Connective tissue disease Flashcards
Rheumatoid arthritis
Diagnosis: joint involvement, serology, ESR/CRP, duration of symptoms
Associated with sjogren’s SND and anti Ro/La abs
Some get better, some get worse, 90% get worse PP.
Risks: SGA, PTB, neonatal lupus, cervical disease in GA
NSAIDs avoid in third trimester.
SLE + neonatal lupus
Diagnosis: specific clinical and laboratory diagnosis; FBC may show anaemia, ESR/CRP raised, most common antibody is ANA, dsDNA, anti Ro and la, APLs, complement C3/4 (for baseline - a fall can suggest active SLE, SFLT-1 can suggest PET, renal biopsy used only if trying to achieve viability for a fetus in proving SLE rather than PET).
Pregnancy results in an increased risk of flare to 60% esp puerperium - can be similar to PET and pregnancy sx. Less common if continued doses of hydroxychloroquine. The higher the baseline renal function eg 125+ then the higher risk of long term impairment.
The risk of lupus nephritis much worse if not in remission - delay pregnancy 6months.
Effects on pregnancy: miscarriage, still birth, IUGR, PET, PTB, neonatal lupus.
Management:
PET risk management
Continue meds
MDT
Neonatal lupus: cutaneous lupus risk 5% and CHB 2%
Infants may need pacemakers, steroids and IVIG may slow progression if caught early.
Management
- Weekly dopplers from 16/40, fetal echo if concerns and ECG at delivery
APLS
Clinical criteria:
- 3 xmisc <10 weeks
- 1x misc >10 weeks
- PTB of a baby <34 secondary to placental dysfunction
- Thrombosis: venous, arterial, small vessel
- Other: haemolytic anaemia, thrombocytopenia, livedo reticularis, cerebral involvement, heart valve disease, HTN, pul HTN, leg ulcers
Biochemical criteria
- 2x 12 weeks apart LA or aCL or b2 glycoprotein-1
Mg: either just aspirin if no history of thrombosis or aspirin and clexane (prophylactic dose)
Or if history of thrombosis they will likely need higher doses.
Scleroderma, vasculitis, ED Syndrome, Behcet’s syndrome, pregnancy associated osteoporosis
EDS: Type 1 and 4 carry higher risks; 2 and 5 have favourable outcomes and 3 (joint hyper-mobility is the most common).
IV is associated with increased aortic and visceral rupture in pregnancy. Uterine rupture, preterm delivery, skin fragility and poor healing.
Hypermobility type may increase joint pain and back pain. PTB, precipitous labour, PPH and poor healing.
Avoid pregnancy in type IV (or CS <34 weeks), for all MDT, categorise disorder, refer to anaesthetics due to resistance to LA
Drugs
Azathiopurine; continue
Anti-malarials eg hydroxychloroquine: continue
MMF myophenolate mofetil: teratogenic, cleft lip etc
Pencilliamine: generally stopped due to 5% risk
Sulfasalazine: continue with 5mg folic acid
Cytoxic drugs NO (cyclophosphamide and methotrextae and chlorambucil)
Leflunomide no
Biologics probably fine but minimal evidence but watch for vaccines in babies PP
