AUTOIMMUNE DISEASES IN PREGNANCY - LUPUS

Sustavni eritemski lupus (SLE) kronična je upalna autoimuna bolest nepoznata uzroka karakterizirana oštećenjem tkiva i stanica imunim kompleksima i patogenim autoprotutijelima. Klinički tijek bolesti obilježen je naizmjeničnim egzacerbacijama i remisijama. Najčešće započinje u trećem desetljeću života, u reproduktivnom razdoblju žene. Klinička slika vrlo je raznolika. Bolest se može u početku pojaviti ili kao bolest jednog organa ili kao multisistemska bolest. Svi organski sustavi mogu biti zahvaćeni bolešću. Sustavni simptomi koji su najčešći i obično su nespecifični u vidu opće slabosti, gubitka tjelesne težine, vrućice. Tegobe lokomotornog sustava najčešće su u obliku artralgija i mialgija te neerozivnog artritisa, uz povremenu zakočenost zglobova šaka.Trudnoća sa SLE-om predstavlja izazov za ginekologa, reumatologa i niz specijalista koji moraju sudjelovati u ovakvoj trudnoći. Pacijentice u trudnoći sklone su visokom riziku trudničkih komplikacija kao što su spontani pobačaji, preeklampsija, prijevremeni porod, porod carskim rezom, manja tjelesna masa novorođenčeta. Liječenje se provodi određenim lijekovima ovisno u kojoj je fazi bolest i koje ona komplikacije nosi. U pacijentica se mogu koristiti nesteroidni antireumatici (NSAR) u prvoj i drugoj polovici trimestra, ako se bolest pogorša koriste se glukokortikoidi. Hidroklorokin, kao antimalarik, ima korisni učinak na osnovnu bolest. Obavezno je planiranje trudnoće, jer za uspiješan ishod trudnoće potrebno je remisijsko stanje pacijentice i do 6 mjeseci prije začeća.Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease of unknown cause characterized by damage to tissues and cells by immune complexes and pathogenic autoantibodies. The clinical course of the disease is marked by alternating exacerbations and remissions. It most often begins in the third decade of life, in the reproductive period of a woman. The clinical picture is very diverse. The disease may initially appear either as a single organ disease or as a multisystem disease. Virtually all organ systems can be affected by the disease. Systemic symptoms that are most common and are usually nonspecific in the form of general weakness, weight loss, fever. Problems of the locomotor system are most often in the form of arthralgias and myalgias and non-erosive arthritis, with occasional stiffness of the wrists. Pregnancy with SLE is a challenge for gynecologists, rheumatologists and a number of specialists who must participate in such a pregnancy. Patients in pregnancy are prone to a high risk of pregnancy complications such as miscarriages, preeclampsia, premature birth, cesarean delivery, lower body weight of the newborn. Treatment is carried out with certain drugs depending on the stage of the disease and what complications it carries. Nonsteroidal antirheumatic drugs (NSAIDs) may be used in patients in the first and second half of the trimester, and glucocorticoids are used if the disease worsens. Hydrochloroquine, as an antimalarial, has a beneficial effect on the underlying disease. Pregnancy planning is mandatory, because a successful outcome of pregnancy requires remission of the patient up to 6 months before conception