Document Detail


Influence of prior pregnancies on disease course and cause of death in systemic sclerosis.
MedLine Citation:
PMID:  11874839     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Microchimerism from fetal or maternal cells transferred during pregnancy has been implicated in the pathogenesis of systemic sclerosis (SSc). OBJECTIVE: To determine whether a prior pregnancy influenced disease progression and cause of death in patients with SSc. PATIENTS AND METHODS: The patients comprised a retrospective study cohort of 111 women with SSc: 78 patients with prior pregnancies (PP) and 33 who were never pregnant (NP), followed up at Thomas Jefferson University. Differences in age at onset, disease subset, organ involvement, cause of death, and type of antinuclear autoantibodies were evaluated statistically, including regression analysis. RESULTS: The age at onset of SSc in NP patients was 32.0 years compared with 45.7 years in patients with one or two prior pregnancies (p<0.0001), 46.6 years in patients with three or four pregnancies (p<0.0001), and 51.3 years in patients with five to seven pregnancies (p<0.0005). In the 16 patients who had an elective pregnancy termination, 14/16 (87.5%) had diffuse SSc v 2/16 (12.5%) with limited SSc (p<0.0001; odds ratio (OR)=49.0). Of the NP women, 7/30 (23%) died from SSc related causes v 3/78 (4%) women who had pregnancies (p=0.0058; OR=7.6). A carbon monoxide transfer factor (TLCO) of <60% and disease duration >10 years was found in 10/13 (77%) NP patients v 10/23 (43%) patients who had pregnancies (p=0.05; OR=4.7), and a TLCO <50% and disease duration >10 years was identified in 7/13 (54%) NP patients v 6/23 (26%) of the patients who had pregnancies (p=0.09; OR=3.2). CONCLUSIONS: There are differences in the age at onset, clinical course, severity of lung involvement, and cause of death in women who develop SSc before pregnancy compared with those who develop it after pregnancies. The NP patients with SSc had onset of disease at an earlier age, more severe lung involvement, and higher rate of death due to SSc.
Authors:
C M Artlett; M Rasheed; K E Russo-Stieglitz; H H B Sawaya; S A Jimenez
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  61     ISSN:  0003-4967     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-03-04     Completed Date:  2002-05-07     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  346-50     Citation Subset:  IM    
Affiliation:
Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107-5541, USA. Carol.Artlett@mail.tju.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Age of Onset
Aged
Antibodies, Antinuclear / analysis
Cause of Death
Cohort Studies
Disease Progression
Female
Humans
Middle Aged
Pregnancy / immunology,  statistics & numerical data*
Reproductive History
Scleroderma, Systemic / immunology,  mortality*
Grant Support
ID/Acronym/Agency:
R01 AR 19616/AR/NIAMS NIH HHS; R29 AR 45399/AR/NIAMS NIH HHS
Chemical
Reg. No./Substance:
0/Antibodies, Antinuclear
Comments/Corrections

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