[Systemic autoimmune disorders and pregnancy]. / Szisztémás autoimmun betegségek és terhesség.

The coincidence of systemic autoimmune diseases and pregnancy may modify the outcome of the disease and the pregnancy due to the background immunologic and hormonal processes. The great majority of patients with autoimmune diseases are young females in their reproductive years, willing to have babies. Consequently, we have to prepare for this special situation. Our concept on childbearing in autoimmune women has changed within the last 30 years. Earlier, systemic lupus erythematosus flared in about 50% of patients during pregnancy, but the flare rate has significantly decreased recently. This improvement can be attributed to increased attention to low diseases activity at the time of conception, which might reduce to the half of the risk for flare. Tight control of patients and appropriate use of corticosteroids also contribute to the better results. The adequate use of anti-thrombotic agents resulted in a significant amelioration of pregnancy outcome in antiphospholipid syndrome. The earlier use of methotrexate and the introduction of tumor necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis have changed the natural characteristics of the disease. The increase in remission rate indirectly has beneficial effect on the number of planned and carried out pregnancies. Authors review the connection between systemic autoimmune disorders and pregnancy as well as the possibilities of medical treatment of such diseases during pregnancy.

[Impact of disease progression on health status, quality of life and costs in rheumatoid arthritis in Hungary]. / A betegségprogresszió hatása az egészségi állapotra, életminoségre és költségekre rheumatoid arthritisben Magyarországon.

UNLABELLED: Rheumatoid arthritis (RA) is a chronic, progressive polyarthritis leading to substantial disability. Standardised data on consequences of disease progression are needed for clinical assessments and also for cost-effectiveness models. AIM: To analyse the impact of disease progression on health status, disease specific quality of life and costs in Hungary. METHODS: A cross-sectional survey was performed between April and August, 2004, involving consecutive RA patients of 6 hospital based rheumatology outpatient centres. Self-completed questionnaires were used to assess functional (HAQ) and health status (EQ-5D), quality of life (RAQoL). Disease activity (DAS) and costs were also surveyed, statistical analysis was performed. RESULTS: 255 patients were involved [mean age 55.5 +/- 12.3 years; disease duration 9.0 +/- 9.3 years; HAQ 1.38 +/- 0.76; EQ-5D 0.46 +/- 0.33; RAQoL 16.2 +/- 8.1; DAS 5.09 +/- 1.42; costs 1,043,163 (+/- 844,750) HUF/patient/year, conversion 1 Euro = 250 HUF]. Correlation was significant between the parameters ( p < 0.01): EQ-5D index = 1.014 - 0.25 x HAQ-0.041 x DAS; HAQ = 0.314 + 0.065 x RAQoL. Analysis by disease severity levels (HAQ groups 0.5 difference) revealed that health status worsens (mean EQ-5D: 0.784; 0.576; 0.504; 0.367; 0.211; 0.022) and costs increase (mean 628,280; 888,187; 953,759; 1,291,218; 1,346,112; 1,371,674 HUF/patient/year) with disease progression. Minimally important worsening of functional ability (0.25 HAQ increase) corresponds to -0.0705 EQ-5D and +1.884 RAQoL change. Lower health status difference (EQ-5D -0.05725) was calculated in patients with lower disease activity (DAS < 5.1). CONCLUSIONS: Correlation between disease progression, health status, quality of life and costs does not differ significantly from international results. The amount of costs is much lower in all disease severity levels than in developed European countries. Our study serves baseline data for health economic analysis in RA in Hungary.

[Does the number of patients with autoimmune disorders and the frequency of autoimmune diseases increase?]. / Növekszik-e az autoimmun kórképu betegek száma, az autoimmun betegségek elofordulása?

Autoimmune diseases generally belong to the rare diseases, however, some of them are frequent in the population. In the present work the authors analyse whether can any increase be observed in the number of patients suffering from autoimmune diseases and whether do the frequency of certain autoimmune disorders increase. Due mainly to epigenetic factors the incidence of autoimmune diseases are increasing, therefore there are more patients recognised with particular disorders. On the other hand the incidence is increased by improving diagnostic possibilities, by the use of more specific and sensitive classification criteria and more sophisticated laboratory tests, resulted in the recognition of milder and atypical disease variants as well. The prevalence is also increasing in consequence of novel immune suppressive therapeutic possibilities and the consequent improvement of survival in the most of these diseases. Besides, more and more diseases have been revealed to have autoimmune background, and lot of new autoimmune syndromes, diseases have been characterised recently. This increases the number of the known autoimmune rheumatic disorders with a consequent increase in the number of autoimmune patients. Assigned to the increasing number of variable chronic autoimmune disorders, and the increasing number of disabled patients with such diseases increasing medical and social attention has to be focused on.