Is lupus nephritis a prognosis factor for pregnancy? Maternal and foetal outcomes.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had Class IV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P = .041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P = .047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

Is Lupus Nephritis a Prognosis Factor for Pregnancy? Maternal and Foetal Outcomes. / ¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had ClassIV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P=.041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P=.047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

Subclinical markers of atherosclerosis and cardiovascular risk factors in early arthritis. / [Marcadores subclínicos de aterosclerosis y factores de riesgo cardiovascular en artritis temprana.]

Background: Mortality from cardiovascular disease (CVD) is increased in rheumatoid arthritis, not explained by traditional cardiovascular risk factors (CVRF), suggesting a role of inflammation. This process would occur early. The common sonographic markers of subclinical atherosclerosis (SA), are increased carotid intima-media thickness (cIMT) or the presence of carotid atherosclerotic plaque and they are closely related to CVD. Aims: To evaluate sonographic markers and cardiovascular risk factors in early Arthritis (EA). Methods: A case control study of patients with EA, defined by 3 joints swollen with <1 year of evolution, served consecutively from January 2011 to may 2013, matched with healthy controls, by sex, age and cardiovascular risk factors (hypertension, diabetes mellitus, cardiovascular disease -IAM and ACV, dyslipidemia, family history of CVD) was conducted. We studied demographics data, cardiovascular risk factors, carotid ultrasound measuring increased cIMT or the presence of carotid atherosclerotic plaque in Common Carotid Artery (CCA) and Carotid Bulb (BC), laboratory test that included cholesterol, LDL, HDL, triglycerides in mg%, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR ), anti citrullinated peptide (ACCP), rheumatoid factor (RF), antinuclear antibodies (ANA). EA activity was measured by DAS 28, considering high disease activity (HDA) 5.1; moderate (MDA) from 5.1 to 3.2; and low (LDA) <3.2. Statistics: test Mann-Whitney and chi-square were used, p <0.05 was significant. Results: 25 women, 5 men, average age 43 years (DS 14.7) and 30 controls were included. The average DAS 28 was 4, 8 ± 1. 8; 47% had HDA, 33%MDA and 20%BDA. Both groups had similar values cIMT CCA (0, 57 ± 0.10 mm vs. 0.58 ± 0.15 mm, respectively, P = 0.82) and cIMT BC (0.18mm ± 0.67 vs 0.62 ± 0.15 mm respectively, P = 0.47). There were no carotid plaques. The median total cholesterol was 181,5 vs 183,5 (p = 0.35); triglycerides 99 vs 92,5 (p = 0.68); HDL 54,5 vs 52,5 (p = 0.921 and LDL 105 vs 110 (p = 0.27) in EA and controls respectively. The cIMT CCA and CB were not related to RF, ACCP, CRP, DAS 28 and smoking (NS). There was no difference in other cardiovascular risk factors Conclusions: Ultrasound evidence of atherosclerosis subclinical markers was not found in this study, suggesting that this process may occur after a year of diagnosis.

Introducción: La mortalidad por Enfermedad cardiovascular (ECV) temprana está incrementada en enfermedades inflamatorias. Los marcadores ecográficos de aterosclerosis subclínica (AS) están estrechamente relacionados con ECV. Objetivo: Evaluar marcadores de AS ecográficos y Factores de Riesgo Cardiovascular (FRCV) en Artritis temprana (AT) y correlacionarlo con la actividad de la enfermedad. Material y Métodos: Estudio transversal de casos y controles en pacientes con AT, definida por 3 articulaciones inflamadas con menos de 1 año de evolución, realizado desde 2011 a 2013, apareados con controles sanos, por sexo, edad y FRCV. Se registraron datos demográficos, FRCV, rigidez de pared (cIMT) en Arteria Carótida Común (ACC) y en Bulbo Carotídeo (BC) y presencia de placas ateroscleróticas por ecografía, perfil lipídico, Proteína C Reactiva, eritrosedimentación, anticuerpos anti péptido citrulinado, Factor reumatoide, anticuerpos antinucleares. La actividad de AT se midió por Disease Activity Score (DAS) 28. Estadística: Se usaron test U de Mann-Whitney, Kruskal Wallis y chi-cuadrado, p <0,05 fue significativo. Resultados: Se incluyeron 25 mujeres, 5 hombres con edad promedio 40 años (18-61) y 30 controles. El DAS 28 promedio fue 4,8 ±1.8. Pacientes y controles tuvieron similares valores cIMT ACC (0, 57 ±0.10 mm vs 0,58 ± 0,15 mm, respectivamente) y cIMT CB (0,67 ±0,18mm vs 0,62 ±0,15 mm), no hubo placas carotídeas y el perfil lipídico fue similar en ambos grupos, PNS. El cIMT CCA y CB no tuvieron relación con DAS 28, serología, ni FRCV, P: NS. Conclusiones: La aterosclerosis subclínica se produciría después del primer año de enfermedad en artritis temprana.

