News Rheum - Vol 3 No 2 - October 2022

Introduction

To include or to exclude? That is the question in clinical studies of lupus pregnancy

Pregnant lupus patients have high rates of preeclampsia, fetal and neonatal death, and fetal growth restriction. Identifying women destined for these complications remains challenging and limits our ability to counsel and care.

Inclusion and exclusion criteria may be the most important aspect of a clinical study or trial. Lumping or splitting determines which patients can ultimately use a risk stratification algorithm or a therapy. Systemic lupus erythematosus (SLE) is a prototype illness that displays pros and cons of lumping and splitting. Among all SLE studies, those concerning pregnancy are most illustrative.

HPV, cervical screening and vaccination: Considerations in the rheumatic patient

HPV is controlled by both local and systemic immune response. It is a persistent infection that can result in a precancerous lesion. Generally, it can take up to 10 to 15 years to develop cancer in women with a normal immune system and approximately 5 to 10 years in an immunecompromised patient.

Annually there are nearly 300 000 deaths world-wide from cervical cancer. It is the second most common cancer in women after breast cancer, yet it is the leading cause of cancer death in South Africa. According to the Cancer Association of South Africa, 1 in 42 women will be diagnosed with cervical cancer. This cancer is 100% preventable. It is rapidly declining in developed countries and remains constant in developing countries. This decline is due to the availability of screening and Human papillomavirus (HPV)vaccination programmes.

Menopause and rheumatic disease: A pause for thought?

It is recognised that a multitude of autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (scleroderma) preferentially affect women and these diseases can clinically worsen or improve around the menopause.

Autoimmune disease is more common in women and there is no simple explanation for this. Typical age of onset of diseases such as osteoporosis and osteoarthritis is 50, which correlates with the onset of menopause. It is recognised that a multitude of autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (scleroderma) preferentially affect women and these diseases can clinically worsen or improve around the menopause. This temporal relationship between disease onset and progression raises the question: Do hormonal changes during this time contribute to development of disease, and more specifically what is the role of oestrogen? Is there a prospective role for oestrogen replacement therapy in the treatment of rheumatological disease? This article sets out to explore these questions.

An overview of medication safety in pregnancy and breastfeeding for rheumatic conditions

Rheumatic conditions are vast and varied including inflammatory arthritis and connective tissue diseases. The most common affecting women of childbearing age are rheumatoid arthritis (RA), axial spondylarthritis (AxSPA) and systematic lupus erythematosus (SLE). This poses clinical management challenges related to both disease activity and medication. Disease control is important as active disease increases the risk of adverse pregnancy outcomes. In active RA the inflammatory state increases the risk of developing preeclampsia in pregnancy, premature delivery and small for gestational age neonates between 10-30%. The risk of pregnancy loss also increases. In the context of well controlled disease the risk of adverse pregnancy outcomes reduces to similar rates of background risk.

Neonatal lupus syndrome: Unbreak my heart

As many as 20% of cases of autoimmune complete heart block is fatal, and 64% of live births will require a pacemaker.

Neonatal lupus is an autoimmune disease that is caused by transplacental transfer of specific autoantibodies from mother to foetus, starting in the first and second trimester, resulting in subacute cutaneous lupus erythematosus (SCLE) or congenital heart block, in the neonatal period.

Message from the new SARAA President – Dr Ayesha Wadee

With the COVID-19 pandemic, rheumatologists have been at the forefront because of the many rheumatic treatments that have proven effective. In some ways it has been beneficial and we hope that this will bring about more recognition to rheumatic diseases. 

Message from Dr Farhana Paruk, Chair of SARAA Congress 2022 Organising Committee

The standards of presentations from international and local speakers and the research presented was outstanding. The academic heads put together a brilliant fellow workshop and Sunday quiz was an undoubted success and well done to the winners. The paediatrics and allied health professionals were equally well received.