Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy

Spinillo, Arsenio; Beneventi, Fausta; Ramoni, Vèronique; Caporali, Roberto; Locatelli, Elena; Simonetta, Margherita; Cavagnoli, Chiara; Alpini, Claudia; Albonico, Giulia; Prisco, Elena; Montecucco, Carlomaurizio

doi:10.1136/annrheumdis-2011-154146

Cited by 40 publications

(26 citation statements)

References 35 publications

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“…More effort should be put into public health education to increase the public's awareness of SLE and health care providers should consider the possibility of SLE when young female patients are presented with disorders involving multiple organs. Moreover, it is critical to identify pre-SLE patients as early as possible, for example, through the use of questionnaire [35] and screening tools such as the ANA test. Timely treatment for those at elevated risks of developing SLE might help to reduce the high mortality associated with SLE [36].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Ambulatory Medical Care Utilization and Rheumatologist Consultation Predating the Diagnosis of Systemic Lupus Erythematosus: A National Population-Based Study

et al. 2014

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ObjectiveTo investigate the records of ambulatory medical care from patients predating the diagnosis of systemic lupus erythematosus (SLE) using nationwide, population-based claims data.MethodsThe frequencies and costs of ambulatory medical care utilization in 337 newly-diagnosed SLE cases between 2004 and 2010, identified from Taiwan's National Health Insurance Research Database, were compared with 1,348 controls who were frequency matched for sex, age, and the catastrophic illness certificate application year of the cases.ResultsPatients with SLE had a median frequency of ambulatory medical care utilization compared with controls one year prior to the index date (22 vs. 2, P<0.001). The differences were significant throughout all eight annual periods. Similarly, the inflation-adjusted costs of ambulatory medical care utilization in patients with SLE increased annually over the study period, from a median of US$18 eight years prior to the index date to US$680 one year prior to the index date. Diseases of the respiratory system (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 460–519), digestive system (ICD-9-CM codes 520–579), musculoskeletal system and connective tissue (ICD-9-CM codes 710–739, excluding 710.0), and skin and subcutaneous tissue (ICD-9-CM codes 680–709) were the top four common causes of visits in the 0.5 to 2 year period preceding the index date and percentages of SLE patients suffered from these disorders increased progressively over the study period. Only 56.4% of the patients with SLE had consulted a rheumatologist and most of the serology tests were done within one year predating the index date.ConclusionsIncreased frequencies and costs of ambulatory care utilization among Taiwanese patients with SLE occurred several years predating their definitive SLE diagnosis. When multisystemic disorders are presented in young female patients, the possibility of SLE should be considered and screened with tools such as the antinuclear antibody test.

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Section: Discussionmentioning

confidence: 99%

Patterns of Ambulatory Medical Care Utilization and Rheumatologist Consultation Predating the Diagnosis of Systemic Lupus Erythematosus: A National Population-Based Study

et al. 2014

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“…The enrolment criteria included: a) singleton pregnancy; b) antenatal care and delivery at our Department; c) fluency in the Italian language; d) no previous diagnosis or treatment of connective tissue diseases; e) absence of fetal malformations or chromosomal anomalies. The characteristics of the study and the validation of the methods used have already been reported elsewhere (8). Briefly, after informed consent was obtained and before the medical evaluation was conducted, each woman was asked to complete a screening questionnaire including any connective tissue disorder symptoms (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Early, Incomplete, or Preclinical Autoimmune Systemic Rheumatic Diseases and Pregnancy Outcome

Spinillo

Beneventi

Locatelli

et al. 2016

Arthritis & Rheumatology

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“…[10] Results from the present study suggest the potential utility of a similar approach in PAH patients. Analogously to the effort made in the field of interstitial lung disease with the recent introduction of the concept of interstitial pneumonia with autoimmune features [32] we propose that a population of PAH patients show autoimmune features which may rely undetected at a first examination and which require a multidisciplinary expertise and the mandatory performance of ANA testing and capillaroscopy.…”

Section: Discussionmentioning

confidence: 63%

“…[10] International guidelines for PH diagnosis and management [11] recommend identifying associated CTD and recently several new diagnostic/classification criteria have been proposed for many CTDs. [12–14] .…”

Section: Introductionmentioning

confidence: 99%

Undiagnosed connective tissue diseases

et al. 2016

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Among different subgroups of pulmonary arterial hypertension (PAH), those associated with connective tissue diseases (CTDs) have distinct hemodynamic and prognostic features; a correct etiologic diagnosis is thus mandatory.To estimate frequency and prognosis of previously undiagnosed CTDs in a suspect idiopathic (i) PAH cohort.Consecutive patients with PAH confirmed by right heart catheterization referred at the Cardiology Division of our Hospital without a previous rheumatological assessment or the occurrence of other conditions explaining PAH were checked for CTD by a clinical, laboratory, and instrumental evaluation. Survival in each group has also been analyzed.In our study 17 of 49 patients were classified as CTD-PAH, corresponding to a prevalence (95% CI) of 34.7% (21.7–49.6%). ANA positivity had 94% (71.3–99.9%) sensitivity and 78.1% (60–90.7%) specificity for a diagnosis of CTD-PAH; Raynaud phenomenon (RP) showed 83.3% (51.6–97.9%) sensitivity and 100% (90.5–100%) specificity for the diagnosis of Systemic Sclerosis (SSc)-PAH. At diagnosis, SSc patients were older and had a lower creatinine clearance compared with iPAH and other CTD-PAH. After a median follow-up of 44 (2–132) months, 18 of 49 (36.7%) patients died: 31.2% in the iPAH group, 20% in the CTD-, and 58.3% in the SSc-PAH group. Mortality was significantly higher in SSc-PAH (HR 3.32, 1.11–9.95, P <0.05) versus iPAH.We show a high prevalence of undiagnosed CTDs in patients with iPAH without a previous rheumatological assessment. All patients with RP were diagnosed with SSc. Our data stress the importance of a rheumatological assessment in PAH, especially because of the unfavorable prognostic impact of an associated SSc.

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Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy

Abstract: In our population approximately 2.5% and 1% of first trimester pregnant women had a previously undiagnosed UCTD and definite systemic rheumatic disease, respectively. These conditions were associated with significant negative effects on the outcome of pregnancy.

Cited by 40 publications

References 35 publications

Patterns of Ambulatory Medical Care Utilization and Rheumatologist Consultation Predating the Diagnosis of Systemic Lupus Erythematosus: A National Population-Based Study

Patterns of Ambulatory Medical Care Utilization and Rheumatologist Consultation Predating the Diagnosis of Systemic Lupus Erythematosus: A National Population-Based Study

Early, Incomplete, or Preclinical Autoimmune Systemic Rheumatic Diseases and Pregnancy Outcome

Undiagnosed connective tissue diseases

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