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Membrive-Jiménez C, Sánchez-Piedra C, Martínez-González O, García-González J, Expósito-Pérez L, Bohórquez-Heras C, Campos-Fernández C, Sanchez-Alonso F, Cáliz-Cáliz R, Castrejón-Fernández I. Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry. REUMATOLOGIA CLINICA 2023; 19:500-506. [PMID: 37945183 DOI: 10.1016/j.reumae.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/01/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients. METHOD This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups. RESULT Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation. CONCLUSION Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.
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Affiliation(s)
| | - Carlos Sánchez-Piedra
- Health Technology Assessment Agency (AETS), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | - Rafael Cáliz-Cáliz
- Rheumatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
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2
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Götestam Skorpen C, Lydersen S, Salvesen KÅ, Wallenius M. A population-based study of caesarean section in women with juvenile idiopathic arthritis. Rheumatol Adv Pract 2023; 7:rkad062. [PMID: 37600477 PMCID: PMC10435369 DOI: 10.1093/rap/rkad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/19/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives The literature on delivery methods in women with JIA is limited. Active inflammation is a risk factor for caesarean section (CS) in other arthritic diseases. A CS entails a higher risk for complications than vaginal delivery and restricted physical activity in the first weeks after birth. Our objective was to explore a possible association of inflammatory active disease and the proportion of CS in women with JIA. Methods Data from the Norwegian nationwide observational register RevNatus were linked with data from the Medical Birth Registry of Norway (MBRN). Cases comprised singleton births in women with JIA (n = 196) included in RevNatus from 2010 to 2019. Singleton births registered in the MBRN during the same period of time, excluding births in mothers with rheumatic inflammatory diseases, served as population controls (n = 575 798). Results CS was more frequent in women with JIA (20.4%) and in the subgroup of women with inflammatory active JIA (30.0%) than in population controls (15.6%). Women with active JIA had a risk for elective CS similar to population controls [risk difference 2.3% (95% CI -2.5, 12.9)] and a higher risk for emergency CS [risk difference 14.0% (95% CI 4.3, 27.4)] compared with population controls. Conclusion Women with active JIA had a higher risk for emergency CS, but not elective CS, compared with population controls.
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Affiliation(s)
- Carina Götestam Skorpen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology Ålesund, Helse More og Romsdal HF, Ålesund, Norway
| | - Stian Lydersen
- Department of Mental Health, Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Å Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Wallenius
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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3
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Andreoli L, Chighizola CB, Iaccarino L, Botta A, Gerosa M, Ramoni V, Tani C, Bermas B, Brucato A, Buyon J, Cetin I, Chambers CD, Clowse MEB, Costedoat-Chalumeau N, Cutolo M, De Carolis S, Dolhain R, Fazzi EM, Förger F, Giles I, Haase I, Khamashta M, Levy RA, Meroni PL, Mosca M, Nelson-Piercy C, Raio L, Salmon J, Villiger P, Wahren-Herlenius M, Wallenius M, Zanardini C, Shoenfeld Y, Tincani A. Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11 th International Conference on Reproduction, Pregnancy and Rheumatic Diseases. Autoimmun Rev 2023; 22:103259. [PMID: 36549355 DOI: 10.1016/j.autrev.2022.103259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Autoimmune rheumatic diseases (ARD) can affect women and men during fertile age, therefore reproductive health is a priority issue in rheumatology. Many topics need to be considered during preconception counselling: fertility, the impact of disease-related factors on pregnancy outcomes, the influence of pregnancy on disease activity, the compatibility of medications with pregnancy and breastfeeding. Risk stratification and individualized treatment approach elaborated by a multidisciplinary team minimize the risk of adverse pregnancy outcomes (APO). Research has been focused on identifying biomarkers that can be predictive of APO. Specifically, preeclampsia and hypertensive disorders of pregnancy tend to develop more frequently in women with ARD. Placental insufficiency can lead to intrauterine growth restriction and small-for-gestational age newborns. Such APO have been shown to be associated with maternal disease activity in different ARD. Therefore, a key message to be addressed to the woman wishing for a pregnancy and to her family is that treatment with compatible drugs is the best way to ensure maternal and fetal wellbeing. An increasing number of medications have entered the management of ARD, but data about their use in pregnancy and lactation are scarce. More information is needed for most biologic drugs and their biosimilars, and for the so-called small molecules, while there is sufficient evidence to recommend the use of TNF inhibitors if needed for keeping maternal disease under control. Other issues related to the reproductive journey have emerged as "unmet needs", such as sexual dysfunction, contraception, medically assisted reproduction techniques, long-term outcome of children, and they will be addressed in this review paper. Collaborative research has been instrumental to reach current knowledge and the future will bring novel insights thanks to pregnancy registries and prospective studies that have been established in several Countries and to their joint efforts in merging data.
