Pregnancy outcome in women with systemic lupus erythematosus treated with immunosuppressive drugs

OBJECTIVE

The aim of this retrospective study was to assess the impact of immunosuppressive drugs (ISD) on pregnancy outcome in women with systemic lupus erythematosus (SLE).

METHODS

Pregnancy outcome, disease manifestations, and medication use were ascertained by interview and review of the medical record. Three hundred thirty-four (88%) of 380 consecutive women with lupus seen during 1979-1989 at the Lupus Diagnostic and Treatment Center at the University of Pittsburgh participated in this study.

RESULTS

Adverse pregnancy outcomes were noted in 59 of 113 (52%) pregnancies in patients with pregnancies after diagnosis of SLE and no exposure to ISD (Group 1) and in 10 of 23 (43%) pregnancies in patients with pregnancies after diagnosis of SLE and with ISD use prior to or during pregnancy (Group 2). Only 3 of 23 or 13% pregnancies in Group 2 resulted in a fetal or neonatal loss compared to 27% in Group 1 (NS). No history of malignancy has been noted in the longterm followup of the surviving children in Group 2 (current mean age is 6.1 years, range 1.5-13 years).

CONCLUSIONS

Although overall survival was encouraging in Group 2, questions remain about the safety and longterm mutagenic effects of ISD in women with SLE. Judicious use of these medications prior to or during pregnancy is warranted.

Team treatment. Does a specialized unit improve team performance?

The treatment of inpatients in a contiguous hospital area designated the Arthritis Rehabilitation Unit (ARU) as opposed to the treatment of patients on units discretely spaced throughout the hospital was studied by means of independent retrospective audit of randomly chosen charts with the primary diagnosis of rheumatoid arthritis. Three time periods were considered: T-1 (2 months to 0 months prior to the beginning of the ARU), T-2 (0 months to 5 months of operation of the ARU), T-3 (after 18 to 24 months of operation of the ARU). At T-1 only seven charts were reviewed; ten charts were reviewed at T-2 and T-3. The frequency of fulfillment to audit criteria was calculated as the arithmetic mean. No weighting or preference was given to any of the items. P values were calculated utilizing the Mann-Whitney U test for nonparametric measures. The criteria by which the charts were reviewed were developed through the Delphi method of opinion convergence. Criteria were generated using the principle of optimal medical care. The categories included initial evaluation, treatment plan, outcomes and discharge plan. T-1 compared to T-3 yielded results in overall percentage of effectiveness of: physician, 81 v 90 (NS): nurse, 42 v 60 (P 0.043); occupational therapy, 62 v 58 (NS); physical therapy, 69 v 78 (NS); and social worker, 17 v 88 (P less than 0.001) Geographic isolation of arthritis rehabilitation patients improved measured aspects of their care but not uniformly throughout the rehabilitation team.