Pub Date : 2021-01-01DOI: 10.1093/MED/9780198845096.003.0004
E. Chakravarty
Pulmonary arterial hypertension (PAH) is a recognized manifestation of connective tissue diseases, particularly systemic lupus erythematosus and systemic sclerosis. It is associated with high rates of morbidity and mortality in general, and these risks increase substantially during pregnancy and delivery. Women with systemic sclerosis who wish to conceive should have an evaluation for PAH prior to pregnancy. Women with known PAH should be counselled about the high risks to maternal health associated with pregnancy, and permanent or long acting reversible contraception strongly recommended. Women who strongly desire pregnancy despite the risks should be supported and aggressive monitoring and management of PAH and congestive heart failure undertaken with vasodilators. Endothelin receptor antagonists and oral anticoagulants should be avoided due to risks of teratogenicity. Women with progressive or abrupt dyspnea should be evaluated for the development of venous thromboembolism (VTE) or PAH, and treated accordingly. o
{"title":"Pulmonary arterial hypertension","authors":"E. Chakravarty","doi":"10.1093/MED/9780198845096.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780198845096.003.0004","url":null,"abstract":"Pulmonary arterial hypertension (PAH) is a recognized manifestation of connective tissue diseases, particularly systemic lupus erythematosus and systemic sclerosis. It is associated with high rates of morbidity and mortality in general, and these risks increase substantially during pregnancy and delivery. Women with systemic sclerosis who wish to conceive should have an evaluation for PAH prior to pregnancy. Women with known PAH should be counselled about the high risks to maternal health associated with pregnancy, and permanent or long acting reversible contraception strongly recommended. Women who strongly desire pregnancy despite the risks should be supported and aggressive monitoring and management of PAH and congestive heart failure undertaken with vasodilators. Endothelin receptor antagonists and oral anticoagulants should be avoided due to risks of teratogenicity. Women with progressive or abrupt dyspnea should be evaluated for the development of venous thromboembolism (VTE) or PAH, and treated accordingly. o","PeriodicalId":103210,"journal":{"name":"Practical management of the pregnant patient with rheumatic disease","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122795089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780198845096.003.0016
M. Clowse, Jon Golenbiewski
A growing number of women with vasculitis are becoming pregnant, largely the result of improved patient outcomes in vasculitis as a whole. Given such pregnancies are infrequent, there is a paucity of outcomes data from which to guide care. Women with vasculitis have higher rates of pregnancy loss and pre-term birth than the general population, and active disease contributes to negative results for the mother and foetus. Pregnancies have been reported in a variety of vasculitis types, with Takayasu arteritis and Behçet’s disease more commonly observed. The majority of pregnancies in women with vasculitis can result in favorable outcomes for both the mother and baby; planning prior to conception, well-controlled disease, the use of pregnancy compatible medications and close follow up with a multidisciplinary team are key to a successful pregnancy.
{"title":"Vasculitis in pregnancy","authors":"M. Clowse, Jon Golenbiewski","doi":"10.1093/MED/9780198845096.003.0016","DOIUrl":"https://doi.org/10.1093/MED/9780198845096.003.0016","url":null,"abstract":"A growing number of women with vasculitis are becoming pregnant, largely the result of improved patient outcomes in vasculitis as a whole. Given such pregnancies are infrequent, there is a paucity of outcomes data from which to guide care. Women with vasculitis have higher rates of pregnancy loss and pre-term birth than the general population, and active disease contributes to negative results for the mother and foetus. Pregnancies have been reported in a variety of vasculitis types, with Takayasu arteritis and Behçet’s disease more commonly observed. The majority of pregnancies in women with vasculitis can result in favorable outcomes for both the mother and baby; planning prior to conception, well-controlled disease, the use of pregnancy compatible medications and close follow up with a multidisciplinary team are key to a successful pregnancy.","PeriodicalId":103210,"journal":{"name":"Practical management of the pregnant patient with rheumatic disease","volume":"198 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133970884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780198845096.003.0018
Muhammed Shipa, D. Isenberg
Pregnancy outcome in patients with inflammatory myositis (IM) remains poorly understood but, current data suggest active disease can increase the risk of adverse foetal outcome. Flare of previously diagnosed myositis or new onset of myositis during the puerperal period has been described. However, a favourable outcome has been noted if myositis is in remission. Caution should be excised with the treatment options, but the use of azathioprine (<2 mg/kg/day), hydroxychloroquine, cyclosporine, and tacrolimus are compatible with pregnancy and can be continued during breastfeeding. Inflammatory myopathies (IIM) comprise a group of diseases of unknown cause resulting in muscle inflammation and subsequent muscle weakness.
