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Practical management of the pregnant patient with rheumatic disease最新文献

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Pulmonary arterial hypertension 肺动脉高压
Pub Date : 2021-01-01 DOI: 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
肺动脉高压(PAH)是结缔组织疾病,特别是系统性红斑狼疮和系统性硬化症的公认表现。它通常与高发病率和高死亡率有关,这些风险在怀孕和分娩期间大大增加。希望怀孕的系统性硬化症妇女应在怀孕前对PAH进行评估。对于已知患有多环芳烃的妇女,应告知其妊娠对孕产妇健康的高风险,并强烈推荐永久性或长效可逆避孕。尽管存在风险,但仍强烈希望怀孕的妇女应得到支持,并应积极监测和管理PAH和充血性心力衰竭,并使用血管扩张剂。内皮素受体拮抗剂和口服抗凝剂应避免致畸风险。进行性或突发性呼吸困难的妇女应评估静脉血栓栓塞(VTE)或PAH的发展,并进行相应的治疗。o
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引用次数: 0
Vasculitis in pregnancy 妊娠期血管炎
Pub Date : 2021-01-01 DOI: 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.
越来越多的患有血管炎的妇女正在怀孕,这主要是血管炎患者整体预后改善的结果。鉴于此类妊娠并不常见,因此缺乏可用于指导护理的结果数据。患有血管炎的妇女的流产率和早产率高于一般人群,活动性疾病对母亲和胎儿都有不利影响。妊娠有多种血管炎类型的报道,其中高松动脉炎和behaperet病更为常见。大多数患有血管炎的妇女怀孕对母亲和婴儿都有有利的结果;怀孕前的计划、良好的疾病控制、使用与妊娠相适应的药物以及多学科团队的密切随访是成功妊娠的关键。
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引用次数: 0
Myositis and pregnancy 肌炎与妊娠
Pub Date : 2021-01-01 DOI: 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.
炎症性肌炎(IM)患者的妊娠结局尚不清楚,但目前的数据表明,活动性疾病可增加不良胎儿结局的风险。以前诊断的肌炎或新发作肌炎在产褥期已被描述。然而,如果肌炎得到缓解,则会出现有利的结果。治疗方案应谨慎,但硫唑嘌呤(< 2mg /kg/天)、羟氯喹、环孢素和他克莫司的使用与妊娠兼容,并可在母乳喂养期间继续使用。炎症性肌病(IIM)包括一组原因不明的疾病,导致肌肉炎症和随后的肌肉无力。
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引用次数: 0
Systemic sclerosis 系统性硬化病
Pub Date : 2021-01-01 DOI: 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.
系统性硬化症(SSc)的特点是非炎症性血管病变以及皮肤和重要器官的纤维化。根据皮肤受损伤的程度,它表现为两种不同的亚型,每种亚型(弥漫性与局限性SSc)具有不同的皮外表现的相对患病率。描述SSc妊娠结局的经验有限,因为疾病主要发生在第4和第5个十年。常见的症状,包括皮肤纤维化和雷诺现象,在怀孕期间没有恶化,甚至可能改善。SSc的严重器官表现,包括肺纤维化、硬皮病、肾危象和肺动脉高压,与妊娠并发症的风险增加有关,并且在妊娠期间更难以治疗。在肺纤维化的情况下,SSc的治疗主要针对血管扩张剂、血管紧张素-肾素拮抗剂、质子泵抑制剂和免疫抑制剂来控制症状。
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引用次数: 0
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Practical management of the pregnant patient with rheumatic disease
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