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Affiliation(s)
- Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cecilia B Chighizola
- Paediatric Rheumatology Unit, ASST G. Pini & CTO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Angela Botta
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Gerosa
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Center for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Véronique Ramoni
- Medicina Generale Lodi, ASST Lodi-Ospedale Maggiore, Lodi, Italy
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Antonio Brucato
- Internal Medicine, Fatebenefratelli Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jill Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Irene Cetin
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospitals, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Christina D Chambers
- Department of Pediatrics, University of California, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Megan E B Clowse
- Division of Rheumatology & Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Nathalie Costedoat-Chalumeau
- Internal Medicine Department, Cochin Hospital, Referral center for rare autoimmune and systemic diseases, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal M edicine, University of Genoa, IRCSS San Martino Polyclinic, Genoa, Italy
| | - Sara De Carolis
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Radboud Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elisa M Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Child Neurology and Psychiatry Unit, ASST Spedali Civili, Brescia, Italy
| | - Frauke Förger
- Department of Rheumatology and Immunology, University Hospital (Inselspitaland University of Bern, Bern, Switzerland
| | - Ian Giles
- Centre for Rheumatology, Department of Inflammation, Division of Medicine, University College London, Department of rheumatology, University College London Hospital, London, UK
| | - Isabell Haase
- Department for Rheumatology and Hiller Research Institute, Heinrich-Heine-University, Düsseldorf, Germany
| | - Munther Khamashta
- Women & Children's Health, King's College, London, UK; GlaxoSmithKline Global Medical Expert, Dubai, United Arab Emirates
| | - Roger A Levy
- Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil; GlaxoSmithKline Global Medical Expert, Collegeville, PA, USA
| | - Pier Luigi Meroni
- IRCCS Istituto Auxologico Italiano, Immunorheumatology Research Laboratory, Milan, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital (Inselspitaland University of Bern, Bern, Switzerland
| | - Jane Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Peter Villiger
- Rheumatology and Clinical Immunology, Medical Center Monbijou, Bern, Switzerland
| | - Marie Wahren-Herlenius
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Wallenius
- National Advisory Unit on Pregnancy and Rheumatic Diseases, St Olavs Hospital, Trondheim, University Hospital and Institute of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Cristina Zanardini
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Ariel University, Ariel, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Bjørngaard H, Koksvik HS, Jakobsen B, Grønning K. Nurses experience increased clinical and organisational competence by working with a medical quality register, RevNatus - a qualitative study. BMC Health Serv Res 2022; 22:1291. [PMID: 36289511 PMCID: PMC9608925 DOI: 10.1186/s12913-022-08595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background RevNatus is a consent-based, nationwide medical quality register that collects data on patients with inflammatory rheumatic diseases during pregnancy and one year postpartum. The entering of data takes place in outpatient clinics in rheumatology wards in hospitals. The aim of this study is to explore how rheumatology nurses experience organizing and working with the medical quality register RevNatus in addition to their normal clinical patient-care tasks. Methods Qualitative focus group interviews and individual in-depth interviews were conducted in 2018 to gain insights into how nurses organize performing quality register work and clinical work simultaneously. Data were analysed using systematic text condensation. Results The informants represented seven different rheumatology outpatient clinics in Norway. The analyses showed that working with RevNatus increased the nurses’ knowledge about pregnancy and rheumatic diseases, improved the content of their nurse consultations and found the ‘register form’ as a useful template to structure the nurse consultations. The nurses took the main responsibility for RevNatus, but lack of routines and uncoordinated collaboration with the rheumatologists and secretaries made the nurses spend too much time verifying the accuracy of data or post-registering missing data. Conclusion The nurses experienced work with RevNatus as time-consuming, but the register work increased both their clinical and organisational competences. Routines and collaboration within the registry team are important to ensure the data quality and reduce the workload. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08595-x.
