Effectiveness of a multidisciplinary clinical pathway for women with systemic lupus erythematosus and/or antiphospholipid syndrome.
antiphospholipid syndrome
lupus nephritis
systemic lupus erythematosus
Journal
Lupus science & medicine
ISSN: 2053-8790
Titre abrégé: Lupus Sci Med
Pays: England
ID NLM: 101633705
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
22
12
2020
revised:
05
03
2021
accepted:
18
04
2021
entrez:
6
5
2021
pubmed:
7
5
2021
medline:
28
9
2021
Statut:
ppublish
Résumé
SLE and/or antiphospholipid syndrome (SLE/APS) are complex and rare systemic autoimmune diseases that predominantly affect women of childbearing age. Women with SLE/APS are at high risk of developing complications during pregnancy. Therefore, clinical practice guidelines recommend that patients with SLE/APS should receive multidisciplinary counselling before getting pregnant. We investigated the clinical effectiveness of implementing a multidisciplinary clinical pathway including prepregnancy counselling of patients with SLE/APS. A clinical pathway with specific evaluation and prepregnancy counselling for patients with SLE/APS was developed and implemented in a tertiary, academic hospital setting. Patients were prospectively managed within the clinical pathway from 2014 onwards and compared with a retrospective cohort of patients that was not managed in a clinical pathway. Primary outcome was a combined outcome of disease flares for SLE and thromboembolic events for APS. Secondary outcomes were maternal and fetal pregnancy complications. Seventy-eight patients with 112 pregnancies were included in this study. The primary combined outcome was significantly lower in the pathway cohort (adjusted OR (aOR) 0.20 (95% CI 0.06 to 0.75)) which was predominantly determined by a fivefold risk reduction of SLE flares (aOR 0.22 (95% CI 0.04 to 1.09)). Maternal and fetal pregnancy complications were not different between the cohorts (respectively, aOR 0.91 (95% CI 0.38 to 2.17) and aOR 1.26 (95% CI 0.55 to 2.88)). The outcomes of this study suggest that patients with SLE/APS with a pregnancy wish benefit from a multidisciplinary clinical pathway including prepregnancy counselling.
Identifiants
pubmed: 33952625
pii: 8/1/e000472
doi: 10.1136/lupus-2020-000472
pmc: PMC8103373
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Rheumatology (Oxford). 2016 Sep;55(9):1698-702
pubmed: 26750125
J Thromb Haemost. 2006 Feb;4(2):295-306
pubmed: 16420554
Front Immunol. 2019 Aug 14;10:1948
pubmed: 31475009
J Pediatr. 2003 Jun;142(6):678-83
pubmed: 12838197
Rheumatology (Oxford). 2002 Aug;41(8):924-9
pubmed: 12154210
Blood. 2014 Jan 16;123(3):404-13
pubmed: 24200687
Implement Sci. 2018 Nov 12;13(1):139
pubmed: 30419942
Ann Intern Med. 2015 Aug 4;163(3):153-63
pubmed: 26098843
Rheumatology (Oxford). 2021 Feb 16;:
pubmed: 33590843
Arthritis Rheumatol. 2019 Sep;71(9):1400-1412
pubmed: 31385462
Lupus. 1999;8(8):677-84
pubmed: 10568906
Rheumatology (Oxford). 2016 Sep;55(9):1693-7
pubmed: 26750124
Lupus. 2019 Oct;28(12):1417-1426
pubmed: 31551036
J Eval Clin Pract. 2007 Dec;13(6):920-9
pubmed: 18070263
Open Access Rheumatol. 2017 Mar 10;9:37-53
pubmed: 28331377
Semin Arthritis Rheum. 2010 Feb;39(4):257-68
pubmed: 19136143
Rheumatology (Oxford). 2017 Nov 1;56(11):1945-1961
pubmed: 28968809
Arthritis Care Res (Hoboken). 2020 Apr;72(4):461-488
pubmed: 32090466
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006632
pubmed: 20238347
J Autoimmun. 2016 Nov;74:6-12
pubmed: 27496151
Lupus. 2017 May;26(6):563-571
pubmed: 28121241
BMC Pregnancy Childbirth. 2018 Jun 7;18(1):212
pubmed: 29879927
Autoimmun Rev. 2015 May;14(5):387-95
pubmed: 25555817
Arthritis Rheum. 2002 Apr;46(4):1019-27
pubmed: 11953980
Ann Rheum Dis. 2016 May;75(5):795-810
pubmed: 26888948
Clin J Am Soc Nephrol. 2010 Nov;5(11):2060-8
pubmed: 20688887
Arthritis Rheum. 2005 Feb;52(2):514-21
pubmed: 15692988
Clin Exp Med. 2017 Aug;17(3):257-267
pubmed: 27334977
J Rheumatol. 2005 Sep;32(9):1709-12
pubmed: 16142865
J Autoimmun. 2017 May;79:17-27
pubmed: 28256367
J Autoimmun. 2012 May;38(2-3):J197-208
pubmed: 22204899
Ann Rheum Dis. 2008 Feb;67(2):195-205
pubmed: 17504841
Ann Rheum Dis. 2017 Mar;76(3):476-485
pubmed: 27457513
Rheumatology (Oxford). 2018 Oct 1;57(10):1707-1720
pubmed: 29165607