Management of the antiphospholipid syndrome

Article Abstract:

In most of the rheumatic diseases, autoantibodies (antibodies inappropriately made against the body's own molecules) are present. In the antiphospholipid syndrome, antibodies against phospholipids (a fat that is important in cell reactions as well as forming part of the membranes that surround cells), including anti-cardiolipin antibody and lupus anticoagulant, occur in the absence or presence of particular rheumatic diseases. The presence of antiphospholipid antibodies is associated with clot formation, recurrent miscarriages, cerebrovascular disease (manifesting as stroke or transient ischemic attacks) and thrombocytopenia (low levels of platelets, important for clotting). Two case studies are described, one of a 60-year-old man, the other a 30-year-old woman, who were both diagnosed with systemic lupus erythematosus (SLE) with cerebral involvement, although SLE was more probable in the second case. Both had stroke-like symptoms, and the woman had experienced nine miscarriages. The man had anticardiolipin antibody, and the woman had lupus anticoagulant and high levels of anticardiolipin antibody. Multiple brain lesions with progressive brain dysfunction may occur in antiphospholipid syndrome, so sites of possible clot formation such as heart valves should be closely watched. The mechanism by which antiphospholipid antibodies contribute to vascular disease in this syndrome is unknown; many possible actions have been proposed. Optimum treatment has not been rigorously studied or established. Opinions range from favoring conservative treatment with antiplatelet drugs to use of stronger anticoagulants and suppression of immune function with steroids. Steroids may suppress lupus anticoagulant activity, but anti-cardiolipin antibody tends to be resistant. Low-dose aspirin, theoretically preventing clot formation in small blood vessels, is generally accepted. In the cases described, high-dose steroids were used initially to treat neurological problems, with good response of lupus in the woman. Warfarin, an anticoagulant, should be used if brain dysfunction progresses. Results from current studies should improve treatment of antiphospholipid syndrome, but understanding of the underlying defects will lead to targeted therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Antiphospholipid syndrome

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Pregnancy in granulomatous vasculitis

Article Abstract:

It may be advisable for women with Wegener's granulomatosis (WG) or Churg-Strauss syndrome (CSS) to exercise caution in contemplating pregnancy. WG and CSS are inflammatory diseases that affects blood vessels. Researchers reviewed the cases of 4 pregnancies in 2 women with WG and one woman with CSS. Three pregnancies resulted in healthy live births, and one resulted in fetal death at 25 weeks of pregnancy. One woman with WG delivered 2 healthy babies while in remission and taking no medication. The other female patient with WG experienced a flare-up at 12 weeks, was treated with prednisolone, and delivered a stillborn infant at 25 weeks. The woman with CSS delivered a healthy baby while continuing azathioprine and prednisolone therapy.

Churg-Strauss syndrome, Wegener's granulomatosis

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Hydroxychloroquine and lupus pregnancy: review of a series of 36 cases

Article Abstract:

It appears that women with lupus who are taking hydroxychloroquine (HCQ) can safely continue to take this medication during their pregnancies. Researchers compared the medical records of 33 women with lupus who took HCQ during their pregnancies with 53 women with lupus who did not take HCQ during their pregnancies. A similar percentage of live births, premature births, and miscarriages occurred in both groups. None of the babies had any significant birth defects or measurable vision defects. HCQ did not significantly reduce the amount of corticosteroids the mothers needed to take during their pregnancies.

Drug therapy, Systemic lupus erythematosus, Hydroxychloroquine

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