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Affiliation(s)
- Hilde Bjørngaard
- grid.52522.320000 0004 0627 3560Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St.Olavs Hospital, 7030 Trondheim, Norway
| | - Hege Svean Koksvik
- grid.52522.320000 0004 0627 3560Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St.Olavs Hospital, 7030 Trondheim, Norway
| | - Bente Jakobsen
- grid.52522.320000 0004 0627 3560Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St.Olavs Hospital, 7030 Trondheim, Norway
| | - Kjersti Grønning
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,Nord-Trøndelag Hospital Trust, 7601 Levanger, Norway
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Weber E, Millet A, Beghin D, Viel S, Guitton J, Gerfaud-Valentin M, Sève P, Jamilloux Y. Safety of canakinumab during pregnancy: seven new cases. Rheumatology (Oxford) 2022; 61:e229-e231. [PMID: 35325056 DOI: 10.1093/rheumatology/keac177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emmanuelle Weber
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Aurélien Millet
- Laboratoire de Pharmaco-Toxicologie,Centre Hospitalier Lyon, Sud, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Delphine Beghin
- Centre de Référence sur les Agents Tératogènes (CRAT, ), DMU ESPRIT, GHU APHP Sorbonne Université, Hôpital Armand-Trousseau, Paris, France
| | - Sebastien Viel
- Immunology Department, Lyon Sud University Hospital, Pierre-Bénite, 69495, France.,Lyon Immunopathology Federation (LIFE), Lyon, France
| | - Jérôme Guitton
- Laboratoire de Pharmaco-Toxicologie,Centre Hospitalier Lyon, Sud, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Pascal Sève
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Yvan Jamilloux
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.,Lyon Immunopathology Federation (LIFE), Lyon, France
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Gerosa M, Chighizola CB, Pregnolato F, Pontikaki I, Luppino AF, Argolini LM, Trespidi L, Ossola MW, Ferrazzi EM, Caporali R, Cimaz R. Pregnancy in juvenile idiopathic arthritis: maternal and foetal outcome, and impact on disease activity. Ther Adv Musculoskelet Dis 2022; 14:1759720X221080375. [PMID: 35282569 PMCID: PMC8905061 DOI: 10.1177/1759720x221080375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/26/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: This retrospective cohort study describes the modulation of disease activity during gestation and in the year following delivery as well as maternal and neonatal outcomes in a monocentric cohort of women with juvenile idiopathic arthritis (JIA). Methods: Disease activity was assessed using DAS28-CRP before conception and every 3 months during pregnancy and in the first year postpartum. The risk of complicated pregnancies was measured applying a generalized estimating equation model. Changes in disease activity during gestation and in the first year postpartum were assessed in a linear mixed model for repeated measures. Results: Thirty-one women (49 pregnancies) with persisting JIA and at least one conception were enrolled. Adjusted DAS28-CRP levels remained stable from preconception through the first trimester, but increased significantly in the second and decreased not significantly in the third. In the postpartum, adjusted disease activity peaked at 3 months after delivery, stabilized at 6 months to decrease at 1 year, although not significantly. Preconceptional DAS28-CRP and number of biological drugs predicted disease activity fluctuation during gestation. The number of biological drugs and the length of gestational exposure to biologics significantly predicted pregnancy morbidity. In particular, JIA women had a higher probability of preterm delivery compared with healthy and disease controls. Adjusted for breastfeeding and DAS28-CRP score in the third trimester, postconceptional exposure to biologics was inversely related with disease activity in the postpartum: the longer the patient continued treatment, the lower the probability of experiencing an adverse pregnancy outcome. Conclusion: These data offer novel insights on how treatment affects disease activity during pregnancy and postpartum as well as obstetric outcomes in women with JIA.
