of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E70th Street, New York, NY 10021, USA.
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Ruiz-Irastorza G, Khamashta MA, Gordon C, Lockshin MD, Johns KR, Sammaritano L, Hughes GRV. Measuring systemic lupus erythematosus activity during pregnancy: validation of the lupus activity index in pregnancy scale. ACTA ACUST UNITED AC 2004; 51:78-82. [PMID: 14872459 DOI: 10.1002/art.20081] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To validate the Lupus Activity Index in Pregnancy (LAI-P) scale as a diagnostic tool for lupus flares during pregnancy and the puerperium. METHODS The LAI-P is a modified activity scale specific for pregnancy. Thirty-eight pregnant women with systemic lupus erythematosus (SLE) were prospectively followed in 3 clinics specific for lupus in pregnancy. On each visit, LAI-P was calculated. A modified physician global assessment (m-PGA) scale was used as gold standard (0 = no activity, 1 = mild-moderate activity, 2 = severe activity). A change > or = 0.25 in LAI-P was predefined as a flare according to previous studies in nonpregnant patients. For the purposes of the study, each visit was considered as an independent case. RESULTS During the study period, 158 visits took place for a total 621 patient-weeks. Sensitivity to change was high (standardized response mean for LAI-P = 1.6). We found a significant association between LAI-P and m-PGA (P < 0.002 in all regression models performed). Sensitivity, specificity, and positive and negative predictive values were 0.93, 0.98, 0.88, and 0.99. Positive and negative likelihood ratios were 49 and 0.07, respectively. CONCLUSIONS LAI-P has a high sensitivity to changes in lupus activity, a significant correlation with m-PGA, and high sensitivity, specificity, predictive values, and likelihood ratios for diagnosing SLE flares during pregnancy and the puerperium.
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Roman MJ, Shanker BA, Davis A, Lockshin MD, Sammaritano L, Simantov R, Crow MK, Schwartz JE, Paget SA, Devereux RB, Salmon JE. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003; 349:2399-406. [PMID: 14681505 DOI: 10.1056/nejmoa035471] [Citation(s) in RCA: 965] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although systemic lupus erythematosus is associated with premature myocardial infarction, the prevalence of underlying atherosclerosis and its relation to traditional risk factors for cardiovascular disease and lupus-related factors have not been examined in a case-control study. METHODS In 197 patients with lupus and 197 matched controls, we performed carotid ultrasonography, echocardiography, and an assessment for risk factors for cardiovascular disease. The patients were also evaluated with respect to their clinical and serologic features, inflammatory mediators, and disease treatment. RESULTS The risk factors for cardiovascular disease were similar among patients and controls. Atherosclerosis (carotid plaque) was more prevalent among patients than the controls (37.1 percent vs. 15.2 percent, P<0.001). In multivariate analysis, only older age, the presence of systemic lupus erythematosus (odds ratio, 4.8; 95 percent confidence interval, 2.6 to 8.7), and a higher serum cholesterol level were independently related to the presence of plaque. As compared with patients without plaque, patients with plaque were older, had a longer duration of disease and more disease-related damage, and were less likely to have multiple autoantibodies or to have been treated with prednisone, cyclophosphamide, or hydroxychloroquine. In multivariate analyses including patients with lupus, independent predictors of plaque were a longer duration of disease, a higher damage-index score, a lower incidence of the use of cyclophosphamide, and the absence of anti-Smith antibodies. CONCLUSIONS Atherosclerosis occurs prematurely in patients with systemic lupus erythematosus and is independent of traditional risk factors for cardiovascular disease. The clinical profile of patients with lupus and atherosclerosis suggests a role for disease-related factors in atherogenesis and underscores the need for trials of more focused and effective antiinflammatory therapy.
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Affiliation(s)
- Mary J Roman
- Division of Cardiology, Weill Medical College of Cornell University, the Hospital for Special Surgery, New York, NY 10021, USA.
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Abstract
Pregnancy in patients with systemic lupus erythematosus (SLE) presents an additional risk to an already complex clinical situation--overlap in symptoms between changes of pregnancy and SLE, presence of antiphospholipid antibodies, and need for potentially teratogenic medications can all complicate the management of pregnant patients with SLE. Studies demonstrate that, with careful planning, the majority of patients with lupus can complete pregnancy without serious complications. Recent developments are modified instruments to measure disease activity in pregnancy, increasingly common continuation of hydroxychloroquine during pregnancy, more frequent use of in vitro fertilization, and more aggressive fetal monitoring in patients positive for anti-Sjögren's syndrome (SS)-A/Ro or anti- SS-B/La antibody.
