scholarly journals Successful outcome of pregnancy in a case of systemic lupus erythematosus : a case report

2019 ◽  
Vol 6 (4) ◽  
pp. 1340
Author(s):  
Gurinder Mohan ◽  
Avleen Kaur ◽  
Umang Khullar
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Immunosuppressive Agents ◽  
Reproductive Age ◽  
Intrauterine Fetal Death ◽  
Successful Outcome ◽  
Antiphospholipid Antibody ◽  
Systemic Lupus ◽  
Emergency Cesarean ◽  
Increased Risk

Systemic lupus erythematosus (SLE) is a multisystem, auto immune connective tissue disease that commonly affects women of reproductive age and may coexist with pregnancy. The autoantibodies and immune complexes lead to damage of various organs and tissues. Pregnant woman with SLE have increased risk of spontaneous abortion, preterm delivery, intrauterine growth retardation, preeclampsia, neonatal lupus, stillbirth and intrauterine fetal death. The therapeutic intervention with anticoagulants, steroids, immunosuppressive agents pose a high risk to both mother and fetus. A multidisciplinary approach and close medical, obstetrical and neonatal monitoring leads to optimal outcome. Authors describe a successful management of an antenatal patient with positive antinuclear antibody, anti-ds DNA antibody and antiphospholipid antibody with bad obstetric history. She underwent an emergency cesarean section and delivered a healthy female child.

scholarly journals Systemic Lupus Erythematosus and Pregnancy Outcome in Tertiary Level Hospital of Nepal

2019 ◽  
Vol 2 (1) ◽  
pp. 167-172
Author(s):  
Suniti Rawal ◽  
Pooja Paudyal ◽  
Mahesh Raj Sigdel
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Multidisciplinary Approach ◽  
Membranous Glomerulonephritis ◽  
Reproductive Age ◽  
University Teaching ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Systemic Lupus ◽  
Planned Pregnancy

Introduction: Systemic Lupus Erythematosus is an autoimmune disease frequently prevalent in women starting from early childhood and towards the reproductive age. Pregnancy with SLE has always imposed great risk both to the mother and the fetus. A multidisciplinary approach with Nephrologist, neonatologist and senior obstetrician during remission leads to a favorable response, through limitation and complications with the use of drugs impose difficulties in their management.Materials and Methods: A prospective, descriptive study was conducted in the Department of Obstetrics and Gynecology and Nephrology at Tribhuvan University Teaching Hospital, for 2 years, from June 2015 to 2017. The study included obstetrical and related complications with outcome in pregnant patients with Systemic Lupus Erythematosus.Results: A total of 19 cases were analyzed of which 15 (79%) had a viable pregnancy and 4 (21%) abortions. Of thirteen cases, 4 (21%) had antiphospholipid antibody syndrome, 8 (42.1%) lupus, and membranous glomerulonephritis and 1 (5.2%) lupus optic neuropathy with loss of vision. All the patients were under drug therapy, like prednisolone, azathioprine, hydroxychloroquine, aspirin, low molecular weight Heparin, tacrolimus, and cyclophosphamide. Only 2 (10.5%) of 19 developed severe pre-eclampsia. There were 12 (80%) term and 3 (20%) each of preterm and intrauterine growth retardation pregnancies with 1 (6.6%) neonatal death (NND) and 1 (5.2%) maternal mortality.Conclusions: Multidisciplinary approach and planned pregnancy reduces the risk of probable complications in the patient resulting to a decreased morbidity and mortality.

scholarly journals Systemic lupus erythematosus and infections

Reumatismo ◽  
2020 ◽  
Vol 72 (3) ◽  
pp. 154-169
Author(s):  
B.K. Singh ◽  
S. Singh
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Opportunistic Infections ◽  
Immunosuppressive Agents ◽  
Immune Dysregulation ◽  
Systemic Lupus ◽  
Irreversible Damage ◽  
Increased Risk ◽  
Increased Susceptibility