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Affiliation(s)
- Maria Gerosa
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan 20122, Italy
| | - Francesca Pregnolato
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Irene Pontikaki
- Pediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Angela Flavia Luppino
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Lorenza Maria Argolini
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico M. Ferrazzi
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy Pediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
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Marrone G, Galati F, Biolato M, Oddy C, De Carolis S, Zoli A, Grieco A. Acute liver failure in Still's disease relapse during pregnancy: case report and discussion of a possible trigger role of DILI. BMC Gastroenterol 2021; 21:317. [PMID: 34362307 PMCID: PMC8349071 DOI: 10.1186/s12876-021-01878-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Still's disease is a rare systemic inflammatory disease with frequent but generally mild liver involvement. The most common cause of acute liver failure in western countries is drug-induced liver injury, while it has rarely been reported in subjects suffering from Still's disease. CASE PRESENTATION We report a case of a young woman presenting with SD reactivation in pregnancy and acute liver failure after delivery with a possible triggering role of drug induced liver injury. CONCLUSIONS The prompt recognition of Still's disease reactivation allowed early introduction of steroid therapy and resolution of the clinical picture. We discuss potential factors precipitating ALF in this case, and implications for the diagnosis and management of such patients.
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Affiliation(s)
- Giuseppe Marrone
- Transplant Hepatology Unit - CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Francesco Galati
- Transplant Hepatology Unit - CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Marco Biolato
- Transplant Hepatology Unit - CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Christopher Oddy
- FY2 Intensive Care Medicine, Epsom & St Helier University Hospitals NHS Trust, Epsom, UK
| | - Sara De Carolis
- Obstetrics and Obstetric Pathology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Zoli
- Osteo-articular Disease Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Grieco
- Transplant Hepatology Unit - CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
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8
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Disease course and obstetric outcomes of pregnancies in juvenile idiopathic arthritis: are there any differences among disease subtypes? A single-centre retrospective study of prospectively followed pregnancies in a dedicated pregnancy clinic. Clin Rheumatol 2020; 40:239-244. [PMID: 32945981 DOI: 10.1007/s10067-020-05404-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/06/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
To study disease activity during pregnancy and obstetric outcomes in patients with juvenile idiopathic arthritis (JIA) upon different subsets and with focus on medication use. Retrospective observational study of 22 pregnancies in 16 JIA patients (95.5% Caucasian) who were followed between 2010 and 2018. Disease activity, flares and medications were recorded before conception, during each trimester and postpartum period. Pregnancies occurred in 10 (45.5%) oligoarticular extended (OLA-E), 6 (27.3%) in polyarticular (PLA), 4 in (18.2%) systemic (SYS), 1 (4.5%) in oligoarticular persistent (OLA-P) and 1 (4.5%) in enthesitis-related arthritis (ERA) JIA patients. The median age at disease diagnosis and at conception was 5.5 and 28 years (respectively). The median disease duration was 20 years. Nineteen (95%) pregnancies started in a period of stable disease remission. Among the 22 pregnancies, 20 ended with a live birth (90.9%). No spontaneous miscarriages occurred; two voluntary interruption of pregnancy were performed. There were 7 flares in 6/20 pregnancies (35%) and 8 flares (8/22, 36.4%) occurred in postpartum period, all of them in OLA-E and PLA patients. Seven patients (35%) were taking biological disease-modifying anti-rheumatic drugs (bDMARDs) at conception, and 6 of them stopped this treatment at positive pregnancy test. Five patients resumed bDMARDs either during pregnancy (3 exposed during the third trimester) or puerperium due to a flare. Four preterm deliveries (20%) were recorded, all in patients who had a flare during pregnancy. The preconception counselling should include the evaluation of disease subset, as OLA-E and PLA may flare more than other subsets, especially if bDMARDs are discontinued at positive pregnancy test. Continuation of bDMARDs during pregnancy should be considered to minimize the risk of adverse pregnancy outcomes, particularly preterm delivery. Key Points • In our cohort, all the flares during pregnancy and 75% of postpartum flares were observed in patients who withdrew bDMARDs and cDMARDs at the beginning of pregnancy. • Flares were observed only in PLA and OLA-E patients. • Preterm delivery occurred in 20% of the pregnancies; all of these patients had a disease flare during pregnancy.
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Abstract
Caring for women in the postnatal period can be challenging. One of the most important aspects is ensuring disease control as there is a risk of flare in the postpartum period. Other aspects of care also need to be addressed with the mother in mind such as breastfeeding or with the neonate in mind such as vaccinations or complications of the maternal condition affecting the neonate. This article highlights aspects of care that need to be addressed in the postpartum period such as flare rates, maternal wellbeing, thromboembolism, vaccinations, contraception and breast feeding.
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Affiliation(s)
- Maria Mouyis
- Rheumatology Department, West Middlesex University Hospital, London, UK.
