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Radin M, Cecchi I, Crisafulli F, Klumb EM, de Jesús GR, Lacerda MI, Saavedra MÁ, Reyes-Navarro GV, Iaccarino L, Larosa M, Moroni G, Tamborini F, Roccatello D, Andreoli L, Sciascia S, Chighizola CB. Complement levels during the first trimester predict disease flare and adverse pregnancy outcomes in systemic lupus erythematosus: A network meta-analysis on 532 pregnancies. Autoimmun Rev 2023; 22:103467. [PMID: 37852515 DOI: 10.1016/j.autrev.2023.103467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Complement levels have been proposed as candidate biomarkers of disease activity and obstetric risk in systemic lupus erythematosus (SLE) pregnancies, but their reliability has been questioned due to the physiologic fluctuations of complement during gestation. Thus, this network meta-analysis aimed at assessing the clinical significance of complement fluctuations in lupus pregnant women. METHODS Corresponding authors of 19 studies meeting inclusion criteria were invited to contribute with additional data including C3 and C4 levels [before pregnancy, at conception, in every trimester (T) and 3 months after delivery]; data were pooled together in a network meta-analysis. RESULTS A total of 532 lupus women from four studies were included in the analysis. In SLE women, C3 and C4 increased progressively during gestation: levels remained stable during T1 and peaked in T2 to decrease in T3. Patients with previous lupus nephritis (LN) and those who experienced flares during pregnancy had significantly lower mean levels of C3 and C4 at all timepoints. The lowest levels of complement were observed, particularly during T1, in patients with LN and gestational flare. Both reduction and the lack of increase of C3 and C4 levels at T1 versus conception were associated with gestational flares, particularly in LN patients. Pregnancies with flare had a statistically significant higher rate of maternal and fetal complications(60% versus 50.3%; p = 0.03). CONCLUSIONS Low complement levels, particularly in T1, were associated with a higher frequency of gestational flare. Either reduction or smaller increase of C3 and/or C4 levels, even within normal range, might predict flares especially in early gestation.
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Affiliation(s)
- Massimo Radin
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Irene Cecchi
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST SpedaliCivili of Brescia, University of Brescia, Brescia, Italy
| | - Evandro Mendes Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Miguel Ángel Saavedra
- RheumatologyDepartment, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy; Division of Rheumatology, Department of Locomotor System, ASL3, Genoa, Italy
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy; IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | | | - Dario Roccatello
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST SpedaliCivili of Brescia, University of Brescia, Brescia, Italy
| | - Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
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Tani C, Zucchi D, Bellis E, Birru Talabi M, Frise C, de Jesús GR, Koksvik HS, Lledó GM, Mekinian A, Marinello D, Palla I, Mehta P, Sáez Comet L, Shaimaa S, Smeele HTW, Talarico R, Brucato A, Khamashta M, Shoenfeld Y, Tincani A, Mosca M. Patient Care Pathways for Pregnancy in Rare and Complex Rheumatic Diseases: Results From an International Survey. J Rheumatol 2023:jrheum.220773. [PMID: 36642433 DOI: 10.3899/jrheum.220773] [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: 01/16/2023]
Abstract
OBJECTIVE To map existing organizational care pathways in clinical centers of expertise that care for pregnant women affected by rare and complex connective tissue diseases (rcCTDs). METHODS An international working group composed of experts in the field of pregnancy in rcCTDs co-designed a survey focused on organizational aspects related to the patient's pathway before, during, and after pregnancy. The survey was distributed to subject experts through referral sampling. RESULTS Answers were collected from 69 centers in 21 countries. Patients with systemic lupus erythematosus and/or antiphospholipid syndrome were followed by more than 90% of centers, whereas those with disorders such as IgG4-related diseases were rarely covered. In the majority of centers, a multidisciplinary team was involved, including an obstetrician/gynecologist in 91.3% of cases and other healthcare professionals less frequently. Respondents indicated that 96% of the centers provided routine pre-pregnancy care, whereas the number of patient visits during pregnancy varied across centers. A formalized care pathway was described in 49.2% of centers, and 20.3% of centers had a predefined protocol for the monitoring of pregnant patients. Access to therapies during pregnancy also was heterogeneous among different centers. CONCLUSION In international referral centers, a high level of care is provided to patients with rcCTDs before, during, and after pregnancy. No significant discrepancies were found between European and non-European countries. However, this work highlights a potential benefit to streamlining the care approaches across countries to optimize pregnancy and perinatal outcomes among patients with rcCTDs.