Systemic lupus erythematosus (SLE) is an inflammatory and multi-systemic autoimmune disorder, characterized by an uncontrolled auto-reactivity of B and T lymphocytes, leading to the production of autoantibodies against self-directed antigens and tissue damage. The life expectancy in patients with SLE has improved tremendously in the last two decades, but the mortality rates still remain three times greater compared to those of the general population. Despite increased awareness and improved management, infections remain a major source of morbidity, mortality, hospitalization, and death in patients with SLE. The infections in SLE patients widely range from opportunistic to common bacterial and viral infections with typical or atypical presentations. Moreover, SLE patients exhibit an increased susceptibility to hospital-acquired infections. Factors associated with increased risk of infections include high disease activity, specific immune dysregulation, drug-induced immune deficiency, and organ failure with irreversible damage. Furthermore, immunosuppressive agents may make patients more susceptible to opportunistic infections. A big challenge faced by physicians in these patients is to distinguish between infections and flares of SLE, as infections may mimic them, leading to predicament in diagnosis and appropriate management. Immunosuppression used to treat severe flares of lupus can have catastrophic complications in patients with active infections. There is an urgent need for biomarkers to make an accurate differential diagnosis in this situation. In spite of increased understanding of SLE, many questions remain unanswered. Further research is needed to determine specific immune dysregulation underlying the increased susceptibility to specific infections, predictors of infection in SLE such as genetic markers, and biomarkers that discriminate between disease activity and active infections. Also, measures must be evaluated appropriately to prevent infections, and their complications in SLE.

Safety and effectiveness of transjugular renal biopsy for systemic lupus erythematosus and antiphospholipid antibody syndrome patients taking antithrombotics

2019 ◽  
Vol 35 (10) ◽  
pp. 1721-1729
Author(s):  
Hubert Nielly ◽  
Alexis Mathian ◽  
Maud Cazenave ◽  
Hassan Izzedine ◽  
Julien Haroche ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Biopsy ◽  
Lupus Erythematosus ◽  
Red Blood Cell Transfusion ◽  
Antiphospholipid Antibody ◽  
Complication Rates ◽  
Systemic Lupus ◽  
Artery Embolization ◽  
Risk Of Bleeding ◽  
Increased Risk

Abstract Background Renal biopsy is the cornerstone of systemic lupus erythematosus (SLE) nephritis and antiphospholipid syndrome (APS) nephropathy management. However, transcutaneous renal biopsy (TCRB) is hampered by the antithrombotic treatment frequently prescribed for those diseases. Transjugular renal biopsy (TJRB) offers an attractive alternative for patients at increased risk of bleeding. The primary objective of the study was to describe the safety profile and diagnostic performance of TJRB in SLE and APS patients. Methods All SLE and/or APS patients who underwent a renal biopsy in our department (between January 2004 and October 2016) were retrospectively reviewed. Major complications were death, haemostasis nephrectomy, renal artery embolization, red blood cell transfusion, sepsis and vascular thrombosis; macroscopic haematuria, symptomatic perirenal/retroperitoneal bleeding and renal arteriovenous fistula without artery embolization were considered as minor complications. Results Two hundred and fifty-six TJRBs—119 without antithrombotics (untreated), 69 under aspirin and 68 on anticoagulants and 54 TCRBs without antithrombotics—were analysed. Their major and minor complication rates, respectively, did not differ significantly for the four groups: 0 and 8% for untreated TJRBs, 1 and 6% for aspirin-treated, 6 and 10% for anticoagulant-treated and 2 and 2% for TCRBs. The number of glomeruli sampled and the biopsy contribution to establishing a histological diagnosis was similar for the four groups. Conclusions TJRBs obtained from SLE and APS patients taking antithrombotics had diagnostic yields and safety profiles similar to those of untreated TCRBs. Thus, TJRB should be considered for SLE and APS patients at risk of bleeding.

scholarly journals Maternal and Perinatal Outcome in Women with Systemic Lupus Erythematosus: A Retrospective Bicenter Cohort Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Sylvia J. Kroese ◽  
Carolien N. H. Abheiden ◽  
Birgit S. Blomjous ◽  
Jacob M. van Laar ◽  
Ronald W. H. M. Derksen ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Intrauterine Fetal Death ◽  
Antiphospholipid Antibody ◽  
Hypertensive Disorder ◽  
Complication Rates ◽  
Patient Counseling ◽  
Systemic Lupus ◽  
Hypertensive Disorder Of Pregnancy

