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1.
Pregnancy Hypertens ; 17: 82-88, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487662

RESUMO

BACKGROUND: Peripartum cardiomyopathy (PPCM) and preeclampsia are strongly associated, yet a description of risk factors for PPCM among women with preeclampsia is currently lacking. Additionally, the effect of preeclampsia on PPCM-related outcomes is not well known. METHODS: We constructed a cohort of delivery admissions from 2011 to 2014 using a large US administrative database (Marketscan). We assessed risk factors for the development of PPCM among women with preeclampsia. We compared the risks of major adverse cardiovascular events (MACE) at 6 months between PPCM with co-incident preeclampsia (pePPCM) and PPCM without preeclampsia (npePPCM). RESULTS: We included 1,024,035 pregnancies, of which 64,503 (6.3%) had preeclampsia. A total of 874 had PPCM (283 with preeclampsia and 591 without preeclampsia). Among women with preeclampsia, clinical risk factors for PPCM consisted in chronic kidney disease (OR 3.18, 95% CI [1.51, 6.69]), multiple pregnancy (OR 2.11, 95% CI [1.49, 2.98]), chronic hypertension (OR 1.88, 95% CI [1.43, 2.47]), advanced maternal age (OR 1.82, 95% CI [1.42, 2.33]), and type 2 diabetes (OR 1.58, 95% CI [1.00, 2.48]). Women with pePPCM had a higher risk of MACE than women with npePPCM (adjusted RR 1.29, 95% CI [1.06, 1.57]) due to increased rates of clinical heart failure and pulmonary embolism in the pePPCM group. Mortality did not differ between groups. CONCLUSION: Preeclamptic women with risk factors for PPCM and women with pePPCM at increased risk of MACE should be followed closely. Further studies are required to determine whether preeclampsia affects the long-term prognosis of women with PPCM.

2.
J Rheumatol ; 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31474597

RESUMO

OBJECTIVE: Hydroxychloroquine (HCQ) and chloroquine (CQ) are key drugs in systemic lupus (SLE) and related diseases. Retinal toxicity remains the most concerning complication. We studied factors potentially associated with retinal toxicity, using case-control analyses. METHODS: Within our lupus clinic cohort, we identified patients with retinal changes using the SLICC Damage Index. We confirmed HCQ/CQ retinopathy with chart review, and selected up to three SLE controls for each case, matched on age at SLE diagnosis and SLE duration. RESULTS: Over an average 12.8 years of follow-up, within 326 patients exposed to antimalarial drugs, 18(5.5%) developed retinal toxicity. The minimum number of years of HCQ/CQ exposure before retinopathy developed was 8 years (maximum 33 years). Mean HCQ/CQ duration was similar in cases (18.5 years, 95% CI 15.2, 21.7) and controls (16.7 years, 95% CI 14.3, 19.0) likely due to our matching on SLE duration. Versus controls, cases tended to have more renal disease (cases 22.2%, controls 14.8%) and were slightly less likely to be Caucasian (cases 61.1%, controls 74.1%), but neither variables reached statistical significance. Among patients with retinal toxicity, the number previously exposed to CQ was more than three times that in controls. CONCLUSION: Just over 5% of patients developed anti-malarial retinal complications, over an average of 12.8 years. No cases were detected in the first 5 years of therapy. Past CQ use was more common in cases versus controls. Future studies using larger cohorts are underway to better define the roles of therapy duration, race/ethnicity, and other factors.

3.
Lupus Sci Med ; 6(1): e000325, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448125

RESUMO

Objectives: Chronic rheumatic diseases can challenge social and family relationships. We compared marital status in patients with systemic lupus erythematous (SLE) with their general population counterparts, stratified by sex and age of SLE onset. Methods: We performed a cross-sectional analysis of a cohort of 382 patients with SLE at our centre (349 females, 33 males). We determined how many were married or living common-law at the time of last study visit. Patients were then divided into: SLE diagnosis before 18, between 18 and 30, between 31 and 44 and after 45 years of age. We then compared marital status among male and female patients with SLE, to Quebec age-specific marital statistics. Results: Of 382 patients with SLE, 202 (52.9%) were married or living common-law, which was 9% lower than general population rates (95% CI 2% to 16%). One-third of women with paediatric-onset SLE were married or living common-law, which was 28% lower than their general population counterparts (95% CI 6% to 46%). Half of women diagnosed between age 18 and 30 were married or living common law, which was 14% less than general population rates (95% CI 4% to 25%). We could not establish significant differences for women diagnosed after age 30, or for males, versus their general population counterparts. Conclusions: Women diagnosed with SLE before age 30 were less likely to be married/living common-law, versus general population rates. This was not apparent for those diagnosed later in life. We did not clearly establish this effect in males, possibly due to power issues (vs a true effect of sex/gender). Additional studies (eg, focus groups) could elucidate reasons for our findings.

