Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies

Andréoli, Laura; Gerardi, Maria Chiara; Fernandes, Melissa; Bortoluzzi, Alessandra; Bellando-Randone, Silvia; Brucato, Antonio; Caporali, Roberto; Chighizola, Cecilia Beatrice; Chimenti, Maria Sole; Conigliaro, Paola; Cutolo, Maurizio; Cutro, Maria Stefania; D’Angelo, Salvatore; Doria, Andrea; Elefante, Elena; Fredi, Micaela; Galeazzi, Mauro; Gerosa, Maria; Govoni, Marcello; Iuliano, Annamaria; Larosa, Maddalena; Lazzaroni, Maria Grazia; Matucci‐Cerinic, Marco; Meroni, M.; Meroni, Pier Luigi; Mosca, Marta; Patanè, Massimo; Pazzola, Giulia; Pendolino, Monica; Perricone, Roberto; Ramoni, Vèronique; Salvarani, Carlo; Sebastiani, Gian Domenico; Selmi, Carlo; Spinelli, Francesca Romana; Valesini, Guido; Scirè, Carlo Alberto; Tincani, Anǵela

doi:10.1016/j.autrev.2018.08.008

Cited by 58 publications

(45 citation statements)

References 123 publications

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“…4 Women with rheumatic disease seeking pregnancy have to be counselled properly and followed with a tailored specialized approach to achieve the best outcomes for both the mother and baby. 2,5 In the context of rheumatic diseases, antiphospholipid syndrome is characterized by thrombosis and/or recurrent preg- 6 Although both of these recommendations aimed to improve and harmonize the care of women with rheumatic diseases during pregnancy, they also emphasized the need for further research in this field.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of antiphospholipid antibodies in women with late pregnancy complications and low‐risk for chromosomal abnormalities

Foddai

Radin

Cecchi

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Antiphospholipid antibodies (aPL) are known to increase the risk of obstetrical complications. However, aPL significance and prevalence in women with late-onset pregnancy complications (LO-PC) need further clarification. Objectives: To investigate the prevalence of aPL in a cohort of women who experienced LO-PC and to compare it with a cohort of uneventful pregnancies. Methods: One hundred pregnant women who experienced LO-PC, had a low risk for chromosomal abnormalities, and absence of fetal abnormalities were recruited from August 2018 to August 2019. One hundred women with uneventful pregnancy were included as controls. aPL testing was performed on serum samples derived from prenatal screening test and included both criteria and "extra criteria" aPL. Results: Patients with LO-PC had significantly higher aPL prevalence when compared with controls (31/100 [31%] vs 10/100 [10%]; P < .001). More in detail, up to 26% of women with LO-PC were positive for one aPL, with an overall prevalence significantly higher than controls (26% vs 9%; P < .05). Among single aPL positivity, patients had significantly higher rate of positivity and titers of anticardiolipin IgG (10% vs 2%; mean ± standard deviation 11 ± 13 vs 4 ± 9.6 chemoluminescent unit; P < .05) and phosphatidylserine-prothrombin antibodies (aPS/PT) IgM (15% vs 6%; mean ± standard deviation 10.2 ± 21.7 vs 3.7 ± 13.7 U; P < .05). Testing for aPS/PT (IgM/IgG) alone allowed the identification of 17 patients negative for criteria aPL. aPL-positive patients had a significantly higher risk of preterm birth (34-36 + 6 weeks; 10% vs 8%; P < .012). Conclusions: We report a high prevalence of aPL in our cohort. Testing for both criteria and "extra criteria" aPL in women with previous LO-PC could improve the diagnostic accuracy identifying women at higher risk for recurrent pregnancy complications.