Objective. To investigate disease activity around and during pregnancy and pregnancy outcome in women with systemic lupus erythematosus (SLE) considering antiphospholipid antibody status. Moreover, differences between first and consecutive pregnancies were examined. Methods. Pregnancies > 16 weeks gestation of SLE patients receiving joint care from rheumatologists and gynecologists in two tertiary centers in the Netherlands between 2000 and 2015 were included. Disease activity, flare rate, and pregnancy outcomes and complications were assessed. Results. Ninety-six women (84% Caucasian) with 144 pregnancies were included. The median SLE(P)DAI score was 2 before, during, and after pregnancy. Flare rates were 6.3%, 20.1%, and 15.3%, respectively. Severe hypertensive disorder of pregnancy, intrauterine fetal death, preterm birth, and small-for-gestational age infants occurred in 18.1%, 4.1%, 32.7%, and 14.8%, respectively. Complication rates were similar in the first and consecutive pregnancies. Half of the women did not experience any pregnancy complication whereas 42.7% developed a complication during all pregnancies. Mean number of pregnancies was 2.4 and live births 1.7. Conclusion. In this SLE population with low disease activity, pregnancy complications were present irrespective of antiphospholipid antibody status. Furthermore, there were no differences in complication rates between the first and consecutive pregnancies as seen in healthy mothers. This information is useful for patient counseling.

scholarly journals Vaccination of Patients with Systemic Lupus Erythematosus

2020 ◽  
Vol 95 (3) ◽  
pp. 170-175
Author(s):  
Chang-Nam Son ◽  
Sang-Hyon Kim
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Hepatitis A ◽  
Immunosuppressive Agents ◽  
Risk Of Infection ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Inflammatory Autoimmune Disease ◽  
Chronic Inflammatory Autoimmune Disease ◽  
Lupus Disease Activity

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects various organs. SLE patients have an increased risk of infection compared to the general population. Immunosuppressive agents commonly used in SLE increase the risk of infection. Vaccination is a good way to reduce the risk of infection. However, some SLE patients are concerned that vaccination may worsen lupus disease activity or cause side effects. The latest SLE patient vaccination data were reviewed in this study, which focused on the safety, immunogenicity, and efficacy of influenza, pneumococcal, tetanus, hepatitis A, herpes zoster, and human papillomavirus vaccines. Korean immunization recommendations were also compared to those of other countries.

scholarly journals Luaran Kehamilan Dengan Sistemik Lupus Eritematosus

2017 ◽  
Vol 5 (2) ◽  
pp. 63
Author(s):  
Maya Savira
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Fetal Death ◽  
Good Control ◽  
Intrauterine Fetal Death ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Mother And Child ◽  
Immune Complex Formation

Systemic lupus erythematosus often abbreviated to SLE or lupus, is a systemicautoimmune disease (or autoimmuneconnective tissue disease) that can affect any part ofthe body. As occurs in other autoimmune diseases, the immunesystem attacks the body’scells and tissue, resulting in inflammation and tissue damage. It is a type IIIhypersensitivityreaction caused by antibody-immune complex formation. Women with lupus are at risk for various complications ofpregnancy, and those with antiphospholipid antibodies may have an increased risk of miscarriage. Systemic lupuserythematosus increases the risk of spontaneous abortion, intrauterine fetal death, preeclampsia, intrauterine growthretardation, and preterm birth. The outcome for both mother and child is best when systemic lupus erythematosus hasbeen under good control for at least six months before pregnancy and when the kidney disease is in remission.

scholarly journals Salmonella Paratyphi B bacteremia in Systemic Lupus Erythematosus with an unusual presentation- a case report

2014 ◽  
Vol 2 (03) ◽  
pp. 73-75
Author(s):  
Madhuri Kulkarni ◽  
K. G. Rajeshwari ◽  
A. Tejashree ◽  
R. Subramanian
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Bacterial Infections ◽  
Rare Case ◽  
Immunosuppressive Agents ◽  
Autoimmune Disorder ◽  
Systemic Lupus ◽  
Juvenile Onset ◽  
Increased Risk ◽  
Paratyphi B

Background- Systemic Lupus Erythematosus (SLE) is an inflammatory and multisystem autoimmune disorder. Patients of SLE are at increased risk of infections owing to underlying immunological derangements and to the use of therapeutic regimens like immunosuppressive agents. Among the bacterial infections presenting as bacteremia in these patients, non typhoidal and typhoidal salmonellosis are commonly encountered. We report a rare case of Salmonella Paratyphi B bacteremia in a patient with juvenile onset SLE on treatment with corticosteroids.

