Could Frida Kahlo have had antiphospholipid syndrome?

Frida Kahlo's medical history shows sequelae of polio, a severe traumatic event that caused multiple fractures and a penetrating pelvic injury, as well as a history of countless surgeries. In her biographical accounts and her works, chronic disabling pain always appears for long periods. Besides, a chronic foot ulcer, gangrene that required amputation of the right leg, a history of abortions, and a positive Wasserman reaction suggest that the artist could have suffered from antiphospholipid antibody syndrome (APS).

Could Frida Kahlo Have Had Antiphospholipid Syndrome?

Frida Kahlo's medical history shows sequelae of polio, a severe traumatic event that caused multiple fractures and a penetrating pelvic injury, as well as a history of countless surgeries. In her biographical accounts and her works, chronic disabling pain always appears for long periods. Besides, a chronic foot ulcer, gangrene that required amputation of the right leg, a history of abortions, and a positive Wasserman reaction suggest that the artist could have suffered from antiphospholipid antibody syndrome (APS).

Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part I.

BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions.

Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II.

BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions.

Lupus y embarazo: mitos y evidencias / Lupus and pregnancy: myths and evidences

Debido a que el lupus eritematoso generalizado es una enfermedad frecuente en mujeres jóvenes y que no afecta su fertilidad, no es raro tener que enfrentar la situación clínica del embarazo en una paciente con lupus. Si bien el pronóstico del embarazo en la mujer lúpica ha cambiado favorablemente, se debe considerar como alto riesgo y debe ser controlado por un equipo multidisciplinario que tenga comunicación frecuente. Existe gran controversia sobre si el embarazo incide sobre la acitvidad del lupus eritematoso generalizados o no; sin embargo, de existir exacerbaciones, éstas son leves y se controlan con cambios menores en la medicación. Por otra parte, sin duda, la actividad del lupus eritematoso generalizado se asocia a complicaciones tales como pérdida del embarazo, parto pretérmino, preeclampsia o HELLP (por sus siglas en inglés: Hemolysis, elevated liver enzymes and low platelets). Más aún, en los embarazos planeados durante la etapa de inactividad del lupus eritematoso generalizado, se observan complicaciones maternas (hipertensión, parto pretérmino), así como prematurez, retraso en el crecimiento intrauterino y lupus neonatal (que ocurre por el paso transplacentario del anticuerpo anti-SS-A/Ro de la madre al producto). La historia de nefropatía no impide un embarazo exitoso, pero la nefritis activa se relaciona con pérdida del embarazo y preeclampsia. Existe una fuerte asociación entre la presencia de anticuerpos anticardiolipina y/o anticoagulante lúpico con muerte fetal, parto pretérmino, preeclampsia y retraso en el crecimiento fetal. Además, la historia obstétrica de pérdidas previas de embarazos es uno de los factores más importantes para predecir pérdidas futuras. El embarazo en la mujer con lupus eritematoso generalizado requiere una vigilancia muy intensa por un equipo multidisciplinario para lograr que llegue a feliz término. El tratamiento será indvidualizado en cada caso. No se recomienda aumento profiláctico de esteroides. Si existe síndrome antifosfolípido asociado, se deberá tratar de acuerdo a las características individuales del caso. Si bien el embarazo en la mujer con lupus es un embarazo de alto riesgo, hoy en día se considera una opción viable para la mujer que así lo desee

Evaluación ecocardiográfica en pacientes con fiebre reumática con corea de Sydenham / Echocardiographic assessment in patients with rheumatic fever and sydenham chorea

Se estudiaron mediante ecocardiografía a 24 niños con fiebre reumática (FR) manifestada por corea de Sydenham "pura" (CSP). Fueron distribuidos en dos grupos de 12 enfermos cada uno. En uno se incluyeron los casos con CSP; seis de estos tuvieron reactantes de la fase aguda del proceso inflamatorio positivos (proteína C reactiva positiva y/o velocidad de sedimentación acelerada). El otro grupo se integró con los niños que tuvieron historia de artralgias, artritis transitoria o que a la auscultación tuviesen un solplo cardiaco con o sin reactantes de la fase aguda de la inflamación positivos. Ninguno de los 24 niños recibió tratamiento con antiinflamatorios. Se encontró alteración valvular mitral en 18/24 casos, hallazgo que difiere ampliamente de los informes que se han hecho sobre esta enfermedad. Se discute y se insiste en la necesidad de realizar estudios ecocardiográficos a los niños con FR, complementar su evaluación clínica; la existencia en ellos de lesión valvular puede modificar el pronóstico y el manejo integral de los niños