Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Pregnancy Related Morbidity and Mortality in Patients with Systemic VasculitisA Single Centre Controlled Study.

Sangle1,  Shirish R., Vounotrypidis2,  Periklis, Chaib2,  Ahlem, Salas-Manzanedo2,  Veronica, Briley1,  Annette I., Angel1,  Simon, Shennan1,  Andrew

St Thomas' Hospital, London, United Kingdom
St Thomas' Hospital

Objective:

To study the outcome of pregnancy and effect of pregnancy on disease activity in patients with systemic vasculitis (SV) compared to age and ethnicity matched controls

Patients and Methods:

We retrospectively studied 20 SV patients and 25 pregnancies attending the clinic since 1998. There were 4 with Wegener's WG), 3 Churg-Strauss syndrome (CSS), 3Takayasu arteritis (TA), and 2 ANCA positive vasculitis with renal involvement and 1 Henoch Schonlein purpura (HSP). All fulfilled the Chapel Hill Consensus Criteria and/ or ACR Criteria for SV. Two others had Behcet's disease, 3 urticarial vasculitis (UV), 1 adult onset Still's disease (AOSD) and 1 primary cerebral vasculitis (PCV). Two patients with WG had 2 pregnancies each and each patient with CSS, TA and UV had 2 pregnancies. Details regarding the duration of SV, antibody and hepatitis profile, disease activity—Birmingham vasculitis disease activity score (BVAS) and vasculitis damage index (VDI) were retrospectively evaluated from the notes during the pregnancy. Pregnancy outcome along with maternal and foetal complications were documented. Data regarding 19 healthy women who were matched for age, ethnicity and year of delivery formed the control group which was collected from the Obstetrics database of St Thomas' Hospital.

Results:

The median age of the patients at the conception was 36 (24–46) and in the control group 36 (25–43) years. There were 16 Caucasian, 3 Asian and 1 Afro Caribbean in the SV group and 16 Caucasian, 2 Asian and 1 Afro Caribbean in the control subjects. The mean duration of SV was 3 (0–14) years. Six patients were receiving prednisolone, 10 azathioprine, 3 hydroxychloroquine and 2 no treatment during the pregnancy.

In the SV group, there were 19 successful pregnancies. There were 16 miscarriages in 7 patients. Median age of the gestation in SV was 38 (34–42) and in the controls 40 (37–42) weeks. Median birth weights in the SV group was 3.0 (2.0–5.2) and in the control subjects was 3.5 (2.28–4.32) kgs (p = NS). Six patients had pregnancy morbidity: 2 had pre-eclamptic toxemia (PET), 2 each had still births and premature deliveries and 1 patient had a post partum haemorrhage (she received heparin during pregnancy). In the control group 2 had miscarriages and 1 had PET. One patient with WG and HSP flared during the pregnancy and one other with WG required surgery in the 3rd trimester for subglottic stenosis. Eight patients with SV (2 WG, 1 each of HSP, CSS, TA, UV, AOSD and ANCA positive) flared after delivery. Four women were positive for antiphospholipid antibodies (aPL) and 2 had previous miscarriages. Three patients in the SV and 4 in the control groups were smokers. The median BVAS during pregnancy was 2 (range 1–5) and VDI was 2 (range 1–3).

PregnanciesMiscarriagesPET*Still birthPrematurePostpartum bleedSmokingMed Gest age*Medn Birth wt**Median age
Vasculitis N=2516 in 7 patients22213383.036
Control N=21210004403.536
*+PET: Pre-eclamptic toxaemia
+*Median gestational age
**Median birth weight

Conclusions:

Patients with systemic vasculitis are likely to flare during pregnancy and the post-partum period and may have significant pregnancy morbidity.

To cite this abstract, please use the following information:
Sangle, Shirish R., Vounotrypidis, Periklis, Chaib, Ahlem, Salas-Manzanedo, Veronica, Briley, Annette I., Angel, Simon, et al; Pregnancy Related Morbidity and Mortality in Patients with Systemic VasculitisA Single Centre Controlled Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2035
DOI: 10.1002/art.29800

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