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Beça S, Alba MA, Hernández-Rodríguez J, Espígol-Frigolé G, Prieto-González S, Cid MC, Baños N, Espinosa G. Maternal and fetal outcomes of pregnancy in women with primary systemic vasculitis: A single-center cohort study of 20 patients and 30 pregnancies. Semin Arthritis Rheum 2024; 66:152412. [PMID: 38387195 DOI: 10.1016/j.semarthrit.2024.152412] [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: 07/21/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To analyze pregnancy outcomes of patients with primary systemic vasculitis followed in a third-level referral center. METHODS Retrospective cohort study of all pregnant women with systemic vasculitis followed between 2009 and 2022 at the High-Risk Pregnancy Clinic of the Department of Systemic Autoimmune Diseases of the Hospital Clínic, Barcelona. RESULTS Twenty women with primary vasculitis were identified, with a total of 30 pregnancies. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (n = 7) and Behçet disease (n = 4) were the most frequent types of vasculitis. All women had the diagnosis of vasculitis before pregnancy, with a median time between disease diagnosis and pregnancy of 5.8 years (range: 2 months-29 years). Most were in remission at conception (76.7 %). During pregnancy, a vasculitis flare occurred in 4 (13.3 %) patients (one each with Takayasu arteritis, eosinophilic granulomatosis with polyangiitis [EGPA], IgA vasculitis [IgAV], and Behçet disease [BD]). Four (16.7 %) of the successful pregnancies had post-partum relapses (one each with EGPA, granulomatosis with polyangiitis, IgAV, and BD). Eighty percent of pregnancies resulted in live babies. In four cases (13.3 %), medical termination of pregnancy was decided, considering the mother or baby health risk. There were two spontaneous miscarriages, and no stillbirths or neonatal deaths. Preeclampsia was the most frequent maternal complication (25 %). Newborns were preterm in 24 % and low birthweight in 20 % of cases. No maternal deaths occurred. CONCLUSIONS This cohort study shows that vasculitis relapses during pregnancy and post-partum, together with other pregnancy complications, occur in a considerable number of patients with systemic vasculitides, although a final good pregnancy outcome can be expected in most cases. These findings emphasize the convenience of managing these special situations in expert reference centers.
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Affiliation(s)
- Sara Beça
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marco A Alba
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Georgina Espígol-Frigolé
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - María C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Núria Baños
- Department of Maternal-Fetal Medicine, BCNatal, Barcelona Centre for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain.
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Adami G, Alarcon G, Albert D, Allen K, Aringer M, Arkema EV, Ashour HM, Atzeni F, Ayan G, Baer A, Baker J, Barber C, Bautista-Molano W, Beça S, Beamer B, Bergstra SA, Bermas B, Bilgin E, Boers M, Bolster M, Bosco J, Bowden JL, Buttgereit F, Calabrese L, Campochiaro C, Cappelli L, Carmona L, Carvalho J, Castañeda S, Chao Chao CM, Chatterjee S, Cherry L, Christensen R, Coates LC, Cohen SB, Collins JE, Cornec D, D'Agostino MA, Daikeler T, D'Angelo S, de Boysson H, de Jong P, de Wit M, Dellaripa P, Dessein P, Diekhoff T, Doumen M, Eckstein F, Elhai M, Fairley JL, Felson D, Amaro IF, Ferucci E, Fiorentino D, FitzGerald J, Fleischmann R, Galloway J, Salinas RG, Giorgi V, Golightly Y, Gono T, Gonzalez-Gay MA, Goules A, Gravallese E, Griffith M, Grosman S, Gupta L, Hamuryudan V, Hana C, Haschka J, Hawker G, Hervas-Perez JP, Hocevar A, Iudici M, Iyer P, Jasmin M, Judson M, Kerschbaumer A, Kiefer D, Kiltz U, Kivity S, Kremer JM, Kroon FPB, Kviatkovsky S, Lee BS, Liew D, Lim SY, Littlejohn G, Medina CL, Maksymowych W, March L, Marotte H, Navarro OM, Mavragani C, McInnes I, McMahan Z, Meara A, Mecoli C, Merriman T, Mikdashi J, Mikuls T, Misra DP, Mitchell BD, Moore T, Moutsopoulos H, Naredo E, Nash P, Nurmohamed M, Oddis C, Ojaimi S, Oliver M, Ozen S, Ozgocmen S, Palmowski A, Pascart T, Perelas A, Pile K, Pincus T, Poddubnyy D, Ramiro S, Reddy A, Regierer A, Roccatello D, Rookes T, Rosenthal A, Rubinstein T, Rudwaleit M, Rueda-Gotor J, Rus V, Saketkoo LA, Samson M, Schur P, Sepriano A, Shadmanfar S, Shmagel A, Sibbitt WL, de Souza AWS, Sims C, Singh N, Sjöwall C, Smith V, Song JJ, Soriano ER, Sparks J, Studenic P, Sugihara T, Suissa S, Szekanecz Z, Tascilar K, Taylor P, Terkeltaub R, Tiniakou E, Todd N, Vilarino GT, Treemarcki E, Tsuji H, Turesson C, Twilt M, Vassilopoulos D, Vojinovic T, Volkmann E, Vosse D, Wagner-Weiner L, Wallace ZS, Wallace D, Wang GC, Wei J, Weisman MH, Westhovens R, Winthrop K, Wysham KD, Xue J, Yang C, Yau M, Yazici Y, Yazici H, YIM ICW, Young J, Zhang W. Referees. Semin Arthritis Rheum 2024:152375. [PMID: 38245402 DOI: 10.1016/j.semarthrit.2024.152375] [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] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
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Rato IR, Barbosa AR, Afonso DJ, Beça S. Catastrophic antiphospholipid syndrome presented as ruptured papillary muscle during puerperium in a patient with systemic lupus erythematosus. Lupus 2021; 30:1017-1021. [PMID: 33736518 DOI: 10.1177/09612033211002273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Catastrophic antiphospholipid syndrome (CAPS) is a rare and serious phenomenon that requires prompt recognition and treatment. CASE PRESENTATION The authors present the case of a puerperal woman with systemic lupus erythematosus (SLE) admitted to the emergency room with headache, blurred vision, thoracic pain, and purpuric lesions on both ears. Echocardiogram revealed global decrease in left ventricular function while cardiac and inflammatory markers were elevated. Three days after admission she developed cardiogenic shock due to rupture of mitral papillary muscle which required emergent cardiac surgery, with replacement of the mitral valve; treatment with anticoagulation, high-dose glucocorticoids, and intravenous immunoglobulins were initiated. Cardiac and brain MRI revealed signs of ischemic lesions in both organs. Histopathology analysis of the placenta and papillary muscle showed signs of ischemia secondary to microvascular thrombosis. Based on the clinical demonstration of thrombosis in three organs, and the presence of lupus anticoagulant antibodies, a diagnosis of probable CAPS was established. CONCLUSION This case highlights the importance of a high level of suspicion of CAPS, particularly in patients with risk factors, and the value of immediate adequate treatment. Moreover, the rupture of a papillary muscle with histologically consistent signs of antiphospholipid syndrome expands the spectrum of involvement of this disease and should be considered as a rare but life-threatening possibility in patients with myocardial injury.