[Lipid profile in early arthritis and its relation with inflammatory activity] / Prevalencia de dislipidemia en artritis temprana y su relación con actividad inflamatoria.

Cardiovascular risk is increased in Rheumatoid Arthritis and it is associated with higher morbility and mortality. Few studies have evaluated the lipid profile in early arthritis (EA). Aims: To study the lipid profile in patients with EA and its association with disease activity (DA). Methods: We studied 31 patients with diagnosis of EA and a control group, with age, gender and cardiovascular risk factors matched, who were attended to Rheumatology Unit at Córdoba Hospital from January 2011 to May 2013. We evaluated demographic data, lipid profile and DA by DAS28. Results: 31 patients were included with mean age of 42.3 years old, 87% female , the cholesterol level was 191.9 mg/dl, HDL 54, LDL 115.8, Triglycerides 117,6; and 31 patients were included in the control group with average age of 42.7 years old, and cholesterol level of 198.7 mg / dl, HDL 56.9 LDL 122.6, Triglycerides 99.6 (p NS). Regards disease activity, in the low DA group the Cholesterol level was 196.3 , LDL 115.8, HDL 62 y triglycerides 95.17, and in the Moderate and High DA the Cholesterol level was 190 mg/ dl, LDL 115, HDL 52 y triglycerides 122,9 (p NS) Conclusions: The lipid profile was normal and it was not associated with DA in EA patients.

El riesgo cardiovascular está aumentado en pacientes con Artritis Reumatoidea establecida, con aumento de la morbimortalidad cardiovascular, inclusive tempranamente y puede ser expresión subclínica de la enfermedad. Pocos estudios han evaluado el perfil lipídico en artritis temprana (AT). Objetivos: Determinar la prevalencia y el tipo de alteración del perfil lipídico en pacientes con AT y su asociación con la actividad de la enfermedad (AE). Material y métodos: Se estudiaron pacientes con diagnóstico de AT comparados con un grupo control, apareados por sexo, edad y factores de riesgo cardiovascular, asistidos de forma consecutiva desde enero de 2011 a mayo de 2013 en el Hospital Córdoba. Se recolectaron datos demográficos, perfil lipídico y actividad de la enfermedad (AE) por Disease Activity Score (DAS 28). Se comparó el nivel de lípidos en ambos grupos y entre pacientes con artritis según el nivel de AE, clasificándolos en Baja AE y Mediana / Alta AE. P menor a 0.05 fue considerada significativa. Resultados: El número de pacientes con Artritis temprana fue de 31, con una media de edad de 42.3 años, 87% sexo femenino y el nivel de Colesterol Total promedio fue de 191.9 mg/dl, HDL 54, LDL 115.8, Triglicéridos 117,6, mientras que el grupo control fue de 31 pacientes con una media de edad de 42.7 años, con nivel promedio de Colesterol 198.7 mg/dl, HDL 56.9, LDL 122.6, Triglicéridos 99.6 (p=NS, para todas las determinaciones). En cuanto a la actividad de la enfermedad, en el grupo de Baja AE los niveles de Colesterol fueron 196.3, LDL 115.8, HDL 62 y triglicéridos 95.17 y en el grupo moderada y alta AE, Colesterol 190,1 LDL 115, 8, HDL 52 y triglicéridos 122,9 (p NS para todas las comparaciones) Conclusion: El perfil lipídico fue normal y no se encontró asociado a la AE en pacientes con AT.