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Section: Introductionmentioning

confidence: 99%

The prevalence of antiphospholipid antibodies in women with late pregnancy complications and low‐risk for chromosomal abnormalities

Foddai

Radin

Cecchi

et al. 2020

Journal of Thrombosis and Haemostasis

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“…SpA tend to be stable or to get worse during pregnancy, even though the available literature is scarce. 176 According to the EULAR overarching principles, family planning must be part of our routine practice in each patient of reproductive age and adjustment of therapy must be considered before a planned pregnancy. 177,178 On the contrary, female gender influence bDMARDs efficacy: female sex is a negative predictive factor for TNF-i response in PsA.…”

Section: Discussionmentioning

confidence: 99%

<p>An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis</p>

Chimenti¹,

D’Antonio²,

Conigliaro³

et al. 2020

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Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy typically associated with psoriasis (PsO). The pathogenesis is strictly related to the association among the presence of genetic risk alleles and innate and acquired immune response with dramatic consequences on bone remodeling. Clinically, PsA patients may present heterogenicity of articular and periarticular manifestations that may be associated with the presence of comorbidities making treatment decision challenging in patients management. The identification of patient-targeted therapies is still a critical issue. Actually, several biological and synthetic drugs are promising in terms of efficacy and safety profile. National and international treatment recommendations support clinicians in the decision of the best treatment, although they may have limits basically related to updates and different outcomes included in the clinical studies evaluated. The aim of this narrative review is therefore to give guidance for clinicians for PsA patients treatment. For this purpose, we evaluated evidence on biological therapies efficacy used for PsA treatment. Specifically, we reviewed data on biological therapies, Janus kinases (JAK) inhibitors, and drugs with a new mechanism of action that are part of the treatment pipeline. The concept of "switching" and "swapping" is also described, as well as data concerning special populations such as pregnant women and elderly patients.

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“…Особую диагностическую трудность могут представлять случаи нарастания выраженности смешанной боли в спине при отсутствии других признаков воспаления, таких как утренняя скованность и повышенный уровень СРБ. Уровень боли по ЧРШ является составной частью индексов BASDAI и ASDAS-СРБ, включение в подсчет индексов выраженности боли, не являющейся симптомом АС, приведет к завышению оценки активности заболевания и, как следствие, может стать причиной ошибок при выборе тактики ведения пациентки со стороны как ревматологов, так и акушеров-гинекологов [1,10]. Кроме того, слабость (утомляемость), интенсивность которой учитывается при вычислении BASDAI, также может быть обусловлена физиологически протекающей беременностью.…”

Section: Discussionunclassified

“…Some BASDAI components (fatigue and back pain) reflect not only the activity of AS, but also changes associated with physiological pregnancy. The BASDAI index requires adaptation for use in pregnancy Key words: ankylosing spondylitis, pregnancy, activity, BASDAI, ASDAS-CRP, activity predictors Анализ немного численных литературных источников, посвященных проблеме взаимовлияния анкилозирующего спондилита (АС) и беременности, показал, что в настоящее время единое представление о влиянии гестации на активность АС отсутствует [1]. Большинство имеющихся данных получены при ретроспективном анализе исходов беременности и динамики отдельных клинических проявлений заболевания без объективной оценки активности.…”

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“…В противном случае восприятие боли в спине только как клинического проявления ревматического заболевания, без учета возможности присоединения боли механического ритма, связанной с беременностью, может привести к завышению результата определения активности АС как по BASDAI, так и по ASDAS-СРБ, что может стать причиной выбора неправильной тактики ведения пациента. Кроме того, наличие слабости/утомляемости, являющейся одним из параметров индекса BASDAI, также может быть обусловлено нормально протекающей беременностью [1]. Поэтому встает вопрос о целесообразности использования индекса BASDAI в период гестации, учитывая, что утомляемость и боль в спине вносят весомый вклад в его значение.…”

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Assessment of Ankylosing Spondylitis Activity During Pregnancy Using Different Disease Activity Indices