4.
Front Neurol ; 10: 163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30873111

RESUMO

Rheumatoid meningitis is a rare complication of rheumatoid arthritis (RA). It is associated with substantial morbidity and mortality. The condition may present in a variety of ways and is therefore diagnostically challenging. Uncertainty still exists regarding the optimal treatment strategy. Herein, we describe the case of a 74-year-old man with a history of well-controlled seropositive RA on low-dose prednisone, hydroxychloroquine, and methotrexate. The patient presented with a several-month history of multiple prolonged episodes of expressive aphasia, right hemiparesis, and encephalopathy. Although no epileptiform activity was recorded on repeated electroencephalography, the symptoms fully resolved following treatment with antiepileptic drugs. He subsequently developed acute asymmetrical parkinsonism of the right hemibody. Magnetic resonance imaging revealed subtle enhancement of the leptomeninges over the left frontoparietal convexity. Cerebrospinal fluid analysis revealed a mild lymphocytic pleocytosis and elevated proteins. Histopathologic analysis of a meningeal biopsy revealed nodular rheumatoid meningitis. The patient was treated with corticosteroids and cyclophosphamide, following which he incompletely recovered. This is the first description of rheumatoid meningitis manifesting with acute parkinsonism and protracted non-convulsive seizures. A summary of cases reported since 2005, including data on pathology, therapy and outcomes, along with a discussion on the efficacy of different treatment strategies are provided.

5.
Rheumatology (Oxford) ; 58(7): 1259-1267, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753683

RESUMO

OBJECTIVES: To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. METHODS: This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ⩽15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. RESULTS: A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. CONCLUSION: CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.

6.
Arthritis Care Res (Hoboken) ; 71(12): 1606-1610, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30418703

RESUMO

OBJECTIVE: To determine whether offspring from mothers with systemic lupus erythematosus (SLE), exposed in utero to antimalarials, have an increased risk of ocular anomalies during childhood versus unexposed SLE offspring. METHODS: We systematically performed searches of PubMed, Embase, and Web of Science databases for original human data on fetal and/or child ocular outcomes following exposure to antimalarials during pregnancy and/or lactation, from their inception until March 2017. RESULTS: A total of 10 cohort studies and 2 randomized controlled trials, ranging in size from 6 to 444 exposed infants studied, and 3 case reports met the inclusion criteria for our systematic review. Collectively, 1,477 infants were studied, 789 of which were exposed to hydroxychloroquine or chloroquine. In all, 563 exposed infants had follow-up visits after delivery (ranging from <3 months to 19 years), and 331 of these exposed infants underwent ophthalmologic examinations during the follow-up period. Our review of the literature suggests a low-to-nonexistent risk of visual abnormalities in offspring exposed to antimalarials. CONCLUSION: In children exposed to appropriate doses of antimalarials antenatally, the risk of ocular toxicity appears low to nonexistent. The potential benefits and risks of antimalarials should be discussed in all SLE pregnancies, and high dosages should continue to be avoided.

8.
J Rheumatol ; 45(10): 1426-1439, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30173152

RESUMO

OBJECTIVE: To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada. METHODS: Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian Arthritis Patient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online. RESULTS: There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination. CONCLUSION: These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.


