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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sera from 86 individuals were tested for circulating immune complexes by the polyethylene glycol precipitation method and a Raji cell enzyme immunoassay (Raji-ELISA). These included normal nonpregnant control subjects, nonpregnant patients with autoimmune diseases, healthy women in the second and third trimesters of pregnancy, patients with preeclampsia, and women with pregnancies complicated by preexisting autoimmune diseases. Diseases such as systemic lupus erythematosus and rheumatoid arthritis were associated with increased levels of immune complexes in both pregnant and nonpregnant individuals. Circulating immune complexes were not observed in normal pregnancies or in preeclampsia. Although pregnancy itself is not an immune complex-associated state, the presence of immune complexes in autoimmune diseases may explain some of the complications observed during pregnancy in these patients.
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PMID:Circulating immune complexes in pregnancy, preeclampsia, and autoimmune diseases: evaluation of Raji cell enzyme-linked immunosorbent assay and polyethylene glycol precipitation methods. 635 22

Lesions of the uteroplacental vasculature may be involved in the pathogenesis of "placental insufficiency" in pregnancies complicated by hypertension, diabetes, systemic lupus erythematosus, and idiopathic fetal growth retardation. The decidual arteries of the placental bed of normotensive, hypertensive, and diabetic women were studied by histologic examination and direct immunofluorescence for immunoglobulins and complement. Decidual tissue was obtained by curettage and snap frozen immediately after delivery of the placenta in 21 normal pregnant control subjects, 73 nondiabetic women with hypertensive disorders, and 41 women with insulin-dependent diabetes. Lesions of fibrinoid necrosis and/or atherosis were observed in some of the decidual arteries of 53% of women with preeclampsia (primary or superimposed) and also in a proportion of women with stable chronic hypertension or normotensive diabetes. Thus, fibrinoid necrosis/atherosis of the decidual arteries is not specific for preeclampsia. Immunoglobulins and complement were detected in arteries with lesions in subjects of all clinical groups. The findings do not support the concept that immunoprotein deposition in pathologic decidual arteries is related to a hypothetical immunologic reaction specific for preeclampsia. In preeclampsia, vascular deposition of immunoglobulin and complement may be related to local intravascular coagulation.
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PMID:Decidual arteriopathy in hypertension and diabetes in pregnancy: immunofluorescent studies. 703 98

Placentae from 63 term pregnancies were studied. Of these, 19 were from normal pregnancies in which the neonates were within the normal weight range for their gestational age. The remaining 44 placentae were from pregnancies in which the infants were small for their gestational age (SGA). A chronic villitis was found in 68 per cent of all placentae. In the control group this lesion was present in 26 per cent but a mean of only 1.2 per cent of villi in these cases was inflamed. In the SGA group 86 per cent of placentae showed a chronic villitis and in these an average of 10 per cent of the villi were inflamed. Lymphocytic infiltrates in basal plate anchoring villi were observed in 48 of the 63 placentae and there were no differences among the various groups. Vascular lesions were found, similar to those described in placental bed arteries in preeclampsia and more recently in biopsies of the placental bed of SGA infants and in the decidua of mothers with systemic lupus erythematosus: this type of vasculopathy has also been described in rejection of renal transplants. It is suggested that the cellular infiltrate around and inside anchoring villi and free villi in cases of chronic villitis may represent the histological hallmark of an immunological reaction between mother and fetus rather than a response to infection.
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PMID:Chronic villitis of unknown aetiology in placentae of idiopathic small for gestational age infants. 713 98

Eleven patients with 18 pregnancies occurring during the course of systemic lupus erythematosus (SLE) were reviewed. Ten had long-standing lupus glomerulonephritis and a single patient developed glomerulonephritis during pregnancy. Patients were divided into those without (Group A) and those with (Group B) clinical evidence of renal disease or active SLE at conception. In Group A there were 10 pregnancies in five patients; all pregnancies were uncomplicated, except for mild superimposed pre-eclampsia in two, and all resulted in term delivery. Eight pregnancies in six patients occurred in Group B; four pregnancies were complicated by severe (2) or mild (1) superimposed pre-eclampsia and the onset of glomerulonephritis (1), resulting in three premature deliveries and a spontaneous abortion. The remaining four pregnancies were uncomplicated but resulted in one term delivery, one elective abortion, and two spontaneous abortions. None of the patients developed either renal failure or a rapidly progressive course following pregnancy.
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PMID:Pregnancy and systemic lupus erythematosus. 742 97

Two classes of antiphospholipid antibodies (APA) are associated with adverse pregnancy outcomes. Those APA identified by immunoassays using phospholipid-coated surfaces (e.g., anticardiolipin antibodies) seem to bind to the 57 kD anticoagulant protein, beta 2-glycoprotein-I, when complexed with anionic phospholipid bilayers. Such APA may or may not prolong phospholipid-dependent clotting assays. A second class of APA are identified by their interference with phospholipid-dependent clotting assays (i.e., lupus anticoagulants). The latter bind to phospholipids present in a unique hexagonal phase either alone or complexed with prothrombin or beta 2-glycoprotein-I. There is evidence that both classes of APA are directly responsible for adverse pregnancy outcomes including spontaneous abortions, stillbirths, fetal growth retardation, thrombosis, thrombocytopenia, and preeclampsia. Putative APA-mediated pathogenic mechanisms include intervillous thrombosis, intravillous infarctions and decidual vasculopathy. The thrombogenicity of APA may result from their interference with endothelial phospholipids required for antithrombin III and protein C and S anticoagulant activity and prostacyclin synthesis and/or increased endothelial expression of the procoagulants: tissue factor, von Willebrand factor, platelet-activating factor, and plasminogen activator inhibitor type-1. Other prothrombotic properties seem to include: increased platelet aggregation, and reduced beta 2-glycoprotein-1 and annexin V anticoagulant activity. Rigorous diagnostic criteria must be applied to the detection of both classes of APA because the prevention of adverse pregnancy outcomes requires potentially hazardous anticoagulant therapy.
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PMID:The immunobiology and obstetrical consequences of antiphospholipid antibodies. 752 11

