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However, researchers found that a common treatment for SLE reduces the risk of flares to that of non-pregnant women with lupus.
By nature, systemic lupus erythematosus (SLE) is characterized by periods of low disease activity and intermittent flares of more severe disease. The relationship between pregnancy and the course of SLE has been debated for some time.
Eudy and colleagues point out that a wide range of lupus flare rates during pregnancy has been reported without a good idea as to the true rate.1 It appears, however, that flares are more common during pregnancy.
The evidence is limited in this area. The researchers conducted a study with the aim of estimating the effect of pregnancy on disease flares in SLE. They recently reported their findings in the Annals of the Rheumatic Diseases.
Patients with lupus in The Hopkins Lupus Pregnancy Cohort who met American College of Rheumatology or Systemic Lupus International Collaborating Clinics criteria for SLE were included. Disease activity and flares were examined in relation to pregnancy. The cohort included 1349 women at baseline and 304 women at first pregnancy.
• Physician Global Assessment (PGA) flares were more common during pregnancy than outside of pregnancy (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.27-1.96).
• There was an increased risk of SLE flare during the first 3 months after delivery as well (HR, 1.48; 95% CI, 1.07-1.95).
• Nearly half of flares occurred during the third trimester, while about one-quarter occurred during the first.
• When the Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) was used, an even higher rate of flare was seen during pregnancy (HR, 1.57; 95% CI, 1.25-1.92).
• About half of flares during pregnancy were mild.
• Women who took hydroxychloroquine (HCQ) did not see an increase in flares during pregnancy [1.83 (95% CI, 1.34 to 2.45) for patients with no HCQ use vs 1.26 (95% CI, 0.88 to 1.69) for those taking HCQ].
• Prednisone had a variable effect depending on the measure used.
Implications for clinicians
• Counsel women with SLE who are considering pregnancy that flare-ups are more common during pregnancy, especially in the third trimester.
• Advise pregnant women with lupus that the increased risk of flares extends into the months following delivery.
• Patients with SLE who want to get pregnant and who already take HCQ should continue it, because it reduces the risk of flares to that of non-pregnant women with lupus.
• Women with lupus who want to get pregnant and are not taking HCQ may benefit from it if they wish to reduce the risk of lupus flares during and after pregnancy.
1. Eudy AM, Siega-Riz AM, Engel SM, et al. Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Ann Rheum Dis. 2018 Feb 20. doi:10.1136/annrheumdis-2017-212535. [Epub ahead of print]