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10
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Tang T, Zhang Y, Luo C, Liu M, Xu L, Tang X. Adjunctive vitamin D for the treatment of active juvenile idiopathic arthritis: An open-label, prospective, randomized controlled trial. Exp Ther Med 2019; 18:4921-4926. [PMID: 31798713 PMCID: PMC6880388 DOI: 10.3892/etm.2019.8133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
Vitamin D has an important immunomodulatory effect, but no trial has examined the effect of boosting serum levels of 25-hydroxyvitamin D (25OHD) in individuals with juvenile idiopathic arthritis (JIA). The aim of the present study was to assess whether vitamin D supplementation reduced disease activity and adjusted/maintained bone mass in patients with active JIA. A 24-week randomized trial was undertaken at Children's Hospital of Chongqing Medical University. Treatment-naive patients with JIA were randomly assigned (1:1) to one of two groups: Standard treatment with high dose oral cholecalciferol [2,000 IU per day; experimental group (EG)] or without supplementation [control group (CG)]. The primary outcomes were the 27-joint Juvenile Arthritis Disease Activity Score (JADAS-27 score), the Z-score for bone mineral density (BMD), and serum levels of 25OHD. A per-protocol analysis set approach was used. The Mann-Whitney U test was the main tool used for data analysis. A total of 42 participants were assigned randomly to the EG (n=20) or the CG (n=22); of these, 36 (n=18 and n=18, respectively) were included in per-protocol analysis. After 24 weeks, the mean level of 25OHD in the EG was higher than that in the CG (P<0.05). At the end of the intervention, there were no clear differences between the two groups in terms of BMD or JADAS-27 score (both P>0.05). Cholecalciferol supplementation (2000 IU/day) for 24 weeks raised serum levels of 25OHD in JIA patients but did not reduce disease activity or improve BMD (registration no. ChiCTR-INR-16009235; Date of Registration: 2016-10-12).
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Affiliation(s)
- Tao Tang
- Rheumatology and Immunology Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, P.R. China
| | - Yu Zhang
- Rheumatology and Immunology Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, P.R. China
| | - Chong Luo
- Rheumatology and Immunology Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, P.R. China
| | - Mingyue Liu
- Rheumatology and Immunology Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, P.R. China
| | - Li Xu
- Rheumatology and Immunology Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, P.R. China
| | - Xuemei Tang
- Rheumatology and Immunology Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, P.R. China
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Meissner Y, Strangfeld A, Costedoat-Chalumeau N, Förger F, Goll D, Molto A, Özdemir R, Wallenius M, Fischer-Betz R. European Network of Pregnancy Registers in Rheumatology (EuNeP)-an overview of procedures and data collection. Arthritis Res Ther 2019; 21:241. [PMID: 31727137 PMCID: PMC6854642 DOI: 10.1186/s13075-019-2019-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The collaborative initiative of the European Network of Pregnancy Registers in Rheumatology (EuNeP) aims to combine data available in nationwide pregnancy registers to increase knowledge on pregnancy outcomes in women with inflammatory rheumatic diseases (IRD) and on drug safety during pregnancy and lactation. The objective of this study was to describe the similarities and differences of the member registers. METHODS From all registers, information about their structure and design was collected, as well as which parameters regarding demographics, maternal outcomes, treatment, course and outcome of pregnancy, and development of the child were available in the respective datasets. Furthermore, the current recruitment status was reported. RESULTS The four registers (EGR2 (France), RePreg (Switzerland), RevNatus (Norway), and Rhekiss (Germany)) collect information prospectively and nationwide. Patients can be enrolled before conception or during pregnancy. To date, more than 3500 patients in total have been included, and data on 2200 pregnancies with an outcome are available. The distribution of diagnoses in the respective registers varies considerably, and only three entities (rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis) are captured by all the registers. Broad consistency was found in non-disease-specific data items, but differences regarding instruments and categories as well as frequency of data collection were revealed. Disease-specific data items are less homogeneously collected. CONCLUSION Although the registers in this collaboration have similar designs, we found numerous differences in the variables collected. This survey of the status quo of current pregnancy registers is the first step towards identifying data collected uniformly across registers in order to facilitate joint analyses. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Yvette Meissner
- Programmbereich Epidemiologie, Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum, Charitéplatz 1, 10117, Berlin, Germany.
