New-Onset Systemic Lupus Erythematosus and Pregnancy:a Systematic Review

摘要

PART 1. NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS DURING PREGNACY:A SYSTEMATIC REVIEW
　　Background
　　Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease that occurs predominantly among reproductive age women. When SLE is newly diagnosed during pregnancy or puerperium, it is known as new-onset SLE during pregnancy. The diagnosis of new-onset SLE tends to be delayed or missed diagnosed due to similar clinical feature presentation with normal physiological changes and common pathologi-cal disease (preeclampsia) encountered during pregnancy. Furthermore, new-onset SLE during pregnancy has major organ involvement with poor maternal and fetal outcomes. In addition, certain lupus medications are potentially teratogenic and are contraindicated during pregnancy.
　　Objective
　　The objective of this systematic review is to investigate the clinical features, laboratory findings, treatment, complications and outcomes of new-onset SLE during pregnancies.
　　Study methods
　　Systematic review
　　The MEDLINE, EMBASE, PubMed, SCOPUS data bases related to new-onset SLE were searched up to February 2016.
　　Results
　　This review comprises of results of 21 studies;16 were case reports published between year 1994-2016 and remaining being retrospective study published between year 2005-2015. A total of 149 patients with new-onset SLE during pregnancy were identified and studied their course of disease. The mean maternal age of diagnosis of SLE was in their mid 20’s. The new-onset SLE generally have more severe disease with higher preva-lence of renal and hematological involvement, which might have significant impact on health of mother and fetus. The most common maternal complication was preeclampsia. When lupus was missed diagnose with preeclampsia especially during third trimester it tended to delay diagnosis for 5 days to more than 12 months after delivery. Despite vig-orous treatment with glucocorticoids and/or immunosupprestant, the outcome is poor with fetal loss, spontaneous abortion, preterm birth, maternal death and severe organ failure.
　　Conclusion
　　Knowledge and awareness of this complex disease allows physician to more effectively address and less likely for patients to suffer from missed diagnosis and inappropriate treatment. Assessment greatly depends on clinical and laboratory data along with clini-cal experience of the rheumatologist and obstetrician expertise on this subject
　　PART 2. NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS DURING PREGNANCY:A CHALLANGE IN DIAGNOSIS. (REVIEW)
　　NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS DURING PREGNANCY:A CHALLANGE IN DIAGNOSIS.
　　Systemic lupus Erythematosus (SLE) is a chronic, multi-organ autoimmune disease that occurs predominantly among reproductive age women. When SLE is newly diagnosed during pregnancy or puerperium, it is known as new-onset SLE during pregnancy. De-layed or missed diagnosis of new-onset SLE during pregnancy due to similar clinical manifestation of SLE with normal physiological changes of pregnancy and lupus ne-phritis with preeclampsia have drawn attention towards this topic. Furthermore, new-onset SLE during pregnancy has major organ involvement with poor maternal and fetal outcomes. Knowledge and awareness of this complex disease allows physicians to more effectively address and less likely for patient to suffer from misdiagnosis and inappro-priate treatment. This article will briefly review important issues in new-onset SLE dur-ing pregnancy and describes challenges to overcome its diagnosis.

目录

封面

声明

致谢

目录

ABBREVIATIONS

PART 1. NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS DURING PREGNACY:A SYSTEMATIC REVIEW

ABSTRACTS

1. BACKGROUND

2. OBJECTIVES

3. METHODS

4. RESULTS

5. DISCUSSION

6. DRAWBACKS OF THIS STUDY

7. CONCLUSION

8. REFERENCES

PART 2. NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS DURING PREGNANCY:A CHALLANGE IN DIAGNOSIS. (REVIEW)

Abstract

1. Introduction

2. New-onset SLE during pregnancy

3. Clinical features of SLE

4. Clinical features of new-onset SLE during pregnancy

5. Comparison between clinical presentation of new-onset SLE during pregnancy with flare-SLE during pregnancy and non-pregnant new-onset SLE

6. Differentiation of normal physiological changes of pregnancy from active SLE during pregnancy

7. Differentiation of Preeclampsia from Lupus Nephritis

8. Effect of pregnancy on laboratory diagnosis of SLE

9. Maternal and fetal outcomes

10. Conclusion

References