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Affiliation(s)
- Chiara Tani
- C. Tani, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- D. Zucchi, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Bellis
- E. Bellis, MD, Rheumatology Unit, Mauriziano Umberto I Hospital, Turin Italy, and Rheumatology Unit, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Mehret Birru Talabi
- M. Birru Talabi, MD, PhD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charlotte Frise
- C. Frise, MD, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Hege Svean Koksvik
- H.S. Koksvik, MD, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gema Maria Lledó
- G.M. Lledó, MD, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Arsène Mekinian
- A. Mekinian, MD, Sorbonne University, Internal Medicine Department, Saint Antoine Hospital, Paris, France
| | - Diana Marinello
- D. Marinello, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Ilaria Palla
- I. Palla, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Puja Mehta
- P. Mehta, MD, Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Luis Sáez Comet
- L.S. Comet, MD, Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Shoela Shaimaa
- S. Shaimaa, MD, Internal Medicine & Rheumatology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Hieronymus T W Smeele
- H.T.W. Smeele, MD, Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
| | - Rosaria Talarico
- R. Talarico, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Brucato
- A. Brucato, MD, Università di Milano, Department of Biomedical and Clinical Sciences, Milan, Italy
| | - Munther Khamashta
- M. Khamashta, MD, PhD, Department of Women and Children's Health, King's College London, London, UK, and Gulf Medical Expert-Lupus, GSK, Dubai, UAE
| | | | - Angela Tincani
- A. Tincani, MD, Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marta Mosca
- M. Mosca, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Erton ZB, K Leaf R, de Andrade D, Clarke AE, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, Lopez-Pedrera C, Atsumi T, Zhang Z, Cohen H, Ramires de Jesús G, Branch DW, Wahl D, Andreoli L, Rodriguez-Almaraz E, Petri M, Barilaro G, Zuo Y, Artim-Esen B, Willis R, Quintana R, Vendramini MB, Barber MW, Bertolaccini ML, Roubey R, Erkan D. Immunosuppression use in primary antiphospholipid antibody-positive patients: Descriptive analysis of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ("Registry"). Lupus 2022; 31:1770-1776. [PMID: 36206383 DOI: 10.1177/09612033221128742] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE APS ACTION Registry was created to study the outcomes of patients with persistently positive antiphospholipid antibodies (aPL) with or without other systemic autoimmune disease (SAIDx). Given that immunosuppression (IS) is used for certain aPL manifestations, for example, thrombocytopenia (TP), our primary objective was to describe the indications for IS in aPL-positive patients without other SAIDx. Secondly, we report the type of IS used in patients with selected microvascular or non-thrombotic aPL manifestations. METHODS An online database is used to collect clinical data. The inclusion criteria are positive aPL based on the laboratory section of the APS Classification Criteria, tested at least twice within one year prior to enrollment. Patients are followed every 12 ± 3 months. For this descriptive retrospective and prospective analysis, we included aPL-positive patients without other SAIDx and excluded those with new SAIDx classification during follow-up. For each patient, we retrieved clinical data at baseline and follow-up including selected aPL manifestations (diffuse alveolar hemorrhage [DAH], antiphospholipid-nephropathy [aPL-N], livedoid vasculopathy [LV]-related skin ulcers, TP, autoimmune hemolytic anemia [AIHA], cardiac valve disease [VD]), and IS medications. RESULTS Of 899 patients enrolled, 537 were included in this analysis (mean age 45 ± 13 years, female 377 [70%], APS Classification in 438 [82%], and at least one selected microvascular or non-thrombotic aPL manifestation in 141 (26%)). Of 537 patients, 76 (14%) were reported to use IS (ever), and 41/76 (54%) received IS primarily for selected aPL manifestation. In six of 8 (75%) DAH patients, 6/19 (32%) aPL-N, 4/28 (14%) LV, 25/88 (28%) TP, 6/11 (55%) AIHA, and 1/43 (2%) VD, the IS (excluding corticosteroids/hydroxychloroquine) indication was specific for selected aPL manifestation. CONCLUSION In our international cohort, 14% of aPL-positive patients without other SAIDx were reported to receive IS; the indication was at least one of the selected microvascular and/or non-thrombotic aPL-related manifestations in half. Thrombocytopenia was the most frequent among those selected aPL-related manifestations; however, approximately one-third received IS specifically for that indication. Diffuse alveolar hemorrhage was frequently treated with IS followed by AIHA and aPL-N. Systematic controlled studies are urgently needed to better define the role of IS in APS.