Assuntos
Diretrizes para o Planejamento em Saúde , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Programas de Rastreamento , Adulto , Canadá , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Criança , Feminino , Pessoal de Saúde , Hepatite C/diagnóstico , Hepatite C/etiologia , Humanos , /etiologia , Lúpus Eritematoso Sistêmico/complicações , Masculino , Osteonecrose/diagnóstico , Osteonecrose/etiologia , Osteoporose/diagnóstico , Osteoporose/etiologia , Período Periparto/sangue , Gravidez , Reumatologistas , Medição de Risco , Índice de Gravidade de Doença , Revisão Sistemática como Assunto , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etiologia , Vacinação
9.
Rheumatology (Oxford) ; 57(suppl_5): v40-v47, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30137590

RESUMO

Collecting useful data on a sufficiently large cohort of pregnancies in women with rheumatic disease is a challenge. The original manuscripts that demonstrated the dangers of pregnancy in women with lupus were relatively small case series. As larger prospective cohorts were collected by university-based experts, however, greater safety was demonstrated and the current norms of treatment were determined. In recent years, larger administrative databases have been tapped to study pregnancies not managed within university clinics and to study the long-term impact of maternal rheumatic disease on the offspring. Each of these methods of study has both strengths and weaknesses, adding a unique piece of data to our overall knowledge. We will discuss a range of approaches to the study of rheumatic disease in pregnancy, covering the potential benefits that each brings as well as the biases that can impact study results. When the results of studies are viewed through these lenses, each can contribute to our larger understanding of the rheumatic diseases in pregnancy.


Assuntos
Pesquisa Biomédica/métodos , Lúpus Eritematoso Sistêmico/terapia , Exposição Materna/efeitos adversos , Complicações na Gravidez/terapia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Antirreumáticos/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez
10.
J Rheumatol ; 45(10): 1477-1490, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30008450

RESUMO

OBJECTIVE: Few data exist to guide the frequency and type of monitoring in systemic lupus erythematosus (SLE) pregnancies. A systematic literature review was performed to address this gap in the literature. METHODS: A systematic review of original articles (1975-2015) was performed using Medline, Embase, and Cochrane Library. We included search terms for SLE, pregnancy, and monitoring. We also hand-searched reference lists, review articles, and grey literature for additional relevant articles. RESULTS: The search yielded a total of 1106 articles. After removing 117 duplicates, 929 articles that were evidently unrelated to our topic based on title and/or abstract, and 7 that were in a language other than English or French, 53 articles were included for full-text review. Following a more in-depth review, 15 were excluded: 6 did not use any measure of SLE activity and 6 did not specifically address SLE monitoring in pregnancy; 1 case series, 1 review, and 1 metaanalysis were removed. Among the 38 included studies, presence of active disease, antiphospholipid (aPL) antibodies positivity, and abnormal uterine and umbilical artery Doppler studies predicted poor pregnancy outcomes. No studies evaluated an evidence-based approach to the frequency of monitoring. CONCLUSION: Few existing studies address monitoring for optimal care during SLE pregnancies. The available data imply roles for aPL antibodies measurement (prior to pregnancy and/or during the first trimester), uterine and umbilical artery Doppler studies in the second trimester, and following disease activity. Optimal frequency of monitoring is not addressed in the existing literature.


Assuntos
Lúpus Eritematoso Sistêmico/fisiopatologia , Resultado da Gravidez , Anticorpos Antifosfolipídeos/sangue , Canadá , Feminino , Humanos , Período Pós-Parto , Gravidez , Primeiro Trimestre da Gravidez/imunologia , Segundo Trimestre da Gravidez , Índice de Gravidade de Doença , Ultrassonografia Doppler , Artérias Umbilicais/diagnóstico por imagem , Artéria Uterina/diagnóstico por imagem
11.
Arthritis Rheumatol ; 70(10): 1565-1571, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29771477

RESUMO

OBJECTIVE: To evaluate the risk of serious infections in rheumatoid arthritis (RA) offspring exposed to tumor necrosis factor inhibitors (TNFi) in the gestational period compared to unexposed RA offspring, as well as to children from the general population. METHODS: We used US claim data (2011-2015) to identify 2,989 offspring born to women who have RA and a randomly selected group of 14,596 control children, matched ≥4:1 for maternal age, year of delivery, and state of residence. We defined TNFi exposure based on ≥1 filled prescription during pregnancy. We ascertained serious infections based on ≥1 hospitalization, with infection as a primary diagnosis, at ≤12 months of life. We performed multivariable analyses, adjusting for maternal demographics, comorbidities, pregnancy complications, and drugs. RESULTS: Among RA offspring, 380 (12.7%) were exposed to TNFi during pregnancy. The percentage of serious infections in RA offspring with no TNFi exposure (2.0%; 95% confidence interval [95% CI] 1.5, 2.6) was similar to that in non-RA offspring (1.9%; 95% CI 1.9, 2.2), while the percentage of serious infections in RA offspring with TNFi exposure was 3.2% (95% CI 1.5, 5.6). In multivariable analyses, we were unable to establish an increased risk of serious infections in RA offspring exposed to TNFi versus both non-RA offspring (odds ratio [OR] 1.7, 95% CI 0.8, 3.7) and RA offspring unexposed to TNFi (OR 1.4, 95% CI 0.7, 2.8). CONCLUSION: We did not demonstrate a marked excess risk for serious infections in RA offspring exposed to TNFi during pregnancy versus unexposed RA offspring or general population controls.