| | - Anja Strangfeld
- Programmbereich Epidemiologie, Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum, Charitéplatz 1, 10117, Berlin, Germany
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine Department, Cochin Hospital, Referral Center for Rare Autoimmune and Systemic Diseases, Paris, France.,Paris Descartes Sorbonne, Paris Cité University, Paris, France.,INSERM (Unit 1153) Université de Paris, CRESS, Paris, France
| | - Frauke Förger
- Department of Rheumatology, Inselspital University Hospital, Bern, Switzerland
| | | | - Anna Molto
- INSERM (Unit 1153) Université de Paris, CRESS, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Rheumatology Department, Cochin Hospital, Paris, France
| | | | - Marianne Wallenius
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Saint Olavs University Hospital in Trondheim, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rebecca Fischer-Betz
- Department of Rheumatology and Hiller Research Unit, University Clinic Duesseldorf, Duesseldorf, Germany
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12
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Drechsel P, Stüdemann K, Niewerth M, Horneff G, Fischer-Betz R, Seipelt E, Spähtling-Mestekemper S, Aries P, Zink A, Klotsche J, Minden K. Pregnancy outcomes in DMARD-exposed patients with juvenile idiopathic arthritis—results from a JIA biologic registry. Rheumatology (Oxford) 2019; 59:603-612. [DOI: 10.1093/rheumatology/kez309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/09/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Objectives
To investigate the courses and outcomes of pregnancies involving JIA patients who were exposed to DMARDs.
Methods
In the Juvenile arthritis MTX/Biologics long-term Observation study, pregnant patients or male patients with pregnant partners were identified. Standardized patient interviews were conducted, and the course and outcome of pregnancy were assessed. Prospectively collected physician- and patient-reported data were also considered in the analysis.
Results
The study sample included 152 pregnancies in 98 women with JIA and 39 pregnancies involving 21 male patients as partners. The majority of patients had polyarticular-onset/-course JIA (61%). The average age of patients at first pregnancy was 24.1 (4.5) years, and their mean disease duration was 13.8 (5.9) years. Patients had been exposed to DMARDs for 9.5 (5.6) years, and 90% of these patients had received biologics before. Half of the pregnancies occurred during DMARD exposure, mostly with etanercept. Significant differences in pregnancy outcomes between DMARD-exposed and -unexposed pregnancies were not observed. Spontaneous abortion (13.1%) and congenital anomaly (3.6%) rates were not suggestive of increased risk compared with expected background rates. However, the rates of premature birth (12.3%) and caesarean section (37.7%) were slightly above those in the German birthing population. The disease activity of female patients remained relatively stable in pregnancy, with mean cJADAS-10 scores of 5.3, 7.1 and 5.6 in each trimester, respectively.
Conclusion
Young adults with JIA often become pregnant or become fathers of children while still being treated with DMARDs. Data suggest no increased risk of major adverse pregnancy outcomes.
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Affiliation(s)
- Paula Drechsel
- Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute, Berlin
| | - Katrin Stüdemann
- Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute, Berlin
| | - Martina Niewerth
- Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute, Berlin
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, University Hospital of Cologne, Cologne
| | - Rebecca Fischer-Betz
- Hiller Research Center & Department of Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf
| | - Eva Seipelt
- Department of Internal Medicine, Rheumatology, Clinical Immunology and Osteology, Immanuel Krankenhaus Berlin, Berlin
| | | | | | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute, Berlin
- Department of Rheumatology and Clinical Immunology
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute, Berlin
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute, Berlin
- Department of Rheumatology and Clinical Immunology
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13
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Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Psoriatic Arthritis Disease Activity During and After Pregnancy: A Prospective Multicenter Study. Arthritis Care Res (Hoboken) 2019; 71:1092-1100. [PMID: 30192071 DOI: 10.1002/acr.23747] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/04/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To study disease activity in women with peripheral psoriatic arthritis (PsA) during and after pregnancy. Previous knowledge on this topic is sparse. METHODS The study included 108 pregnancies in 103 women with PsA from a Norwegian nationwide register. Disease activity was assessed prospectively at 7 time points before, throughout, and after pregnancy with the 3-variable Disease Activity Score in 28 joints (DAS28) using C-reactive protein levels and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Scores assessed at each time point were analyzed in a linear mixed model. We did additional analyses with "tumor necrosis factor inhibitor (TNFi) in pregnancy" as a covariate. The same statistical method was used to study self-reported physical function, pain, and mental health. RESULTS Approximately 75% of the women were in remission or had low disease activity during and after pregnancy according to the DAS28-CRP score. Although disease activity was altogether stable, we found that it decreased in pregnancy and increased within 6 months postpartum. Disease activity at 6 months postpartum was significantly higher than at 6 weeks postpartum (mean DAS28-CRP score 2.71 versus 2.45; P = 0.016). Women using TNFi in pregnancy had significantly lower disease activity than women not using TNFi (mean DAS28-CRP score at 6 months postpartum 2.22 versus 2.72; P = 0.043). BASDAI scores were also low and stable during pregnancy but significantly higher at 6 months postpartum than at 6 weeks postpartum (mean BASDAI score 3.69 versus 2.95; P = 0.013). CONCLUSION Studying women with PsA, we found that disease activity was highest at 6 months postpartum but altogether low and stable in the period from planning pregnancy to 1 year after delivery. Women using TNFi in pregnancy had significantly lower disease activity.
