ABSTRACT
SLE is an important risk factor for mother and fetus during pregnancy. To identify clinical and serological risk factors that may cause poor maternal and fetal outcomes in pregnant systemic lupus erythematosus [SLE] patients. Forty selected SLE pregnant women [group A] versus 35 non-pregnant SLE patients [group B]. SLE disease activity index [SLEDAI] and flares were evaluated for both groups. Laboratory investigations included double stranded DNA, anticardiolipin antibodies [aCL], and complements [C3 and C4]. SLE pregnant patients were followed up in the second and third trimesters by ultrasonography and fetal Doppler were done to assess fetal outcome. Risk factors for poor maternal and fetal outcome were recorded. SLEDAI was increased in both groups more in group A. Lupus flares were increased during pregnancy as it occurred in [62.5%] of group A compared to [37.14%] in group B where severe flares were more frequent in group A. Gestational hypertension and active SLEDAI were found statistically significant for poor maternal outcome. Fetal outcome included full term 37.5%, prematurity 25%, intra-uterine growth retardation [IUGR] 22.5%, stillbirth 12.5%, abortion 7.5% and congenital heart block [CHB] 2.5%. Factors significantly associated with poor fetal outcome were severe flares and active renal disease where fetal loss significantly associated with aCL antibodies. Full term was more common in patients with no flares. These data demonstrate that pregnancy in SLE patients should be considered as a high-risk pregnancy and conception should be planned during a quiescent period. Close monitoring for optimal disease control of flares, lupus nephritis, gestational hypertension and aCL antibodies is recommended
Subject(s)
Humans , Female , Pregnancy , Risk Factors , Antibodies, Anticardiolipin/blood , Complement C3 , Disease ProgressionABSTRACT
Pulmonary involvement is a common finding in adults with systemic lupus erythematosus [SLE] also it is one of the most important systems that can be affected in Juvenile onset SLE [JOSLE]. Early detection and evaluation of the extent and severity of pulmonary involvement are quite critical for disease prognosis and patients management. To determine the frequency and type of pleuropulmonary involvement in JOSLE using pulmonary function tests [PFTs] and multidetector CT [MDCT]. Twenty five patients with JOSLE were evaluated for the detection of pleuropulmonary affection in them. The evaluation included clinical, functional and radiological examination using MDCT as a recent and accurate modality for chest imaging. Based on clinical evaluation, patients were divided into two groups; group A [No = 16] and group B [No = 9], consisting of those asymptomatic and symptomatic as regard pleuropulmonary symptoms, respectively. This study revealed that PFT abnormalities were detected in 60% of all studied JOSLE patients while MDCT abnormalities were detected in 52% of them. 37.5% of the asymptomatic patients had abnormal PFTs and 31.25% of them had abnormal findings on MDCT. There was statistically significant difference between patients groups regarding SLEDAI, percentages of abnormal PFTs, abnormalities in plain X-ray and MDCT. With the exception of forced expiratory flow at 25-75% of forced vital capacity [FEF[25-75%]], the study revealed statistically significant lower values of mean +/- SD of all measured PFTs in group B compared to group A. The most frequent MDCT findings in all studied patients were pleural effusion and pleural thickening in 16% of all findings, also ground glass opacities found in 16% of all abnormalities suggesting early interstitial lung disease. Clinical assessment and PFTs revealed a significant percentage of pleuropulmonary involvement in JOSLE patients. MDCT can be helpful in diagnosing the pulmonary involvement in asymptomatic JOSLE patients with normal chest X-ray and uncertain PFT