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Affiliation(s)
- Inês Rueff Rato
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Rita Barbosa
- Department of Internal Medicine, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - David João Afonso
- Department of Anatomic Pathology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sara Beça
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Freitas A, Coelho T, Beça S, Gregório T. Pleural Effusion Secondary to Obstructive Uropathy: A Case of Urinothorax. Eur J Case Rep Intern Med 2020; 7:001865. [PMID: 33312995 PMCID: PMC7727635 DOI: 10.12890/2020_001865] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/19/2020] [Indexed: 11/05/2022] Open
Abstract
Urinothorax is a rare type of pleural effusion and usually the result of genitourinary tract disease. An accurate and early diagnosis is crucial as resolution of the underlying pathology is the mainstay of treatment. We report the case of a 69-year-old man who was admitted to the Internal Medicine ward due to obstructive acute kidney injury of unknown origin. The patient was submitted to urinary catheterization and to right percutaneous nephrostomy. Two weeks after admission he developed a large left pleural effusion; a left urinoma was also visible on computed tomography. After thoracentesis, pleural fluid analysis demonstrated a paucicellular transudate with pH <7.40 and pleural fluid/serum creatinine ratio >1.0. The diagnosis of urinothorax was made and further study allowed the diagnosis of prostate cancer as the aetiology of the obstruction. When bilateral percutaneous nephrostomy was performed, resolution of the urinothorax and normalization of renal function occurred. LEARNING POINTS Urinothorax is a rare and possibly under-recognized cause of transudative pleural effusion; over the last five decades, fewer than 60 cases have been reported in the English literature worldwide.Diagnosis of urinothorax depends upon a high index of clinical suspicion and on pleural fluid analysis, but imaging can also support the diagnosis, for example by showing the presence of a urinoma.Clinicians should recognize urinothorax early in its clinical course as favourable outcomes are often achieved after correction of the underlying genitourinary tract pathology.
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Affiliation(s)
- Andreia Freitas
- Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Telmo Coelho
- Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sara Beça
- Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Tiago Gregório
- Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Reis MSR, Salvador P, Gomes AM, Beça S, Fernandes JC. P0765RHEUMATOID ARTHRITIS AND CHRONIC KIDNEY DISEASE: DOES INFLAMMATION SAY IT ALL? Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Rheumatoid arthritis (RA) increase risk of developing chronic kidney disease (CKD), but it is unknow which risk factors contributes to CKD in this population. This study aims to determine predictors for the development of CKD in RA patients.
Method
A retrospective study was conducted in 106 patients with RA followed at a sub-specialized internal medicine appointment between January 2007 and December 2017. RA was defined according to the American College of Rheumatology criteria and CKD was defined as an estimated glomerular filtration rate less than 60mL/min/ 1.73m2 or presence of abnormalities of urinary sediment for 3 months.
Results
The mean age was 61 ± 12.83 years, and 67.9% (n=72) were female. The prevalence of CKD was 20.8% (n=22). Renal disease had multifactorial etiology in 20 patients, and one case of ANCA negative glomerulonephritis and other of diabetic nephropathy. Individuals with RA and CKD were older, presented more cardiovascular disease, diabetes and hypertension. There was no statistically significant association between gender and the presence of CKD (p = 0.131). Age (p = 0.031) and diabetes (p = 0.031) were independent risk factors for development of CKD in RA patients. RA duration in patients with CKD (8, 4-13) was not statistically different from RA duration in non-CKD patients (7.50, 4,75 – 12,25), (p=0.890).
Conclusion
Patients with RA and CKD had higher incidence of cardiovascular events, diabetes and hypertension which are a major cause of mortality and morbidity in this group. The presence of diabetes mellitus that often arise as an adverse effect of drugs used in the treatment of RA, significantly increased the risk of developing CKD. Otherwise, RA duration didn’t represent a risk factor for developing CKD. Thus, it is important to control diabetes, particularly glucocorticoid-induced diabetes to prevent development of CKD in AR patients.
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Affiliation(s)
| | - Pedro Salvador
- Vila Nova de Gaia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Marta Gomes
- Vila Nova de Gaia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sara Beça
- Vila Nova de Gaia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carlos Fernandes
- Vila Nova de Gaia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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