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SYSTEMIC LUPUS ERYTHEMATOSUS

INTRODUCTION . Autoimmune disease characterized by acute or chronic inflammation of various tissues of the bodyIt can affect skin, kidney, lung, joints, and nervous systemMore common in womenAll age (common begin at 24-45). Signs and symptoms. Fatigue, low grade fever, muscle achesFacial rash (

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SYSTEMIC LUPUS ERYTHEMATOSUS

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    1. SYSTEMIC LUPUS ERYTHEMATOSUS and PREGNANCY muhamad amin bin abu hassan

    2. INTRODUCTION Autoimmune disease characterized by acute or chronic inflammation of various tissues of the body It can affect skin, kidney, lung, joints, and nervous system More common in women All age (common begin at 24-45)

    3. Signs and symptoms Fatigue, low grade fever, muscle aches Facial rash (butterfly rash) arthritis Photosensitivity Raynaud’s phenomena Alopecia Clinical manifestation confines to the system that involve

    4. CAUSES 1) Genetic link identical twins have threefold to tenfold higher risk to get lupus compared to nonidentical twins. 2) Environment factors sun exposure ( ultraviolet light) can worsen the rashes of the patient who have lupus. 3) Reversible drug induce lupus a) procainamide ,hydralazine, isoniazid b) drgu to treat  rheumatoid arthritis, etanercept, infliximab and adalimumab.

    5. pathogenesis Genetic susceptibility  involvement of human leucocyte antigen (HLA) class II gene polymorphisms. presence of anti-small nuclear ribonuclear protein, anti-nuclear ribonuclear protein and anti-DNA antibodies. hormones Increase in estrogen lead to ?B cell differentiation & ?In vitro apoptosis of PBMCs &?TNF production, This will leads to B cell hyperactivity and the production of pathogenic autoantibodies. Disturbances of the immune response Environmental antigens and self antigens are taken up by antigen presenting cells (APCs). process the antigens into peptides & present them to T cells through their surface HLA molecules.  The activated T cells in turn stimulate the B cells to produce pathogenic autoantibodies.

    6. Effects of pregnancy on SLE Lupus flare are frequent in pregnancy Any trimester or postpartum The flares are generally with arthritis, and cutaneous manifestation

    7. Effect of SLE on pregnancy Fertility in general, SLE does not affect the fertility of patients When and how to time pregnancy planned pregnancy counseled about various type of contraception method women who have completed their families can safely undergo BTL

    8. Cont… In general, pregnancy outcome is better if: - lupus activities has been quiescent for at least 6 months before conception - there is no active renal involvement manifest by proteinuria or renal dysfunction - superimposed preeclampsia does not develop -There is no evidence of antiphospholipid antibody activity

    9. Cont…. Obstetric issues during pregnancy increase risk of pre-eclampsia (5-38%) - risk factor for pre-eclampsia include pre-existing hypertension, nephritis, and present of anti-phospholipid antibodies (aPL)

    10. Cont… Fetal issues - higher rate of abortion (6-35%) - stillbirth (0-22%) - prematurity - IUGR - IUFD - congenital heart block

    11. Management during pregnancy Monitoring the clinical conditions of both maternal and fetus. Maternal laboratory values Monitoring of lupus activity Fetus should be closely observed for adverse effect Unless hypertension develops, or there is evidence of fetal decompromise or growth restriction, pregnancy is allowed to progress to term

    12. Pharmacological treatment Arthralgia and serositis are managed by NSAIDs Low dose aspirin safe throughout gestation Corticosteroids Immunosuppressive and cytotoxic agents such as azathioprin (safe in pregnancy) Control of hypertension such as methlydopa

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