Neonatal Lupus

Mendez, Barbara; Saxena, Amit; Buyon, Jill P.; Izmirly, Peter

doi:10.1007/978-1-4939-0673-4_13

Cited by 3 publications

(3 citation statements)

References 110 publications

(96 reference statements)

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“…Women who are antibody positive should be monitored with fetal ultrasounds between weeks 16 and 34 of gestation. Recommendations regarding the frequency of screening (weekly, biweekly, monthly) vary [ 48 ]. While treatment with dexamethosone and IVIG have been used on a case by case basis as heart block evolves, neither of these therapies have been proven successful [ 48 – 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…Recommendations regarding the frequency of screening (weekly, biweekly, monthly) vary [ 48 ]. While treatment with dexamethosone and IVIG have been used on a case by case basis as heart block evolves, neither of these therapies have been proven successful [ 48 – 50 ]. There is growing evidence that maintaining women on hydroxychloroquine throughout pregnancy may reduce the recurrence rate of CCHB [ 51 ], and prospective studies are underway.…”

Section: Resultsmentioning

confidence: 99%

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Fertility and pregnancy in rheumatoid arthritis and systemic lupus erythematosus

Bermas

Sammaritano

2015

Fertil Res and Pract

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BackgroundRheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are disorders that commonly impact reproductive aged women.FindingsBoth women with RA and SLE have smaller sized families than do controls. In the case of RA factors other than fertility contribute, while in women with SLE there may be diminished ovarian reserve due to cyclophosphamide therapy and advanced maternal age. RA pregnancies can be complicated by preterm birth and small-for-gestational aged infants. SLE pregnancies have higher rates of fetal loss, in particular in those patients with co-existing antiphospholipid syndrome. SLE pregnancies are also more likely to be complicated by pre-eclampsia and hypertension and to result in preterm birth and small-for-gestational aged infants.ConclusionAppropriate fertility evaluation and careful pregnancy planning with coordinated obstetrical care help ensure better outcomes in these patient populations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fertility and pregnancy in rheumatoid arthritis and systemic lupus erythematosus

Bermas

Sammaritano

2015

Fertil Res and Pract

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“…Although the relationship between systemic lupus erythematosus (SLE) and Sjogren's syndrome and congenital heart block (CHB) and neonatal skin rashes was described by 1960, the ‘culprit’ antibody reactivity to the SSA/ Ro-SSB/La ribonucleoprotein complex was identified 20 years later [1]. Neonatal lupus was a term given to various fetal and neonatal manifestations associated with exposure to maternal anti-SSA/Ro-SSB/La antibodies [2]. With time came the remarkable realization that the mother's clinical disease was not the common denominator but rather this specific set of autoantibodies.…”

Section: Introductionmentioning

confidence: 99%

Progress in the pathogenesis and treatment of cardiac manifestations of neonatal lupus

Izmirly

Saxena²,

Buyon³

2017

Current Opinion in Rheumatology

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Purpose of review To provide new insights into pathogenesis, prevention and management of cardiac manifestations of neonatal lupus (cardiac neonatal lupus) and issues pertinent to all anti-SSA/Ro positive individuals of childbearing age. Recent findings Antibody specificity with high risk for cardiac neonatal lupus remains elusive, but high titers of Ro60, Ro52 or Ro52p200 antibodies appear to be required. Varying antibody specificities to the p200 region of Ro52 can induce first-degree block in a rodent model. In consideration of the contribution of macrophages to inflammation and fibrosis in cardiac neonatal lupus, hydroxychloroquine (HCQ) is being considered as preventive therapy. Cord blood biomarkers support the association of fetal reactive inflammatory and fibrotic components with the development and morbidity of cardiac neonatal lupus. Data from U.S. and French registries do not provide evidence that the prompt use of fluorinated steroids in cases of isolated block significantly alters fetal/neonatal morbidity or mortality. Summary The search for a high-risk cardiac neonatal lupus antibody profile remains, but high-titer antibodies to Ro60 and R052 are a consistent finding, and this may guide the need for fetal echocardiographic surveillance. The uniform use of fluorinated steroids to prevent progression of cardiac neonatal lupus or reduce mortality does not appear justified. HCQ, based on diminishing an inflammatory component of cardiac neonatal lupus, is under consideration as a potential preventive approach.

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