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Affiliation(s)
- Zeynep B Erton
- Rheumatology, 25062Hospital for Special Surgery, New York, NY, USA
| | - Rebecca K Leaf
- Hematology, 2348Massachusetts General Hospital, Boston, MA, USA
| | | | - Ann E Clarke
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | - Maria G Tektonidou
- Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vittorio Pengo
- Cardiothoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Savino Sciascia
- Centro Multidisciplinare di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Struttura Complessa a Direzione Universitaria di Immunologia Clinica, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Rheumatology, BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - H Michael Belmont
- Rheumatology, New York University Langone Medical Center, New York, NY, USA
| | - Maria Gerosa
- Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paul R Fortin
- Rheumatology, CHU de Québec- Université Laval, Quebec, QC, Canada
| | - Chary Lopez-Pedrera
- Rheumatology, Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - Tatsuya Atsumi
- Medicine II, Hokkaido University Hospital, Sapporo, Japan
| | - Zhouli Zhang
- Rheumatology, Peking University First Hospital, Beijing, China
| | - Hannah Cohen
- Haematology, 4919University College London, London, UK
| | | | - David W Branch
- Obstetrics and Gynecology, 14434University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Denis Wahl
- Rheumatology, Université de Lorraine, Inserm DCAC, and CHRU-Nancy, Nancy, France
| | | | | | - Michelle Petri
- Rheumatology, 1466Johns Hopkins University, Baltimore, MD, USA
| | | | - Yu Zuo
- Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Bahar Artim-Esen
- Internal Medicine, Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Rohan Willis
- Internal Medicine, 12334University of Texas Medical Branch, Galveston, TX, USA
| | - Rosana Quintana
- Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas GO-CREAR, Rosario Santa Fe Argentina
| | | | - Megan W Barber
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | | | - Robert Roubey
- Rheumatology, Allergy & Immunolog, University of North Carolina, Chapel Hill, NC, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, 25062Hospital for Special Surgery Weill Cornell Medicine, New York, NY, USA
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Bettiol A, Ramires de Jesús G, Haase I, Andreoli L, Urban ML. Editorial: New insights into pathophysiology and management of pregnancy in systemic autoimmune diseases: Toward new therapeutic approaches. Front Pharmacol 2022; 13:1017067. [PMID: 36278194 PMCID: PMC9584806 DOI: 10.3389/fphar.2022.1017067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Guilherme Ramires de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil
| | - Isabell Haase
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- *Correspondence: Maria Letizia Urban,
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Erton ZB, Sevim E, de Jesús GR, Cervera R, Ji L, Pengo V, Ugarte A, Andrade D, Andreoli L, Atsumi T, Fortin PR, Gerosa M, Zuo Y, Petri M, Sciascia S, Tektonidou MG, Aguirre-Zamorano MA, Branch DW, Erkan D. Pregnancy outcomes in antiphospholipid antibody positive patients: prospective results from the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ('Registry'). Lupus Sci Med 2022; 9:e000633. [PMID: 35701043 PMCID: PMC9198709 DOI: 10.1136/lupus-2021-000633] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the outcomes of pregnancies in antiphospholipid antibody (aPL)-positive patients since the inception of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Registry. METHODS We identified persistently aPL-positive patients recorded as 'pregnant' during prospective follow-up, and defined 'aPL-related outcome' as a composite of: (1) Preterm live delivery (PTLD) at or before 37th week due to pre-eclampsia (PEC), eclampsia, small-for-gestational age (SGA) and/or placental insufficiency (PI); or (2) Otherwise unexplained fetal death after the 10th week of gestation. The primary objective was to describe the characteristics of patients with and without aPL-related composite outcomes based on their first observed pregnancies following registry recruitment. RESULTS Of the 55 first pregnancies observed after registry recruitment among nulliparous