Preservation of fertility and ovarian function and minimizing gonadotoxicity                 in young women with systemic lupus erythematosus treated by chemotherapy

Background: Accelerated atherosclerosis is widely present in patients with systemic lupus erythematosus. Objective: The aim of this review is to analyze the relationship between systemic lupus erythematosus and cardiovascular diseases, with the emphasis on acute myocardial infarction. Results: Various molecular mechanisms triggered by infection/inflammation are responsible for endothelial dysfunction and development of atherosclerosis at an earlier age. Contributing factor is the cumulative effect of traditional cardiovascular risk factors interaction with disease related characteristics. Myocardial infarction rates are 2- to 10-fold higher compared to the general population. Young women have the highest relative risk, however, men carry at least 3- fold higher risk than women. Coronary involvement varies from normal coronary artery with thrombosis, coronary microartery vasculitis, coronary arteritis, and coronary atherosclerosis. Typical clinical presentation is observed in men and older women, while atypical is more frequent in young women. Treatment is guided by the underlying mechanism, engaging invasive procedures alone, or accompanied with immunosuppressive and/or antiinflammatory therapy. There are significant gender differences in pathophysiology and clinical presentation. However, they receive the same therapeutic treatments. Conclusion: Systemic lupus erythematosus is a major contributor to atherosclerotic and non-atherosclerotic mechanisms involved in the development of myocardial infarction, which should be taken into account during therapeutic treatment. Although Systemic lupus erythematosus per se is a “female” disease, males are at increased cardiovascular risk and worse outcome. Method: We conducted a literature review through PubMed and Cochrane, using key words: SLE, atherosclerosis, atherothrombosis, coronary artery disease, myocardial infarction, prognosis, sex specifics.

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Do adverse pregnancy outcomes contribute to accelerated cardiovascular events seen in young women with systemic lupus erythematosus?

Lupus ◽

10.1177/0961203317719146 ◽

2017 ◽

Vol 26 (13) ◽

pp. 1351-1367 ◽

Cited By ~ 3

Author(s):

M C Soh ◽

C Nelson-Piercy ◽

M Westgren ◽

L McCowan ◽

D Pasupathy

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Young Women ◽

Lupus Erythematosus ◽

Pregnancy Outcomes ◽

Cardiovascular Events ◽

Adverse Pregnancy Outcomes ◽

Systemic Lupus ◽

Adverse Pregnancy

Cardiovascular events (CVEs) are prevalent in patients with systemic lupus erythematosus (SLE), and it is the young women who are disproportionately at risk. The risk factors for accelerated cardiovascular disease remain unclear, with multiple studies producing conflicting results. In this paper, we aim to address both traditional and SLE-specific risk factors postulated to drive the accelerated vascular disease in this cohort. We also discuss the more recent hypothesis that adverse pregnancy outcomes in the form of maternal–placental syndrome and resultant preterm delivery could potentially contribute to the CVEs seen in young women with SLE who have fewer traditional cardiovascular risk factors. The pathophysiology of how placental-mediated vascular insufficiency and hypoxia (with the secretion of placenta-like growth factor (PlGF) and soluble fms-tyrosine-like kinase-1 (sFlt-1), soluble endoglin (sEng) and other placental factors) work synergistically to damage the vascular endothelium is discussed. Adverse pregnancy outcomes ultimately are a small contributing factor to the complex pathophysiological process of cardiovascular disease in patients with SLE. Future collaborative studies between cardiologists, obstetricians, obstetric physicians and rheumatologists may pave the way for a better understanding of a likely multifactorial aetiological process.

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Prevention of gonadal toxicity and preservation of gonadal function and fertility in young women with systemic lupus erythematosus treated by cyclophosphamide: The PREGO-Study

Autoimmunity Reviews ◽

10.1016/j.autrev.2005.10.001 ◽

2006 ◽

Vol 5 (4) ◽

pp. 269-272 ◽

Cited By ~ 77

Author(s):

Karin Manger ◽

Ludwig Wildt ◽

Joachim R. Kalden ◽

Bernhard Manger

Keyword(s):

Systemic Lupus Erythematosus ◽

Young Women ◽

Lupus Erythematosus ◽

Gonadal Function ◽

Systemic Lupus ◽

Gonadal Toxicity

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Abstract: P1436 EFFECT OF PIOGLITAZONE ON HDL, INSULIN AND ADIPONECTIN CONCENTRATIONS IN YOUNG WOMEN WITH UNCOMPLICATED SYSTEMIC LUPUS ERYTHEMATOSUS