Patients with lupus nephritis frequently exhibit increasing proteinuria, hypertension and deterioration of renal function due to either active lupus nephritis, chronic lupus nephritis and/or superimposed preeclampsia during pregnancy. Percutaneous renal biopsies were therefore performed in 3 women with systemic lupus erythematosus during pregnancy and immediately postpartum in a fourth woman to evaluate their renal disease during pregnancy. Mean serum creatinine at renal biopsy was 2.9 mg/dl, with a mean creatinine clearance of 66 ml/min and protein excretion of 5.3 g/day. All patients had grade IV lupus nephritis and received pulse methylprednisolone immediately; 3 received cyclophosphamide. All 3 patients with crescent formation developed endstage renal disease within 3 years. The fourth patient has normal renal function 3 years after biopsy. Percutaneous renal biopsies during pregnancy in women with lupus nephritis provide an accurate histopathologic diagnosis and are important in providing appropriate therapy, counseling and prognosis.
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PMID:Evaluation of lupus nephritis during pregnancy by renal biopsy. 761 42

Thrombomodulin (TM), an endothelial cell membrane glycoprotein, is released into blood as a soluble TM antigen after inflammation or injury to endothelium. Systemic lupus erythematosus (SLE) is characterized by multisystem inflammation of vascular endothelium. The objective of this study is to determine the circulating TM levels in pregnant and nonpregnant SLE women and the correlation of plasma TM levels with variables used to assess SLE activity. We found that there were no significant differences in plasma TM levels among pregnant SLE, nonpregnant SLE, and normal pregnant patients. However, significantly higher plasma TM levels were found in some SLE women with active disease or preeclampsia.
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PMID:Plasma thrombomodulin levels in women with systemic lupus erythematosus. 771 May 72

Autoimmune diseases are relatively common in women, and tend to occur in the childbearing years. These disorders fall broadly into two groups: (i) Multisystem diseases such as systemic lupus erythematosus (SLE) and related connective tissue disorders (CTD). This group includes the 'pre-clinical' antiphospholipid or lupus obstetric syndrome which may first manifest itself as a pregnancy disorder causing recurrent abortion, fetal death, fetal growth retardation and early onset severe pre-eclampsia. (ii) Tissue- or organ-specific disorders such as autoimmune thrombocytopaenic purpura (ATP), autoimmune thyroid disease (Graves' disease, Hashimoto's autoimmune thyroiditis, and post-postum thyroiditis), autoimmune haemolytic anaemia, and the very rare myasthenia gravis. The study of autoimmune diseases against the background of pregnancy as an experimental system of nature has provided important insights into the nature of the disease processes and the relevance or otherwise of circulating autoantibodies to pathological effects. Thus, for example, if neonatal manifestations of adult disease are causally related to the transfer of autoantibodies across the placenta, they will disappear over a time course consistent with the catabolism of IgG, providing no permanent damage is produced. Conversely, if autoantibodies are demonstrable in the neonate, in the absence of clinical effects, they may only be an epiphenomenon of the maternal disease. In addition, on occasions, disease manifestations may be seen in the baby when the mother shows none. This may occur when the mother is in remission, but still has circulating antibodies, or when she has an occult form of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Autoimmune disease and pregnancy. 784 94

The objective of this work was to analyse the course of maternal disease and fetal outcome in pregnant patients with systemic lupus erythematosus (SLE) counselled and followed according to a protocol intended to optimize maternal and fetal outcome. The prospective study included all pregnancies between 1987 and 1993 in SLE patients known at least 6 months before pregnancy at the Lupus Clinic of our hospital. In 25 patients there were 35 pregnancies. Thirty-four (97%) started at sustained remission of disease; 11 (31%) were in women with antiphospholipid antibodies (aPL); 14 (40%) in women with a history of biopsy-proven lupus nephritis; one (3% in a woman with a serum creatinine above 125 mumol/l. In 29 pregnancies (82%) maternal disease remained inactive during gestation. In three pregnancies (9%) active disease was treated with prednisone. There were no serious post-partum flares of disease. Pregnancy resulted in 25 (71%) live births, 8 (23%) first trimester abortions, and one intrauterine fetal death. One pregnancy was terminated because of hydrocephalus. Nine of 25 (36%) live births were delivered by caesarean section. For 6 of 9 (67%) caesarean sections the indication was fetal distress and pre-eclampsia. In the majority of patients with SLE who conceive at remission, the disease does not flare in pregnancy. With optimal obstetric care, close follow-up and treatment with low-dose aspirin if aPL are present, a high success rate (71%) can be achieved.
Lupus 1994 Jun
PMID:Pregnancy in systemic lupus erythematosus: a prospective study. 795 Dec 99

A patient with active systemic lupus erythematosus presented with generalized convulsions and acute myocardial infarction during the first trimester. Serial determinations of biochemical variables and liver histology indicated that preeclampsia might be responsible for the life threatening episodes.
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PMID:Active lupus and preeclampsia: a life threatening combination. 798 65


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