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Affiliation(s)
- Kristin Ursin
- Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Marianne Wallenius
- Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway
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14
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Förger F, Bandoli G, Luo Y, Robinson L, Johnson DL, Chambers CD. No Association of Discontinuing Tumor Necrosis Factor Inhibitors Before Gestational Week Twenty in Well-Controlled Rheumatoid Arthritis and Juvenile Idiopathic Arthritis With a Disease Worsening in Late Pregnancy. Arthritis Rheumatol 2019; 71:901-907. [PMID: 30663847 DOI: 10.1002/art.40821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/18/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate whether the discontinuation of tumor necrosis factor inhibitors (TNFi) during pregnancy is associated with any changes of the disease course in women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). METHODS Pregnant women with RA and JIA from the US and Canada were enrolled in the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project, a prospective cohort study. Information about medication and disease activity (patient-reported outcome measures) was collected prior to gestational week 20 and at gestational week 32. Associations between patterns of TNFi continuation or discontinuation and disease activity changes were tested in unadjusted and multivariate analyses. RESULTS Among 490 women (397 with RA, 93 with JIA) enrolled between 2005 and 2017, 122 (24.9%) discontinued a TNFi before gestational week 20, 201 (41.0%) received a TNFi beyond week 20, and 167 (34.1%) did not receive a TNFi during pregnancy. At the time of enrollment, disease activity was low to minimal in 72.9% of women. TNFi discontinuation was not associated with a clinically important worsening of patient reported outcome measures at the third trimester. Univariate but not multivariate analysis showed that women receiving TNFi beyond week 20 were more likely to experience improved disease activity scores at the third trimester. CONCLUSION Discontinuing TNFi before gestational week 20 seems feasible in women with RA and JIA who enter pregnancy with well-controlled disease.
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Affiliation(s)
- Frauke Förger
- University Hospital and University of Bern, Bern, Switzerland
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15
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Pre-eclampsia/Eclampsia as a Risk Factor of Noninfectious Uveitis Among Postdelivery Women. Am J Ophthalmol 2019; 198:166-173. [PMID: 30316670 DOI: 10.1016/j.ajo.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE We sought to analyze the incidence and risk of noninfectious uveitis (NIU) among postdelivery women with a history of pre-eclampsia/eclampsia (PEE). DESIGN Population-based retrospective matched cohort study. METHODS All participant data were retrieved from the Longitudinal Health Insurance Database 2005. Two thousand seventy-three postdelivery women ≥20 years of age were diagnosed with PEE between January 1, 1997 and December 31, 2012 and were included in the study. We traced the occurrence of NIU during 5 years of follow-up. The primary outcome measure was the occurrence of NIU with the use of anti-inflammatory drugs and adjudication by an ophthalmologist. RESULTS NIU occurred in 14 of 2073 (0.7%) postdelivery women with PEE. The incidence rate of NIU was 1.5 and 0.5 per 1000 person-years among postdelivery women with and without PEE, respectively (incidence rate ratio 2.96 [95% confidence interval 1.48-5.90]; P = .002). Postdelivery women with PEE demonstrated a significant increase in the cumulative incidence of NIU compared with those without PEE (P = .001). The risk of the occurrence of NIU was significantly higher in the PEE group than in the non-PEE group (adjusted hazard ratio 2.96 [95% CI 1.48-5.92]; P = .002) after adjusting for age, income, urbanization, and comorbidities. CONCLUSIONS This is the first study to substantiate an association between PEE and NIU. Our results suggest that PEE could be a potential risk factor for the occurrence of NIU among postdelivery women.