Atherosclerosis Supplements ◽

10.1016/s1567-5688(09)71444-8 ◽

2009 ◽

Vol 10 (2) ◽

pp. e1486

Author(s):

J Juárez ◽

R Posadas ◽

A Medina ◽

N Caracas ◽

G Cardoso ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Young Women ◽

Lupus Erythematosus ◽

Systemic Lupus

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Kikuchi-Fujimoto disease: three case reports

Sao Paulo Medical Journal ◽

10.1590/s1516-31802010000400011 ◽

2010 ◽

Vol 128 (4) ◽

pp. 232-235 ◽

Cited By ~ 9

Author(s):

Alexandre de Andrade Sousa ◽

João Marcos Arantes Soares ◽

Marco Homero de Sá Santos ◽

Marcelo Portes Rocha Martins ◽

José Maria Porcaro Salles

Keyword(s):

Systemic Lupus Erythematosus ◽

Differential Diagnosis ◽

Young Women ◽

Lupus Erythematosus ◽

Viral Infections ◽

Case Reports ◽

Excisional Biopsy ◽

Review Of The Literature ◽

Systemic Lupus ◽

Specific Therapy

CONTEXT: Kikuchi-Fujimoto disease (KFD) manifests in most cases as unilateral cervical lymphadenomegaly, with or without accompanying fever. The disease mainly affects young women and has a self-limited course. It is more common in oriental countries, with few reports of its occurrence in Brazil. KFD should be included in the differential diagnosis of suspected cases of viral infections, tuberculosis, reactive lymphadenitis, systemic lupus erythematosus and metastatic diseases. It can be histologically confused with lymphoma. The disease is benign and self-limiting and an excisional biopsy of an affected lymph node is necessary for diagnosis. There is no specific therapy. CASE REPORTS: This study reports on three cases of non-Asian female patients with KFD who were attended at our service between 2003 and 2006. A review of the literature was carried out, with a systematic search on this topic, with the aim of informing physicians about this entity that is manifested by cervical masses and fever.

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Gonadal function in adolescents and young women with juvenile systemic lupus erythematosus

Lupus ◽

10.1191/0961203302lu219oa ◽

2002 ◽

Vol 11 (7) ◽

pp. 419-425 ◽

Cited By ~ 41

Author(s):

C A A Silva ◽

M M Leal ◽

C Leone ◽

V P Simone ◽

A D Takiuti ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Young Women ◽

Lupus Erythematosus ◽

Gonadal Function ◽

Systemic Lupus ◽

Juvenile Systemic Lupus Erythematosus

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Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus

Journal of Family & Reproductive Health ◽

10.18502/jfrh.v15i1.6076 ◽

2021 ◽

Author(s):

Felipe Arturo Morales-Martínez ◽

Celina Salas-Castro ◽

Manuel Rolando. García-Garza ◽

Otto Valdés-Martínez ◽

Selene Marysol García-Luna ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Ovarian Reserve ◽

Lupus Erythematosus ◽

Ovarian Function ◽

Autoimmune Disorder ◽

Antral Follicle ◽

Antral Follicle Count ◽

Pharmacological Treatments ◽

Systemic Lupus ◽

Normal Individuals

Objective: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder where the disease activity itself and the medications used for its treatment, may have adverse effects on ovarian function. This study aimed to assess the ovarian reserve (OR) in SLE patients. Materials and methods: The anti-müllerian hormone (AMH) and the antral follicle count (AFC), two markers to evaluate the OR was assessed in 64 SLE patients and compared to normal individuals. Additionally, we assessed whether the disease per se or the pharmacological treatments affect the OR. Results: Patients with SLE displayed alterations in the OR regardless of the presence of alterations of the menstrual cycle. The AFC and AMH were significantly lower in SLE patients with and without menstrual alterations when compared to control individuals (p<0.0001). However, the AFC and AMH levels were significantly correlated (p=0.006) in the SLE patients with menstrual alterations. Except for hydroxychloroquine that was statistically higher in SLE patients with menstrual alterations (p=0.04), the cumulative dose for cyclophosphamide, corticosteroid, and methotrexate was similar in SLE patients regardless of the occurrence of menstrual alterations. Conclusion: The monitoring of AMH and AFC in SLE patients should be used to detect the rapid and irreversible decline of the OR to provide a possibility of pregnancy to the SLE patients.

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