Interaction Of Systemic Lupus Erythematosus And Rheumatoid Arthritis With Pregnancy

Abstract

Since clinical and laboratory findings in rheumatological diseases are also seen in healthy pregnants, diagnosis of activity of rheumotological diseases in pregnancy is difficult. Decrease in complement levels is the most reliable laboratory test of rhematological diseases in pregnancy. Since white blood cell count ESR and CRP levels are normally increased in pregnancy their diagnostic significance is limited. RA patients often enter in remission period in pregnancy but activity in disease is seen in 1 year following post partum period. RA is associated with low birthweight & increased caeserian section rates.SLE generally becomes activated in pregnancy. SLE pregnancies are associated with frequent complications. Fetal loss, preterm labor, hypertension, gestational diabetes, preeclampsia, low birth weight APAS in pregnancy is associated with increased fetal loss rate and thrombosis. Anti ro and anti la levels in pregnancy is associated with congenital heart blocks. For those reasons, pregnancies of SLE patients should be treated as high risk pregnancies and should be followed at third level health centers fetal monitorisation is vital. Disease activation in the 6 month period before conception is associated with gestational complications. For all those reasons preconceptional consultation should be given to SLE patients for becoming pregnant after at least 6 months of silent period of disease.

Keywords

• Pregnancy,rheumatoid arthritis,SLE

Sistemik Lupus Eritematozis ve Romatoid Artritin Gebelik İle Etkileşimi

Abstract

Romatolojik hastalıklar görülebilen çeşitli klinik ve laboratuar bulgular gebelikte normalde de izlenebildiğinden; gebelikte romatolojik hastalıkların alevlenmesi tanısında güçlükler yaşanmaktadır. Gebelikte romatizmal laboratuar testlerinden en güveniliri kompleman düzeyleri azalmasıdır. Beyaz küre, ESR ve CRP gebelikte normalde yükseldiğinden tanı değeri kısıtlıdır. RA gebelikte genellikle remisyona girmekle birlikte postpartum 1. yılda hastalıkta alevlenmeler görülür. RA gebelikte düşük doğum ağırlığı ve artmış sezaryen oranları ile ilişkilidir. SLE, gebelikte genellikle agreve olur. SLE gebelikleri yüksek oranda komplikasyonlar ile ilişkilidir Gebelik kayıpları, preterm doğum, hipertansiyon, gestasyonel diyabet, preeklamsi, düşük doğum ağırlığı . Gebelikte lupus nefriti; fetal kayıp, preeklampsi, son dönem böbrek yetmezliği ve maternal mortalite gibi ağır komplikasyonlarla ilişkilidir. Gebelikte APAS’ u yüksek oranda gebelik kaybı ve tromboz ile ilişkilidir. SLE hastalarında anti- Ro ve anti-La konjenital kalp bloğu ile ilişkilidir. Bu nedenlerle SLE gebelikleri yüksek riskli gebelik olarak değerlendirilip, 3. basamak merkezlerde yakın takip edilmelidir. Fetal monitörizasyon hayatidir. Konsepsiyonda 6 ay öncesi dönemde aktive hastalık gebelik komplikasyonları ile ilişkilidir. Bu nedenlerle SLE hastalarında gebelikten önce 6 ay sessiz hastalık olması durumunda gebelik planlaması için prekonsepsiyonel danışmanlık verilmelidir.

Keywords

• Gebelik,romatoid artrit,SLE

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