{"title":"Myositis and pregnancy","authors":"Muhammed Shipa, D. Isenberg","doi":"10.1093/MED/9780198845096.003.0018","DOIUrl":"https://doi.org/10.1093/MED/9780198845096.003.0018","url":null,"abstract":"Pregnancy outcome in patients with inflammatory myositis (IM) remains poorly understood but, current data suggest active disease can increase the risk of adverse foetal outcome. Flare of previously diagnosed myositis or new onset of myositis during the puerperal period has been described. However, a favourable outcome has been noted if myositis is in remission. Caution should be excised with the treatment options, but the use of azathioprine (<2 mg/kg/day), hydroxychloroquine, cyclosporine, and tacrolimus are compatible with pregnancy and can be continued during breastfeeding. Inflammatory myopathies (IIM) comprise a group of diseases of unknown cause resulting in muscle inflammation and subsequent muscle weakness.","PeriodicalId":103210,"journal":{"name":"Practical management of the pregnant patient with rheumatic disease","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117302859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/med/9780198845096.003.0017
E. Chakravarty
Systemic sclerosis (SSc) is characterized by a non-inflammatory vasculopathy as well as fibrosis of the skin and vital organs. It presents in two distinct subtypes depending on the extent of cutaneous involvement, with each subtype (diffuse vs limited SSc) having different relative prevalence of extra-cutaneous manifestations. Experience describing pregnancy outcomes in SSc is limited because of disease onset mainly in the 4th and 5th decade. Common symptoms, including cutaneous fibrosis and Raynaud’s phenomenon, are not worsened, and may even improve during pregnancy. Severe organ manifestations of SSc, including pulmonary fibrosis, scleroderma renal crisis, and pulmonary arterial hypertension, are associated with increased risks of pregnancy complications and can be more difficult to treat during pregnancy. Therapies for SSc are mostly directed at managing symptoms with vasodilators, angiotensin-renin antagonists, proton pump inhibitors, and immunosuppressives in the case of pulmonary fibrosis.
{"title":"Systemic sclerosis","authors":"E. Chakravarty","doi":"10.1093/med/9780198845096.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780198845096.003.0017","url":null,"abstract":"Systemic sclerosis (SSc) is characterized by a non-inflammatory vasculopathy as well as fibrosis of the skin and vital organs. It presents in two distinct subtypes depending on the extent of cutaneous involvement, with each subtype (diffuse vs limited SSc) having different relative prevalence of extra-cutaneous manifestations. Experience describing pregnancy outcomes in SSc is limited because of disease onset mainly in the 4th and 5th decade. Common symptoms, including cutaneous fibrosis and Raynaud’s phenomenon, are not worsened, and may even improve during pregnancy. Severe organ manifestations of SSc, including pulmonary fibrosis, scleroderma renal crisis, and pulmonary arterial hypertension, are associated with increased risks of pregnancy complications and can be more difficult to treat during pregnancy. Therapies for SSc are mostly directed at managing symptoms with vasodilators, angiotensin-renin antagonists, proton pump inhibitors, and immunosuppressives in the case of pulmonary fibrosis.","PeriodicalId":103210,"journal":{"name":"Practical management of the pregnant patient with rheumatic disease","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123101073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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