and multiparous participants, 15 (27%) resulted in early pregnancy loss <10 weeks gestation. Of the remaining 40 pregnancies: (1) 26 (65%) resulted in term live delivery (TLD), 4 (10%) in PTLD between 34.0 weeks and 36.6 weeks, 5 (12.5%) in PTLD before 34th week, and 5 (12.5%) in fetal death (two associated with genetic anomalies); and (2) The aPL-related composite outcome occurred in 9 (23%). One of 26 (4%) pregnancies with TLD, 3/4 (75%) with PTLD between 34.0 weeks and 36.6 weeks, and 3/5 (60%) with PTLD before 34th week were complicated with PEC, SGA and/or PI. Fifty of 55 (91%) pregnancies were in lupus anticoagulant positive subjects, as well as all pregnancies with aPL-related composite outcome. CONCLUSION In our multicentre, international, aPL-positive cohort, of 55 first pregnancies observed prospectively, 15 (27%) were complicated by early pregnancy loss. Of the remaining 40 pregnancies, composite pregnancy morbidity was observed in 9 (23%) pregnancies.
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Affiliation(s)
- Zeynep Belce Erton
- Divison of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Ecem Sevim
- Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Guilherme Ramires de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricard Cervera
- Autoimmune Diseases, Hospital Clínic de Barcelona Institut Clínic de Medicina i Dermatologia, Barcelona, Spain
| | - Lanlan Ji
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, Beijing, China
| | - Vittorio Pengo
- Cardiac Thoracic and Vascular Sciences, University of Padova, padua, Italy
| | - Amaia Ugarte
- Internal Medicine, Hospital de Cruces, Barkaldo, Spain
| | - Danieli Andrade
- Rheumatology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Tatsuya Atsumi
- Medicine II, Hokkaido University School of Medicine, Sapporo, Japan
| | - Paul R Fortin
- Medicine - Rheumatology, Centre Hospitalier de l'Université Laval, Quebec City, Quebec, Canada
| | - Maria Gerosa
- Dept. of Clinical & Community Science University of Milano, Division of Rheumatology, Milano, Italy
| | - Yu Zuo
- Internal Medicine/Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Petri
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Savino Sciascia
- Dipartimento di Malattie Rare, Immunologiche, Ematologiche ed Immunoematologiche. Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare (CMID). Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Ospedale Torino Nord Emergenza San G. Bosco ed Università di Torino, Torino, Italy
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - D Ware Branch
- Maternal-Fetal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Maternal- Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Doruk Erkan
- Rheumatology, Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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Chighizola CB, de Jesús GR, Gerosa M, Avčin T. Editorial: Therapeutic Implications for Pregnant Women With Systemic Autoimmune Diseases and Their Children. Front Pharmacol 2021; 12:773970. [PMID: 34899335 PMCID: PMC8664155 DOI: 10.3389/fphar.2021.773970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Pediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Guilherme Ramires de Jesús
- Department of Obstetrics, Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil.,Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, Ljubljana, Slovenia.,University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
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Dos Santos FC, Ignacchiti ML, Rodrigues B, Velarde LG, Levy RA, de Jesús GR, de Jesús NR, de Andrade CAF, Klumb EM. Premature rupture of membranes - A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis. Lupus 2021; 30:2042-2053. [PMID: 34806483 DOI: 10.1177/09612033211045056] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study aimed to analyse the frequency of premature rupture of membranes (PROMs) among 190 women with systemic lupus erythematosus (SLE) followed up at the Hospital Universitário Pedro Ernesto from 2011 to 2018 and to review the literature on PROM in patients with SLE. METHODS A cohort study of SLE patients was conducted by analysing the following variables: sociodemographic characteristics, clinical manifestations of lupus, modified disease activity index for pregnancy, drugs used during pregnancy, intercurrent