scholarly journals THU0268 NEURO-DEVELOPMENTAL OUTCOME IN CHILDREN BORN TO MOTHERS WITH SLE AND APS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 360.1-361
Author(s):  
M. Hassanien ◽  
E. Talaat ◽  
H. Abdellatif
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Memory Impairment ◽  
Activity Index ◽  
Reproductive Age ◽  
Developmental Outcome ◽  
Systemic Lupus ◽  
Recent Memory ◽  
Children's Memory ◽  
Children's Memory Scale

Background:Systemic Lupus erythematosus and antiphospholipid disease are very common autoimmune diseases in women at reproductive age.Objectives:Evaluate the neuro-developmental outcome in children born to mothers with SLE or APS and to assess and characterize memory impairment in children’s born to mother with systemic lupus erythematosus or APS using children’s memory scale and the relation between tetrahydrobiopterin concentration range of children with developmental and neurological disorders.Methods:Women attending rheumatology clinics University of Asyut, SLE patients were eligible if they met the American College of Rheumatology (ACR) criteria for SLE and APL prior to pregnancy, and had at least one live birth following SLE diagnosis. Maternal history Data collected using a structured format that included medical and obstetric history. A detailed history of medication exposures and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) during pregnancy was obtained. Offspring history Medical and developmental histories of the offspring including antenatal, delivery, prenatal and pediatric histories, as child’s cognitive, physical or social maturity compared with established age-appropriate norms. Speech or hearing delays, diagnosis of attention- deficit hyperactivity disorder (ADHD), or any special educational needs (eg, occupational or speech therapy, behavioral counseling) was recorded. Assessment and characterization of memory impairment using children’s memory scale by neurologists. Tetrahydrobiopterin was measured by ELISA compared to children born to control healthy subjects of the same age and sex.Results:Data on 38 mothers and 60 offspring were analysed: ADHD was reported for 15 of 60 (25%) offspring. Recent memory delay was detected in 93% (14/15) Speech delay 40% (6/15). Maternal APS history was significantly associated with increased use special educational need among offsprings, including after adjustment for lupus anticoagulant (LA) positivity (39.4% for delays age >2 years; p<0.05). Anticardiolipin and anti-BETA2GP1 were not detected to be associated with delays. Recent memory delay was associated with increased Tetrahydrobiopterin level (P=0.01).Conclusion:The prevalence of neurodevelopmental abnormalities in children born to mothers with SLE or APS seems to be higher than normal population and more educational attention is important in these children, and need long-term follow-up.Disclosure of Interests:None declared

scholarly journals Phase 1 double-blind randomized safety trial of the Janus kinase inhibitor tofacitinib in systemic lupus erythematosus

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Sarfaraz A. Hasni ◽  
Sarthak Gupta ◽  
Michael Davis ◽  
Elaine Poncio ◽  
Yenealem Temesgen-Oyelakin ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Kinase Inhibitor ◽  
Janus Kinase ◽  
Controlled Clinical Trial ◽  
Type I ◽  
Systemic Lupus ◽  
Double Blind ◽  
Premature Cardiovascular Disease ◽  
Increased Risk

AbstractIncreased risk of premature cardiovascular disease (CVD) is well recognized in systemic lupus erythematosus (SLE). Aberrant type I-Interferon (IFN)-neutrophil interactions contribute to this enhanced CVD risk. In lupus animal models, the Janus kinase (JAK) inhibitor tofacitinib improves clinical features, immune dysregulation and vascular dysfunction. We conducted a randomized, double-blind, placebo-controlled clinical trial of tofacitinib in SLE subjects (ClinicalTrials.gov NCT02535689). In this study, 30 subjects are randomized to tofacitinib (5 mg twice daily) or placebo in 2:1 block. The primary outcome of this study is safety and tolerability of tofacitinib. The secondary outcomes include clinical response and mechanistic studies. The tofacitinib is found to be safe in SLE meeting study’s primary endpoint. We also show that tofacitinib improves cardiometabolic and immunologic parameters associated with the premature atherosclerosis in SLE. Tofacitinib improves high-density lipoprotein cholesterol levels (p = 0.0006, CI 95%: 4.12, 13.32) and particle number (p = 0.0008, CI 95%: 1.58, 5.33); lecithin: cholesterol acyltransferase concentration (p = 0.024, CI 95%: 1.1, −26.5), cholesterol efflux capacity (p = 0.08, CI 95%: −0.01, 0.24), improvements in arterial stiffness and endothelium-dependent vasorelaxation and decrease in type I IFN gene signature, low-density granulocytes and circulating NETs. Some of these improvements are more robust in subjects with STAT4 risk allele.

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