Assuntos
Antirreumáticos/efeitos adversos , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adolescente , Adulto , Artrite Reumatoide/tratamento farmacológico , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Complicações na Gravidez/tratamento farmacológico , Fatores de Risco , Adulto Jovem
12.
Arthritis Rheumatol ; 70(11): 1796-1800, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29790298

RESUMO

OBJECTIVE: Several autoimmune diseases have familial aggregation and, possibly, common genetic predispositions. In a large population-based study, we evaluated whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of rheumatic and nonrheumatic autoimmune diseases versus children born to mothers without SLE. METHODS: Using the Offspring of SLE Mothers Registry, we identified children born live to SLE mothers and their matched controls, and ascertained autoimmune diseases based on ≥1 hospitalization or ≥2 physician visits with a relevant diagnostic code. We adjusted for maternal age, education, race/ethnicity, obstetric complications, calendar birth year, and sex of child. RESULTS: A total of 509 women with SLE had 719 children, while 5,824 matched controls had 8,493 children. The mean ± SD follow-up period was 9.1 ± 5.8 years. Children born to mothers with SLE had a similar frequency of rheumatic autoimmune diagnoses (0.14%; 95% confidence interval [95% CI] 0.01-0.90) versus controls (0.19% [95% CI 0.11-0.32]). There was a trend toward more nonrheumatic autoimmune diseases in SLE offspring (1.11% [95% CI 0.52-2.27]) versus controls (0.48% [95% CI 0.35-0.66]). In multivariate analyses, we did not see a clear increase in rheumatic autoimmune disease (odds ratio [OR] 0.71 [95% CI 0.11-4.82]), but children born to mothers with SLE had a substantially increased risk of nonrheumatic autoimmune disease versus controls (OR 2.30 [95% CI 1.06-5.03]). CONCLUSION: Although the vast majority of offspring have no autoimmune disease, children born to women with SLE may have an increased risk of nonrheumatic autoimmune diseases versus controls. Additional studies assessing offspring through to adulthood would be additionally enlightening.


Assuntos
Doenças Autoimunes/epidemiologia , Filho de Pais Incapacitados/estatística & dados numéricos , Lúpus Eritematoso Sistêmico , Complicações na Gravidez , Adolescente , Adulto , Artrite Juvenil/epidemiologia , Artrite Psoriásica/epidemiologia , Doença Celíaca/epidemiologia , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Humanos , Lactente , Doenças Inflamatórias Intestinais/epidemiologia , Esclerose Múltipla/epidemiologia , Análise Multivariada , Miastenia Gravis/epidemiologia , Gravidez , Psoríase/epidemiologia , Quebeque/epidemiologia , Doenças Reumáticas/epidemiologia , Espondilite Anquilosante/epidemiologia , Vasculite Sistêmica/epidemiologia , Tireoidite Autoimune/epidemiologia
13.
Rheum Dis Clin North Am ; 44(2): 327-336, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29622299

RESUMO

Administrative databases, registers, and other sources of big data can be interesting sources to address important research questions on reproduction in women with rheumatic diseases. There are many different types of administrative datasets worldwide, and it is important to understand the type of data present and unavailable in each dataset, validity and potential misclassification of data, and the ability to link maternal data with infant data. This article discusses the advantages and methodologic issues associated with administrative database use for the conduct of observational studies on reproductive issues in women with rheumatic diseases.