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Affiliation(s)
- Doruk Erkan
- Department of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
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Ross G, Sammaritano L, Nass R, Lockshin M. Effects of mothers' autoimmune disease during pregnancy on learning disabilities and hand preference in their children. Arch Pediatr Adolesc Med 2003; 157:397-402. [PMID: 12695238 DOI: 10.1001/archpedi.157.4.397] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine whether children (and particularly sons) of women with systemic lupus erythematosus (SLE) during pregnancy are more likely to have learning disabilities (LD) and be non-right-handed, and if maternal disease variables (ie, presence of maternal antibodies, disease activity level, and use of corticosteroids) predict the prevalence of LD in offspring. DESIGN Case-controlled study with subjects matched by age and sex. PARTICIPANTS We studied 58 children whose mothers had SLE during pregnancy and 58 children of healthy mothers. Measures Data collected included maternal disease variables in women with SLE during their pregnancies. All children took a standardized intelligence test (Wechsler Intelligence Scale for Children-III) and completed a modified version of the Edinburgh Hand Preference Questionnaire. They also took standardized tests of reading, arithmetic, and writing achievement. Learning disability was defined as having an academic achievement score of at least 1.5 SDs below the Full-Scale IQ. RESULTS Sons of women with SLE were significantly more likely to have LD than daughters of women with SLE or children of either sex in the control group. Maternal SLE was not associated with non-right-handedness in sons or daughters. The presence of anti-Ro/La antibodies and disease activity (flare) in mothers during pregnancy were significantly related to higher prevalence of LD in offspring. CONCLUSIONS Autoimmune disease in women during pregnancy is associated with an increased risk for LD in their sons. Maternal antibodies, particularly anti-Ro/La, likely affect the fetal brain of male offspring and result in later learning problems. These findings should promote greater awareness of the risk for LD in sons of women with autoimmune disease and the possible need for early educational intervention in those children.
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Affiliation(s)
- Gail Ross
- Department of Pediatrics, New York Presbyterian Hospital, New York, NY 10021, USA.
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Erkan D, Yazici Y, Peterson MG, Sammaritano L, Lockshin MD. A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology (Oxford) 2002; 41:924-9. [PMID: 12154210 DOI: 10.1093/rheumatology/41.8.924] [Citation(s) in RCA: 214] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Antiphospholipid antibodies (aPL) are major risk factors for thrombosis. Other clinical factors exist in antiphospholipid syndrome (APS) patients which may have an additive or preventive effect on thrombosis. We therefore performed a cross-sectional study to analyse additive clinical thrombotic risk factors and possible preventive treatments in APS patients, and to compare the results with those obtained in asymptomatic aPL-positive (no history of vascular thrombosis or pregnancy morbidity) patients. METHODS We identified 77 APS patients with non-gravid thrombotic events (group A) and 56 asymptomatic aPL-positive patients (group B). The study periods were defined as 6 months prior to the time of first vascular event in group A and 6 months prior to the patient's last visit in group B. Medical records were reviewed to evaluate the incidence of hypertension, diabetes mellitus, hypercholesterolaemia, regular cigarette smoking, oral contraceptive use or hormone replacement therapy, surgical procedures, pregnancy with or without an APS-related event, malignancy and infections. In addition, any history of thrombocytopenia or the use of aspirin, hydroxychloroquine, corticosteroids or immunosuppressives during the study periods was recorded. Bivariate statistical analysis and logistic regression tests were performed to compare groups. RESULTS In group A, 75% (n=58) of patients and in group B 48% (n=27) of patients had at least one of the additional risk factors during the study periods. In the bivariate analysis, pregnancy (P=0.005) and surgical procedures (P=0.04) were significantly more frequent in group A, while aspirin (P<0.001), hydroxychloroquine (P<0.001) and corticosteroids (P=0.002) were used significantly more frequently in group B. In logistic regression, the probability of an event was decreased by taking aspirin and/or hydroxychloroquine. In women only, the probability of an event was increased with thrombocytopenia and pregnancy or surgical procedures. The incidences of hypertension and smoking and the presence of more than one risk factor were significantly associated with arterial thrombosis but not venous thrombosis. CONCLUSION While traditional risk factors were similar between groups, pregnancy and surgical procedures increased the risk of thrombosis. Hypertension and smoking were associated with arterial events. Possessing a combination of risk factors may increase the occurrence of arterial thrombosis but not venous thrombosis. Use of aspirin and/or hydroxychloroquine may be protective against thrombosis in asymptomatic aPL-positive individuals.
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Affiliation(s)
- D Erkan
- Department of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York 10021, SA
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Erkan D, Merrill JT, Yazici Y, Sammaritano L, Buyon JP, Lockshin MD. High thrombosis rate after fetal loss in antiphospholipid syndrome: effective prophylaxis with aspirin. Arthritis Rheum 2001; 44:1466-7. [PMID: 11407709 DOI: 10.1002/1529-0131(200106)44:6<1466::aid-art242>3.0.co;2-c] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- D Erkan
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
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Roman MJ, Salmon JE, Sobel R, Lockshin MD, Sammaritano L, Schwartz JE, Devereux RB. Prevalence and relation to risk factors of carotid atherosclerosis and left ventricular hypertrophy in systemic lupus erythematosus and antiphospholipid antibody syndrome. Am J Cardiol 2001; 87:663-6, A11. [PMID: 11230862 DOI: 10.1016/s0002-9149(00)01453-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The prevalence of preclinical cardiovascular disease was determined in women with systemic lupus erythematosus (SLE) and control subjects matched for traditional risk factors. Compared with control subjects, patients with SLE had a higher prevalence of carotid atherosclerosis (41% vs 9%, p < 0.005) and left ventricular hypertrophy (32% vs 5%, p < 0.005), supporting the possibility that chronic inflammation predisposes to premature cardiovascular disease in SLE.
