Format

Send to

Choose Destination
Autoimmun Rev. 2019 Feb;18(2):164-176. doi: 10.1016/j.autrev.2018.08.008. Epub 2018 Dec 18.

Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies.

Author information

1
Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. Electronic address: laura.andreoli@unibs.it.
2
Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
3
Department of Internal Medicine, Autoimmune Disease Unit, Hospital Curry Cabral/Centro Hospitalar Lisboa Central, Lisbon, Portugal.
4
Department of Medical Sciences, Rheumatology Unit, S. Anna Hospital, University of Ferrara, Ferrara, Italy.
5
Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy.
6
Internal Medicine Division, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
7
Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
8
Department of Clinical Sciences and Community Health, Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, University of Milan, Cusano Milanino, Milan, Italy.
9
Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy.
10
Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, IRCCS San Martino Polyclinic Hospital, University of Genova, Genova, Italy.
11
Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Madonna delle Grazie of Matera, Matera, Italy.
12
Division of Rheumatology, University of Padova, Padova, Italy.
13
Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy.
14
Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Azienda ospedaliera Universitaria Senese, Siena, Italy.
15
Department of Clinical Sciences and Community Health, Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, University of Milan, Milan, Italy.
16
Rheumatology Unit, San Camillo Hospital, Rome, Italy.
17
Rheumatology & Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy.
18
Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Milan, Italy.
19
Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy.
20
Rheumatology & Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy; BIOMETRA Department, University of Milan, Milan, Italy.
21
Dipartimento di Medicina Interna e Specialità Mediche-Reumatologia, Sapienza University of Rome, Rome, Italy.
22
Department of Medical Sciences, Rheumatology Unit, S. Anna Hospital, University of Ferrara, Ferrara, Italy; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy.
23
Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy.

Abstract

Pregnancy requires a special management in women with inflammatory rheumatic diseases (RDs), with the aim of controlling maternal disease activity and avoiding fetal complications. Despite the heterogeneous course of RDs during pregnancy, their impact on pregnancy largely relates to the extent of active inflammation at the time of conception. Therefore, accurate evaluation of disease activity is crucial for the best management of pregnant patients. Nevertheless, there are limitations in using conventional measures of disease activity in pregnancy, as some items included in these instruments can be biased by symptoms or by physiological changes related to pregnancy and the pregnancy itself may influence laboratory parameters used to assess disease activity. This article aims to summarize the current literature about the available instruments to measure disease activity during pregnancy in RDs. Systemic lupus erythematosus is the only disease with instruments that have been modified to account for several adaptations which might interfere with the attribution of signs or symptoms to disease activity during pregnancy. No modified-pregnancy indices exist for women affected by other RDs, but standard indices have been applied to pregnant patients. The current body of knowledge shows that the physiologic changes that occur during pregnancy need to be either adapted from existing instruments or developed to improve the management of pregnant women with RDs. Standardized instruments to assess disease activity during pregnancy would be helpful not only for clinical practice but also for research purposes.

KEYWORDS:

Activity indices; Autoimmune diseases; Pregnancy; Rheumatoid arthritis; Spondyloarthritis; Systemic lupus erythematosus; Vasculitis

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center