Assuntos
Bases de Dados Factuais , Saúde Reprodutiva , Doenças Reumáticas/complicações , Feminino , Humanos , Gravidez , Complicações na Gravidez/etiologia , História Reprodutiva , Estados Unidos
14.
Arthritis Care Res (Hoboken) ; 70(2): 315-319, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28382783

RESUMO

OBJECTIVE: Limited evidence suggests a potentially increased risk of allergic conditions in offspring born to women with systemic lupus erythematosus (SLE). In a large population-based study, we aimed to determine if children born to mothers with SLE have an increased risk of allergic conditions compared to children born to mothers without SLE. METHODS: Using the Offspring of SLE Mothers Registry, we identified children born live to mothers with SLE and their matched controls, and ascertained the number of allergic conditions (asthma, allergic rhinitis, eczema, urticaria, angioedema, and anaphylaxis) based on ≥1 hospitalization or ≥1 or 2 physician(s) visit(s) with a relevant diagnostic code. We adjusted for maternal age, education, race/ethnicity, obstetrics complications, calendar year of birth, sex of the child, and maternal medication. RESULTS: There were 509 women with SLE who had 719 children, while 5,824 matched controls had 8,493 children. The mean ± SD followup period was 9.1 ± 5.8 years. Compared to controls, more children born to mothers with SLE had evidence of allergic conditions (43.9% [95% confidence interval (95% CI) 40.4-47.6] versus 38.1% [95% CI 37.0-39.1]). In multivariate analysis (n = 9,212), children born to mothers with SLE had an increased risk of allergic conditions versus control children (odds ratio 1.35 [95% CI 1.13-1.61]). CONCLUSION: Compared to children from the general population, children born to women with SLE may have an increased risk of allergic conditions. Genetics, shared environmental exposures, as well as in utero exposure to maternal autoantibodies and cytokines may mediate this increased risk.


Assuntos
Hipersensibilidade/etiologia , Lúpus Eritematoso Sistêmico/complicações , Efeitos Tardios da Exposição Pré-Natal , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Gravidez , Quebeque , Sistema de Registros , Medição de Risco , Fatores de Risco
15.
PLoS One ; 12(12): e0189840, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29261752

RESUMO

OBJECTIVES: To compare physical and mental health-related quality of life (HRQoL) across four systemic autoimmune rheumatic diseases (SARD). METHODS: Incident subjects enrolled in four SARD cohorts, namely systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA) and idiopathic inflammatory myopathies (IIM) were studied. The outcomes of interest were baseline Short Form Health Survey physical (PCS) and mental (MCS) component summary scores. Multivariate analysis was conducted to determine whether PCS and MCS scores differed across SARD type. RESULTS: The study included 118 SLE (93% women, mean age 36 years), 108 SSc (79% women, mean age 55), 64 RA (63% women, mean age 58) and 25 IIM (68% women, mean age 49) subjects. Mean PCS scores were 38.9 ± 12.2 in SLE, 37.1 ± 13.3 in RA, 35.0 ± 13.6 in SSc and 28.0 ± 15.4 in IIM. Mean MCS scores were 45.0 ± 13.3 in RA, 44.4 ± 14.7 in SSc, 40.1 ± 14.3 in SLE and 33.6 ± 18.7 in IIM. SARD type was an independent predictor of HRQoL with, in some cases, the magnitude of the differences reaching one standard deviation (IIM worse PCS scores compared to SLE (ß -12.23 [95% CI -18.11, -6.36; p<0.001]); IIM worse MCS scores compared to SSc (ß -11.05 [95% CI -17.53, -4.58; p = 0.001]) and RA (ß -11.72 [95% CI -18.62, -4.81; p = 0.001]). CONCLUSIONS: Cross-SARD research provides a novel approach to gain greater understanding of commonalities and differences across rheumatic diseases. The differences observed warrant further research into correlates and trajectories over time.