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16
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Andreoli L, Gerardi MC, Fernandes M, Bortoluzzi A, Bellando-Randone S, Brucato A, Caporali R, Chighizola CB, Chimenti MS, Conigliaro P, Cutolo M, Cutro MS, D'Angelo S, Doria A, Elefante E, Fredi M, Galeazzi M, Gerosa M, Govoni M, Iuliano A, Larosa M, Lazzaroni MG, Matucci-Cerinic M, Meroni M, Meroni PL, Mosca M, Patanè M, Pazzola G, Pendolino M, Perricone R, Ramoni V, Salvarani C, Sebastiani GD, Selmi C, Spinelli FR, Valesini G, Scirè CA, Tincani A. Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies. Autoimmun Rev 2018; 18:164-176. [PMID: 30572134 DOI: 10.1016/j.autrev.2018.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 01/30/2023]
Abstract
Pregnancy requires a special management in women with inflammatory rheumatic diseases (RDs), with the aim of controlling maternal disease activity and avoiding fetal complications. Despite the heterogeneous course of RDs during pregnancy, their impact on pregnancy largely relates to the extent of active inflammation at the time of conception. Therefore, accurate evaluation of disease activity is crucial for the best management of pregnant patients. Nevertheless, there are limitations in using conventional measures of disease activity in pregnancy, as some items included in these instruments can be biased by symptoms or by physiological changes related to pregnancy and the pregnancy itself may influence laboratory parameters used to assess disease activity. This article aims to summarize the current literature about the available instruments to measure disease activity during pregnancy in RDs. Systemic lupus erythematosus is the only disease with instruments that have been modified to account for several adaptations which might interfere with the attribution of signs or symptoms to disease activity during pregnancy. No modified-pregnancy indices exist for women affected by other RDs, but standard indices have been applied to pregnant patients. The current body of knowledge shows that the physiologic changes that occur during pregnancy need to be either adapted from existing instruments or developed to improve the management of pregnant women with RDs. Standardized instruments to assess disease activity during pregnancy would be helpful not only for clinical practice but also for research purposes.
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Affiliation(s)
- Laura Andreoli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Maria Chiara Gerardi
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Melissa Fernandes
- Department of Internal Medicine, Autoimmune Disease Unit, Hospital Curry Cabral/Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, Rheumatology Unit, S. Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Antonio Brucato
- Internal Medicine Division, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Caporali
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, University of Milan, Cusano Milanino, Milan, Italy
| | - Maria Sole Chimenti
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Maurizio Cutolo
- Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, IRCCS San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Maria Stefania Cutro
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Madonna delle Grazie of Matera, Matera, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Madonna delle Grazie of Matera, Matera, Italy
| | - Andrea Doria
- Division of Rheumatology, University of Padova, Padova, Italy
| | - Elena Elefante
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mauro Galeazzi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Azienda ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, University of Milan, Milan, Italy
| | - Marcello Govoni
- Department of Medical Sciences, Rheumatology Unit, S. Anna Hospital, University of Ferrara, Ferrara, Italy
| | | | | | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Marianna Meroni
- Rheumatology & Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Milan, Italy
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Massimo Patanè
- Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, IRCCS San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Giulia Pazzola
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy
| | - Monica Pendolino
- Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, IRCCS San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Roberto Perricone
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Véronique Ramoni
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Carlo Selmi
- Rheumatology & Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy; BIOMETRA Department, University of Milan, Milan, Italy
| | - Francesca Romana Spinelli
- Dipartimento di Medicina Interna e Specialità Mediche-Reumatologia, Sapienza University of Rome, Rome, Italy
| | - Guido Valesini
- Dipartimento di Medicina Interna e Specialità Mediche-Reumatologia, Sapienza University of Rome, Rome, Italy
| | - Carlo Alberto Scirè
- Department of Medical Sciences, Rheumatology Unit, S. Anna Hospital, University of Ferrara, Ferrara, Italy; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
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