maternal infections and obstetric outcomes. Additionally, seven electronic databases (PubMed, Embase, Cochrane, Scielo, Scielo Brazil, Virtual Health Library Regional Portal and Google Scholar) were systematically searched. The search was updated on 3 February 2020. RESULTS Infections (relative risk (RR): 3.26, 95% confidence interval (CI): 1.5-6.7, p = .001), history of serositis (RR: 2.59, 95% CI: 1.31-5.11, p = .006) and anti-RNP positivity (RR: 3.08, 95% CI: 1.39-6.78, p = .005) were associated risk factors for PROM, while anti-RNP positivity (RR: 3.37, 95% CI: 1.35-8.40; p = .009) were associated with premature PROM (PPROM). The prevalence of PROM and PPROM was 28.7% and 12.9%, respectively. In the systematic review, the prevalence of PROM and PPROM was 2.7%-35% (I2 = 87.62%) and 2.8%-20% (I2 = 79.56%), respectively. CONCLUSIONS PROM, both at term and preterm, occurs more frequently in women with lupus than in the general population. A history of serositis, anti-RN, infections and immunosuppression during pregnancy may increase the susceptibility to PROM. The systematic review did not find any study with the main objective of evaluating PROM/PPROM in women with lupus.
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Affiliation(s)
- Flávia Cunha Dos Santos
- Department of Obstetrics, 28130Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | | - Bruna Rodrigues
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | - Luis Guillermo Velarde
- Postgraduate Program in Medical Sciences, 28110Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Roger Abramino Levy
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | | - Nilson Ramires de Jesús
- Department of Obstetrics, 28130Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Department of Epidemiology, Quantitative Methods in Health, 42499Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Evandro Mendes Klumb
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
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de Azevedo Lopes E, Balbi GGM, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, Lopez-Pedrera C, Ji L, Cohen H, de Jesús GR, Branch DW, Nalli C, Petri M, Rodriguez E, Kello N, Ríos-Garcés R, Knight JS, Atsumi T, Willis R, Bertolaccini ML, Erkan D, Andrade D. Clinical and laboratory characteristics of Brazilian versus non-Brazilian primary antiphospholipid syndrome patients in AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) clinical database and repository. Adv Rheumatol 2021; 61:64. [PMID: 34711275 DOI: 10.1186/s42358-021-00222-3] [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: 07/09/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is characterized by episodes of thrombosis, obstetric morbidity or both, associated with persistently positive antiphospholipid antibodies (aPL). Studying the profile of a rare disease in an admixed population is important as it can provide new insights for understanding an autoimmune disease. In this sense of miscegenation, Brazil is characterized by one of the most heterogeneous populations in the world, which is the result of five centuries of interethnic crosses of people from three continents. The objective of this study was to compare the clinical and laboratory characteristics of Brazilian vs. non-Brazilian primary antiphospholipid syndrome (PAPS) patients. METHODS We classified PAPS patients into 2 groups: Brazilian PAPS patients (BPAPS) and PAPS patients from other countries (non-BPAPS). They were compared regarding demographic characteristics, criteria and non-criteria APS manifestations, antiphospholipid antibody (aPL) profile, and the adjusted Global Antiphospholipid Syndrome Score (aGAPSS). RESULTS We included 415 PAPS patients (88 [21%] BPAPS and 327 [79%] non-BPAPS). Brazilian patients were significantly younger, more frequently female, sedentary, obese, non-white, and had a higher frequency of livedo (25% vs. 10%, p < 0.001), cognitive dysfunction (21% vs. 8%, p = 0.001) and seizures (16% vs. 7%, p = 0.007), and a lower frequency of thrombocytopenia (9% vs. 18%, p = 0.037). Additionally, they were more frequently positive for lupus anticoagulant (87.5% vs. 74.6%, p = 0.01), and less frequently positive to anticardiolipin (46.6% vs. 73.7%, p < 0.001) and anti-ß2-glycoprotein-I (13.6% vs. 62.7%, p < 0.001) antibodies. Triple aPL