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Affiliation(s)
- M J Roman
- Division of Cardiology, The New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA.
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Guballa N, Sammaritano L, Schwartzman S, Buyon J, Lockshin MD. Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome. Arthritis Rheum 2000; 43:550-6. [PMID: 10728747 DOI: 10.1002/1529-0131(200003)43:3<550::aid-anr10>3.0.co;2-y] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE During ovulation induction (OI), ovarian stimulation is accomplished by hormonal manipulation, which includes administration of gonadotropins, gonadotropin-releasing hormone agonists, follicle-stimulating hormone, and luteinizing hormone. In in vitro fertilization (IVF), progesterone is often added. Because of the possibility of hormone-associated flare or thrombosis, patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (primary APS) undergoing OI/IVF are potentially at increased risk. The present study was conducted in order to assess this risk. METHODS Nineteen women who underwent 68 cycles of OI/IVF were studied by interview and retrospective chart review. RESULTS Four OI/IVF cycles (25%) in SLE patients resulted in increased lupus activity and 2 (13%) in ovarian hyperstimulation syndrome. One patient with primary APS who was given heparin during multiple cycles developed osteopenia. No thrombosis occurred. Pregnancy complications included toxemia, lupus flare, gastrointestinal hemorrhage due to Mallory-Weiss tear, polygestation, and diabetes. Postpartum complications included nephritis flare, costochondritis, and suicidal depression. Lupus flares occurred at expected rates. Five of 16 cycles (31%) in 7 SLE patients, 5 of 48 cycles (10%) in 10 primary APS patients, and 0 of 5 cycles in 2 women with antiphospholipid antibody (without SLE or primary APS) resulted in liveborn children, including multiple gestations (3 twin sets with 4 surviving infants and 2 triplet sets with 3 surviving infants). Seven of 14 living children (50%) were premature, 3 had neonatal lupus, and 1 had pulmonic stenosis. Five surviving infants (38%) had complications unrelated to prematurity. CONCLUSION Although OI/IVF can be successful in SLE and primary APS patients, rates of fetal and maternal complications are high.
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Affiliation(s)
- N Guballa
- Weill Medical College of Cornell University, New York, New York, USA
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Yazici Y, Onel K, Sammaritano L. Neonatal lupus erythematosus in triplets. J Rheumatol 2000; 27:807-9. [PMID: 10743829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Neonatal lupus erythematosus (NLE) is an inflammatory syndrome in the fetus or neonate associated with the presence of anti-Ro(SSA) and anti-La(SSB) antibodies in the mother. It is characterized by a combination of dermatologic, hematologic, hepatic, and cardiac manifestations. NLE has been reported in twins; we describe neonatal lupus erythematosus occurring in triplets.
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Affiliation(s)
- Y Yazici
- Division of Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA.
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Roman M, Salmon J, Sobel R, Sammaritano L, Devereux R, Lockshin M. Association of accelerated atherosclerosis and myocardial hypertrophy with systemic lupus erythematosus. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Qamar T, Levy RA, Sammaritano L, Gharavi AE, Lockshin MD. Characteristics of high-titer IgG antiphospholipid antibody in systemic lupus erythematosus patients with and without fetal death. Arthritis Rheum 1990; 33:501-4. [PMID: 2109614 DOI: 10.1002/art.1780330406] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although high-titer IgG antiphospholipid antibody (aPL) is a predictor of mid-pregnancy fetal death in women with systemic lupus erythematosus (SLE), some SLE patients with high-titer aPL carry pregnancies normally, and to term. To determine potential antibody differences between IgG aPL-positive women with and without fetal death, we studied aPL isotype, subclass, anticoagulant activity, phospholipid specificity, and antibody avidity in selected sera from pregnant SLE patients with high-titer IgG aPL. For controls, we selected sera from pregnant SLE patients who had negative results on tests for IgG aPL (with and without fetal loss). None of the specified antibody characteristics distinguished between the aPL-positive patient groups, nor were other specificities defined in IgG aPL-negative sera from women with fetal death. Although high-titer aPL is a good predictor of fetal death, currently known characteristics, other than a high titer of aPL, do not identify which women will experience this complication.
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Affiliation(s)
- T Qamar
- Division of Rheumatic Diseases, Hospital for Special Surgery, New York, New York
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