Assuntos
Doenças Autoimunes/patologia , Saúde , Qualidade de Vida , Doenças Reumáticas/patologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade
16.
Rheumatology (Oxford) ; 56(8): 1378-1385, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28460079

RESUMO

Objective: The aim was to evaluate the prevalence of postpartum complications, including depression, in new mothers who had juvenile idiopathic arthritis (JIA) and to assess whether these differ from mothers who never had JIA. Methods: Our cohort study used data from physician billing and hospitalizations covering Quebec, Canada. We identified females with JIA with a first-time birth between 1 January 1983 and 31 December 2010 and assembled a control cohort of first-time mothers without JIA from the same administrative data, matching 4:1 for date of first birth, maternal age and area of residence. We compared the following postpartum complications: major puerperal infection, anaesthetic complications, postpartum haemorrhage, thromboembolism, obstetrical trauma, complications of obstetrical surgical wounds and maternal depression in the first year after delivery, in the JIA vs non-JIA groups, using bivariate analysis and multiple logistic regression. Results: The mean age at delivery was 24.7 years in the JIA group (n = 1681) and 25.0 years for the non-JIA group (n = 6724). Mothers with JIA were more likely to experience complications attributable to anaesthetic [adjusted risk ratio (aRR) 2.17, 95% CI; 1.05, 4.48], postpartum haemorrhage (aRR = 2.75, 95% CI: 2.42, 3.11) and thromboembolism (aRR = 5.27, 95% CI: 1.83, 15.17) but were at lower risk for obstetrical trauma (aRR = 0.78, 95% CI: 0.64, 0.95) or newly to develop depression in the first year postpartum (aRR = 0.52, 95% CI: 0.40, 0.68). Conclusion: Mothers with JIA appear to be at higher risk for complications attributable to anaesthesia, postpartum haemorrhage and thromboembolism. Prevention strategies for postpartum haemorrhage and thromboembolism may be especially important in this population.


Assuntos
Artrite Juvenil/complicações , Complicações do Trabalho de Parto/etiologia , Transtornos Puerperais/etiologia , Adulto , Anestesia/efeitos adversos , Estudos de Casos e Controles , Estudos de Coortes , Depressão Pós-Parto/etiologia , Feminino , Humanos , Modelos Logísticos , Hemorragia Pós-Parto/etiologia , Período Pós-Parto , Gravidez , Quebeque , Fatores de Risco , Tromboembolia/etiologia , Adulto Jovem
17.
Rheum Dis Clin North Am ; 43(2): 263-273, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28390568

RESUMO

Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are the most prevalent autoimmune rheumatic diseases, predominantly occurring in women during childbearing years. Research has focused on assessing the risk of immediate complications during SLE and RA pregnancies, with studies documenting a higher risk of adverse obstetric outcomes, such as preterm births and infants small for gestational age. Until recently, little was known regarding the long-term health of children born to affected women. We present a review of the current evidence regarding the risk of adverse health outcomes in SLE and RA offspring, and potential mechanisms involved in their pathogenesis.


Assuntos
Doenças Autoimunes/epidemiologia , Cardiopatias Congênitas/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Doenças Reumáticas/epidemiologia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Autoanticorpos/imunologia , Criança , Citocinas/imunologia , Feminino , Humanos , Recém-Nascido , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/imunologia , Efeitos Tardios da Exposição Pré-Natal/imunologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/imunologia
18.
Arthritis Care Res (Hoboken) ; 69(12): 1926-1931, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28319657

RESUMO

OBJECTIVE: There is recent evidence to suggest that in utero exposure to maternal antibodies and cytokines is an important risk factor for autism spectrum disorders (ASDs). We aimed to systematically review the risk of ASDs in children born to mothers with rheumatoid arthritis (RA) compared to children born to mothers without RA. METHODS: We conducted a systematic review of original articles using the electronic databases PubMed, Embase, and Web of Science. RESULTS: Our literature search yielded a total of 70 articles. Of the potentially relevant studies retrieved, 67 were excluded for lack of relevance and/or because they did not report original data. Three studies were included in the final analysis. A case-control study found no difference in the prevalence of RA in mothers of children with ASDs versus control mothers. Another case-control study showed a statistically significant 8-fold increase in autoimmune disorders, including RA, in mothers of offspring with ASDs compared to controls. Forty-six percent of offspring with ASDs had a first-degree relative with RA, compared to 26% of controls. And in a population-based cohort study, investigators observed an increased risk of ASDs in children with a maternal history of RA compared to children born to unaffected mothers. These studies had methodologic limitations: none controlled for medication exposures, only 1 controlled for obstetric complications and considered the timing of RA diagnosis in relation to pregnancy, and all but 1 used a case-control study design. CONCLUSION: Observational studies suggest a potentially increased risk of ASDs in children born to mothers with RA compared to children born to mothers without RA, although data are limited.