positivity was also less frequent (8% vs. 41.6%, p < 0.001) in Brazilian patients. Median aGAPSS was lower in the Brazilian group (8 vs. 10, p < 0.0001). In the multivariate analysis, BPAPS patients still presented more frequently with livedo, cognitive dysfunction and sedentary lifestyle, and less frequently with thrombocytopenia and triple positivity to aPL. They were also less often white. CONCLUSIONS Our study suggests a specific profile of PAPS in Brazil with higher frequency of selected non-criteria manifestations and lupus anticoagulant positivity. Lupus anticoagulant (not triple positivity) was the major aPL predictor of a classification criteria event.
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Affiliation(s)
| | - Gustavo Guimarães Moreira Balbi
- University of São Paulo, Av. Dr. Arnaldo 455, Third Floor, Room 3109, São Paulo, 01246903, Brazil.,Federal University of Juiz de Fora, Minas Gerais, Brazil
| | | | | | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | | | - Maria Gerosa
- Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Chary Lopez-Pedrera
- Rheumatology Service, IMIBIC/Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Lanlan Ji
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Cecilia Nalli
- Rheumatology and Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Roberto Ríos-Garcés
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, London, UK
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Danieli Andrade
- University of São Paulo, Av. Dr. Arnaldo 455, Third Floor, Room 3109, São Paulo, 01246903, Brazil.
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Ignacchiti Lacerda M, Costa Rodrigues B, Ramires de Jesús G, Cunha Dos Santos F, Ramires de Jesús N, Levy RA, Mendes Klumb E. The association between active proliferative lupus nephritis during pregnancy and small for gestational age newborns. Clin Exp Rheumatol 2021; 39:1043-1048. [DOI: 10.55563/clinexprheumatol/xspect] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | | | - Roger A. Levy
- GlaxoSmithKline Immunology and Inflammation Upper Providence, PA, USA
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Flosi FB, da Silva FC, de Jesús GR, Velarde LGC, de Sá RAM. Assessment of Fetal Lung Maturity Using Quantitative Ultrasound Analysis in Patients with Prelabor Rupture of Membranes. Fetal Diagn Ther 2020; 47:636-641. [PMID: 32653881 DOI: 10.1159/000507550] [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] [Received: 06/16/2019] [Accepted: 03/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prelabor rupture of membranes (PROM) is a frequent clinical situation, and the decision about the best time for delivery remains controversial, mainly due to the risk of neonatal respiratory morbidity (NRM). Assessment of fetal lung maturity using ultrasound, a safe method and widely used in current obstetrical practice, could change this scenario. This study was designed to evaluate the ability of quantitative ultrasound method QuantusFLM® to predict NRM in patients with PROM and whether maternal BMI, gestational age, occurrence of the disease, and presence of oligohydramnios influenced the performance. METHODS Patients with singleton gestations, diagnosis of PROM, and gestational age between 24 and 38 weeks and 6 days were included. Fetal lung image was acquired by ultrasound within 48 h prior to delivery and analyzed by QuantusFLM®. The results were then paired with neonatal outcomes to assess the program's ability to predict the NRM in this specific group. A logistic regression model was created to analyze factors that could affect the test results. RESULTS Fifty-four patients were included. Mean maternal BMI was 28.99 kg/m2, and in 25 patients (46.2%), oligohydramnios was observed at the time of examination. Mean gestational age at delivery was 35 weeks and 4 days, and the NRM prevalence was of 18.5%. QuantusFLM® predicted NRM with a 60% sensitivity, 79.5% specificity, 40% positive predictive value, 89.7% negative predictive value, and 75.6% accuracy. Maternal BMI, disease occurrence, presence of oligohydramnios, and gestational age did not interfere with the evaluation. CONCLUSION This study demonstrates a good accuracy of QuantusFLM® as a NRM predictor in patients with PROM, with particular reliability in identifying that pulmonary maturity has already occurred.