Кричевская¹,

Гандалоева²,

Глухова³

et al. 2020

Naučno-praktičeskaâ revmatologiâ

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Objective: Assessment of ankylosing spondylitis activity patterns during pregnancy using BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score — C-Reactive Protein) disease activity indices.Materials and methods. The prospective study included 36 pregnant women with AS (modified New York AS criteria, 1984). Patients’ mean age was 31.6±4.8 years, mean age at AS onset was 21.8±10.9, and disease duration 134.9±89.3 months. The control group included 30 healthy pregnant women with no history of back pain and arthritis, their mean age was 28.2±4.5 years. In the I trimester of pregnancy 10 (33.3%) As patients experienced back pain, while in the III trimester already 15 (50%) had back pain. Throughout pregnancy, the intensity of back pain in the I, II и III trimesters based on numeric scale was on average 1.9±0.9; 2.1±1.1 and 2.1±0.8. BASDAI and ASDAS-CRP were used to measure disease activity on gestational Weeks 10–11, 20–21 and 31–32. The time of conception BASDAI score was assessed retrospectively at the 1st visit.Results and discussion. BASDAI mean values at the time of conception and I, II и III trimesters of pregnancy were: 2.3±1.9; 2.8±1.72 (p<0,05 vs month of conception); 3.2±1.9 and 3.3±2.1 respectively. Mean ASDAS-CRP in the I, II и III trimesters were 1.9±0.7; 2.3±0.9 and 2.2±0,8 respectively. There was a trend to CRP increase in the II and III trimesters vs the I: median CRP values in the I, II and III trimesters were 5.7 [1.6; 6.2], 8.0 [2.1; 9.6] and 7.9 [2.0; 9.2] mg/L, respectively. Percentages of patients with high disease activity based on BASDAI scores in the I, II and III trimesters were 30.6; 34.3 and 34.3%; based on ASDAS-CRP — 36.1; 57.5 and 53%, respectively. Throughout pregnancy, BASDAI scores were lower in the control group than in AS patients (p<0.01). However, no differences were found when comparing BASDAI values of AS patients and healthy women with back pain during pregnancy. The level of fatigue did not differ between pregnant women with AS (median 5[3; 7] and 5[3; 6]) and healthy controls (5[3; 8] and 5[4; 6]) in the I and II trimesters, while in the III trimester, fatigue in healthy pregnant women (6[4; 8]) was more pronounced than in AS patients (5[3; 6], p=0.01). Throughout pregnancy, the intensity of back pain in AS patients and healthy pregnant women with back pain did not differ (p<0.05). Median pain intensity in the I, II and III trimesters was 3[2; 4]; 4[3; 5]; 3[2; 6] and 2,5[1; 4]; 3[2; 7]; 4[2; 6], respectively. A high (rs ≥0,7) correlation of all BASDAI components with the index itself in each trimester of pregnancy, except for joint pain in the month of conception, and in the I and III trimesters was established in the group of pregnant women with AS. The control group had quite high correlation (rs >0.7) of fatigue severity with the BASDAI index in the I and II trimesters of pregnancy and moderate correlation (rs >0.53) in the III trimester; as wells as moderate (rs >0.5-0.69) correlation between back pain and BASDAIConclusion. A trend towards increasing AS activity based on BASDAI and ASDAS-CRP scores and CRP levels was established for the first half of pregnancy. Later in pregnancy these increased values failed to return to normal until the end of gestation. The percentage of AS patients with highto-moderate disease activity throughout pregnancy was lower based on BASDAI score vs based on ASDAS-CRP. Some BASDAI components (fatigue and back pain) reflect not only the activity of AS, but also changes associated with physiological pregnancy. The BASDAI index requires adaptation for use in pregnancy

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Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies

Cited by 58 publications

References 123 publications

The prevalence of antiphospholipid antibodies in women with late pregnancy complications and low‐risk for chromosomal abnormalities

The prevalence of antiphospholipid antibodies in women with late pregnancy complications and low‐risk for chromosomal abnormalities

<p>An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis</p>

Assessment of Ankylosing Spondylitis Activity During Pregnancy Using Different Disease Activity Indices

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