Impact of pregnancy on progression of preclinical autoimmune disorders: a prospective cohort study.

OBJECTIVES: The objective of this study was to evaluate the role of pregnancies in the progression from the preclinical phase of autoimmune disorder to a definite rheumatic disease. METHODS: A cohort study of women with symptoms and laboratory findings suggestive for autoimmune disorder were enrolled during the first trimester of pregnancy and followed-up for 5 years with clinical and laboratory assessment. Multinomial logistic regression was used to compute the risk of progression to definite autoimmune disease correcting for confounders. RESULTS: At the end of follow-up, out of 208 subjects, 81 (38.9%) were considered negative, 53 (25.5%) had symptoms and abnormalities of autoantibody profile compatible with a non-criteria rheumatic status and 74 (35.6%) had a definite rheumatic disease (43 undifferentiated connective tissue disease, 5 systemic lupus erythematosus, 3 SS, 10 antiphospholipid syndrome, and 12 miscellaneous autoimmune disorders). The median time from enrolment to definite diagnosis was 28 months (interquartile range = 18-42). The rate of progression towards a definite autoimmune disease was 47.1% (48/102) among subjects with one or more subsequent viable pregnancies compared with 24.5% (26/106) of those with no subsequent pregnancies (adjusted odds ratio = 4.9, 95% CI: 2.4, 10). The occurrence of preeclampsia during the index pregnancy or subsequent pregnancy was an additional and independent risk factor for progression to a definite autoimmune disease (adjusted odds ratio = 4.3, 95% CI: 1.2, 14.8). CONCLUSIONS: Among women with suspected autoimmune disease during pregnancy, additional viable pregnancies and diagnosis of preeclampsia were independently associated with an increased rate of progression to definite rheumatic disorder. Hormonal modifications associated with pregnancy could worsen preclinical rheumatic disorders favouring their progression to a defined autoimmune disease.

The impact of various entities of antiphospholipid antibodies positivity on adverse pregnancy outcome. An epidemiological perspective.

The aim of the study was to evaluate the rate of obstetric complications and the burden of obstetric outcomes in antiphospholipid syndrome (APS), non-criteria APS and asymptomatic antiphospholipid antibodies (aPL) carriers. From 2013-2018, 163 pregnant subjects with aPL antibodies and 785 controls were enrolled. Penalized logistic regression was used to compare obstetric complications. Cases included 62 complete APS (38 %), 48 non-criteria APS (29.4 %) and 53 (32.5 %) asymptomatic aPL-carriers. Connective tissue diseases (CTDs) were diagnosed in 31.3 % of cases. The rate of high-risk aPL profile was higher (p < .01) in APS (67.7 %) compared to non-criteria (14.6 %) and aPL-carriers (9.4 %). Double/triple positivity was 33.9 % (p < .05 compared to non-criteria and aPL-carriers) in APS, 10.4 % in non-criteria and 9.4 % in aPL-carriers. The rate of adverse pregnancy outcomes were 5.6 % in controls, 41.9 % (adj.OR = 6.95 %CI = 2.7-13.5) in APS, 25 % (adj.OR = 4.4,95 %CI = 2-9.4) in non-criteria and 28.3 % (OR = 4.95 %CI = 1.8-8.8) in aPL-carriers. CTDs were independently associated with an increased risk of adverse obstetric outcomes (OR = 2.8,95 %CI = 1.36-5.89). The attributable fraction (AF) of adverse obstetric events was higher among low-risk antibodies compared to high-risk (AF = 0.27,95 %CI = 0.22-0.31 vs AF = 0.16,95 %CI = 0.16-0.2,p < .01) and among single positivity compared to double/triple positivity (AF = 0.32,95 %CI = 0.26-0.37 vs AF = 0.11,95 %CI = 0.09-0.13,p < .01) suggesting that low-risk subjects are responsible for a high burden of obstetric complications.

Referential communication in Alzheimer's type dementia.

This paper investigates factors that underlie reduced informative content and lack of reference in the discourse of patients with Alzheimer's Type Dementia (DAT). Patients with DAT, fluent aphasics and normal controls were given a referential communication task structured to assess lexical encoding of information, pragmatic/conceptual elaboration of information and effectiveness in establishing reference. The subjects also received standardised aphasia tests (CADL, Holland, 1980; and Cookie Theft Picture Description, Nicholas and Brookshire, 1993). Comparable reduction of lexical encoding of information was found in the discourse of aphasic and DAT participants both on the referential communication task measures and on the standardised evaluation with the Cookie Theft Picture Description test. However, the DAT subjects' discourse on the referential communication task was less efficient in establishing reference than that of the aphasics since the former presented more misunderstandings and required more explicit prompts from the listener. Furthermore, the DAT language on the referential communication task contained confounding and irrelevant information; also, the number of these errors correlated negatively with their referring abilities. Results of the CADL test confirmed that the DAT participants had less communicative effectiveness than their lexical deficit alone predicted. Finally, examination of the performance of individual DAT subjects showed that lexical encoding of information could dissociate from effectiveness in making reference. These findings support the view that difficulty in pragmatic/conceptual elaboration of discourse information content plays a substantial role in the development of reduced information content and lack of reference of DAT "empty speech". These results are discussed in the framework of the hypothesis of early attentional/executive impairment in DAT (Perry and Hodges, 1999).

Coverbal gestures in Alzheimer's type dementia.

Patterns of conversational gestures were analysed in subjects with Alzheimer's type dementia (DAT), fluent aphasics with a primarily lexical-semantic deficit (FA) and normal subjects. The FA subjects produced twice as many gestures as the normal participants with a normal percentage of gestures that showed semantic features of the lexical items in concurrent speech (iconic). A comparable lexical-semantic deficit together with a deficit in conceptual organisation of information corresponded to a normal gesturing rate in the DAT subjects; however, the percentage of iconic gestures was reduced. Gestures were also analysed in four DAT patients whose communicative performance indicated primarily lexical-semantic (2 patients) or conceptual deficit (2 patients). In the two DAT patients with lexical-semantic deficit, the gesture pattern was like that of the FA patients; in the other two, the pattern of the DAT group was observed. These results agree with previous findings that DAT "empty" speech corresponds to reduced production of gestures showing semantic features (Glosser et al., 1998). However, the comparison between DAT with primarily lexical-semantic or conceptual deficits indicates that the nature of the cognitive impairment underlying poor information content and lack of reference in DAT discourse constrains the production of conversational gestures by patients with this disease. These findings are at variance with the hypothesis of parallel dissolution of speech and gestures in language disorders after brain damage (Cicone et al., 1979; McNeill, 1992; Glosser et al., 1998).