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Affiliation(s)
| | - Fernanda Campos da Silva
- Department of Obstetrics, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme Ramires de Jesús
- Department of Obstertics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Renato Augusto Moreira de Sá
- Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, Brazil, .,Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil,
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Radin M, Sciascia S, Erkan D, Pengo V, Tektonidou MG, Ugarte A, Meroni P, Ji L, Belmont HM, Cohen H, Ramires de Jesús G, Branch DW, Fortin PR, Andreoli L, Petri M, Rodriguez E, Rodriguez-Pinto I, Knight JS, Atsumi T, Willis R, Gonzalez E, Lopez-Pedrera R, Rossi Gandara AP, Borges Gualhardo Vendramini M, Banzato A, Sevim E, Barbhaiya M, Efthymiou M, Mackie I, Bertolaccini ML, Andrade D. The adjusted global antiphospholipid syndrome score (aGAPSS) and the risk of recurrent thrombosis: Results from the APS ACTION cohort. Semin Arthritis Rheum 2019; 49:464-468. [PMID: 31153708 PMCID: PMC7402528 DOI: 10.1016/j.semarthrit.2019.04.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [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] [Received: 02/12/2019] [Revised: 04/01/2019] [Accepted: 04/29/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess whether patients with antiphospholipid syndrome (APS) and history of recurrent thrombosis have higher levels of adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) when compared to patients without recurrent thrombosis. METHODS In this cross-sectional study of antiphospholipid antibody (aPL)-positive patients, we identified APS patients with a history of documented thrombosis from the AntiPhospholipid Syndrome Alliance For Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ("Registry"). Data on aPL-related medical history and cardiovascular risk factors were retrospectively collected. The aGAPSS was calculated at Registry entry by adding the points corresponding to the risk factors: three for hyperlipidemia, one for arterial hypertension, five for positive anticardiolipin antibodies, four for positive anti-β2 glycoprotein-I antibodies and four for positive lupus anticoagulant test. RESULTS The analysis included 379 APS patients who presented with arterial and/or venous thrombosis. Overall, significantly higher aGAPSS were seen in patients with recurrent thrombosis (arterial or venous) compared to those without recurrence (7.8 ± 3.3 vs. 6 ± 3.9, p<0.05). When analyzed based on the site of the recurrence, patients with recurrent arterial, but not venous, thrombosis had higher aGAPSS (8.1 ± SD 2.9 vs. 6 ± 3.9; p<0.05). CONCLUSIONS Based on analysis of our international large-scale Registry of aPL-positive patients, the aGAPSS might help risk stratifying patients based on the likelihood of developing recurrent thrombosis in APS.
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Affiliation(s)
- Massimo Radin
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, Turin 10124, Italy
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, Turin 10124, Italy.
| | - Doruk Erkan
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | | | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Amaia Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| | - Pierluigi Meroni
- Laboratory of Immuno-Rheumatology Research, Istituto Auxologico Italiano, Milan, Italy
| | - Lanlan Ji
- Peking University First Hospital, Beijing, China
| | - H Michael Belmont
- NYU School of Medicine Langone Medical Center, New York, NY, United States
| | - Hannah Cohen
- University College London, London, United Kingdom
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, United States
| | | | - Laura Andreoli
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Ignasi Rodriguez-Pinto
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | | | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX,United States
| | - Emilio Gonzalez
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX,United States
| | | | | | | | | | - Ecem Sevim
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, United States
| | | | - Ian Mackie
- University College London, London, United Kingdom
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
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