SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) DURING PREGNANCY
SLE is a serious autoimmune disease with autoantibodies causing specific multisystem (skin, joints, kidneys, lungs, liver, nervous system and other organs) affection. It is 10 times more common in adult women than the adult men. It is first diagnosed during pregnancy in 10–30% cases.
Clinical features: Common presenting features are: fatigue, fever, weight loss, arthralgias, arthritis and myalgias. Joint pains are often migratory in nature.
EFFECTS OF PREGNANCY ON SLE: Long-term prognosis remains unaffected. There is chance of flare ups especially during first half and maximum in puerperium. Majority of maternal deaths occur in puerperium, the cause being pulmonary hemorrhage and lupus pneumonitis and exacerbation of lupus nephritis.
EFFECTS OF SLE ON PREGNANCY: Risks of lupus rash, anemia, leukopenia, thrombocytopenia and renal failure are increased. There are increased risks of first trimester miscarriage, lupus nephritis, recurrent deep vein thrombosis, PIH, prematurity, IUGR and stillbirths. Neonatal lupus syndrome is due to crossing of maternal lupus antibodies (anti-Ro or anti-La) to the fetus causing hemolytic anemia, leukopenia and thrombocytopenia.
Isolated congenital heart block is present in about one-third of cases. An apparently healthy woman delivering a baby with congenital heart block should be observed for the development of SLE.
INVESTIGATION: Antinuclear antibodies are the standard screening test for the disease. Presence of autoantibodies to double-stranded DNA (dsDNA) is highly specific to the diagnosis. Antibodies to Sm antigen (RNA protein) found in 30–40% of SLE patients are highly specific and are correlated with renal involvement. Other antibodies for diagnosis are: Lupus anticoagulant, antiphospholipid antibodies, anti-Ro and anti-La. Baseline laboratory tests are done to assess anemia, thrombocytopenia, renal function tests and serum antibodies (LA, ACL, anti-RO/SSA and anti-La/SSB).
MANAGEMENT: Pre-conception planning is extremely important since conception during a period of quiescence is most likely to result in a live birth. Lupus can flare any time in pregnancy and postpartum period (15%–60%). The predictive factors for successful pregnancy outcome are:
- a) Phase of sustained remission in the past 6 months.
- b) Corticosteroids (prednisolone) are the commonly used drugs. Non-steroidal anti-inflammatory agents can be used during puerperium. Low dose aspirin 80 mg daily is prescribed with advantages (minimizes PIH and IUGR). Mode of delivery is guided by the obstetric behavior. Fetus with congenital heart block should be delivered by cesarean section. Patients should receive corticosteroids during the peripartum period. Oral contraceptives may affect SLE and IUCD may predispose to infection in an immunocompromised patient, as such, barrier method of contraceptives are recommended. Progestins do not flare lupus.
HOMOEOPATHIC MEDICINES FOR SLE: -
- Rhustox: - it is suggested when there is lower back pain and stiffness in and around pelvis accompanied by Bruising. The patient may experience relief with heat,gentle motion.
- Ruta graveolens: - an effective remedy when patient Complaints of feeling of great stiffness.
- Calcarea carb: - symptoms such as inflammation and Soreness of joints, particularly that of knee and hands. It also helps treat stiffness around the neck area.
- Thuja Occidentalis: - when joint inflammation with pain and itching of the skin are noticed.
- Apis Mel: - it helps when symptoms are red burning rashes often associated with fluid retention and swelling