Assuntos
Artrite Reumatoide/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Mães , Efeitos Tardios da Exposição Pré-Natal , Anticorpos/imunologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/imunologia , Criança , Pré-Escolar , Citocinas/imunologia , Feminino , Humanos , Mediadores da Inflamação/imunologia , Masculino , Análise Multivariada , Razão de Chances , Gravidez , Medição de Risco , Fatores de Risco
19.
Arthritis Care Res (Hoboken) ; 69(2): 306-309, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27111101

RESUMO

OBJECTIVE: To determine whether women with a history of juvenile arthritis are at higher risk for heart disease and hypertension and for developing adverse maternal outcomes: gestational diabetes mellitus, maternal hypertension, and preeclampsia/eclampsia. METHODS: We designed a nested case-control study from a cohort of first-time mothers with prior physician billing codes suggesting juvenile arthritis, and a matched comparison group without juvenile arthritis. For the nested case-control design, we selected 3 controls for each case for the outcomes of heart disease (n = 403), prepregnancy hypertension (n = 66), gestational diabetes mellitus (n = 285), maternal hypertension (n = 561), and preeclampsia/eclampsia (n = 236). We used conditional logistic regression, adjusting for maternal age and education. RESULTS: Having juvenile arthritis was associated with heart disease (odds ratio [OR] 2.44 [95% confidence interval (95% CI) 1.15-5.15]) but not with gestational hypertension, diabetes mellitus, or preeclampsia/eclampsia. All 66 cases of prepregnancy hypertension had juvenile arthritis. Having prepregnancy hypertension was strongly associated with preeclampsia/eclampsia (OR 8.05 [95% CI 2.69-24.07]). CONCLUSION: Women with a history of juvenile arthritis had a higher risk of heart disease. This risk signals the potential importance of cardiac prevention strategies in juvenile arthritis. As this was a retrospective study, it was not possible to correct for some relevant potential confounders. Further studies should assess the impact of medications, disease severity, and other factors (e.g., obesity) on cardiac outcomes in juvenile arthritis.


Assuntos
Artrite Juvenil/complicações , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Diabetes Gestacional/epidemiologia , Eclampsia/epidemiologia , Feminino , Humanos , Mães , Razão de Chances , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
20.
Br J Clin Pharmacol ; 83(5): 1126-1133, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27874994

RESUMO

AIM: The use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the newborn (PPHN). Limited data are available on the risk of PPHN associated with serotonin norepinephrine reuptake inhibitors (SNRIs). We aimed to quantify both associations. METHODS: Using data from the Quebec Pregnancy Cohort between 1998 and 2009, we included women covered by the provincial drug plan who had a singleton live birth. Exposure categories were SSRI, SNRI and other antidepressant use; non-users were considered as the reference category. Generalized estimating equation models were used to obtain risk estimates and 95% confidence intervals (CIs). Confounding by indication was minimized by adjusting for history of maternal depression/anxiety before pregnancy. RESULTS: Overall, 143 281 pregnancies were included; PPHN was identified in 0.2% of newborns. Adjusting for maternal depression, and other potential confounders, SSRI use during the second half of pregnancy was associated with an increased risk of PPHN [adjusted odds ratio (aOR) 4.29, 95% CI 1.34, 13.77] compared with non-use of antidepressants; SNRI use during the same time window was not statistically associated with the risk of PPHN (aOR 0.59, 95% CI 0.06, 5.62). Use of SSRIs and SNRIs before the 20th week of gestation was not associated with the risk of PPHN. CONCLUSIONS: Use of SSRIs in the second half of pregnancy was associated with the risk of PPHN. Given our results on SNRIs and the lack of statistical power for these analyses, it is unclear whether SNRI use during pregnancy also increases the risk of PPHN.


Assuntos
Antidepressivos/efeitos adversos , Síndrome da Persistência do Padrão de Circulação Fetal/induzido quimicamente , Inibidores de Captação de Serotonina/efeitos adversos , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Adulto , Antidepressivos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Trimestres da Gravidez , Quebeque , Sistema de Registros , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores da Recaptação de Serotonina e Norepinefrina/administração & dosagem , Adulto Jovem
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