muhamad amin bin abu hassan

Autoimmune disease characterized by acute or chronic inflammation of various tissues of the body It can affect skin, kidney, lung, joints, and nervous system More common in women All age (common begin at 24-45) 24-

Signs and symptoms
Fatigue, low grade fever, muscle aches Facial rash (butterfly rash) arthritis Photosensitivity Raynaud s phenomena Alopecia Clinical manifestation confines to the system that involve

1) Genetic link
identical twins have threefold to tenfold higher risk to get lupus compared to nonidentical twins.

2) Environment factors
sun exposure ( ultraviolet light) can worsen the rashes of the patient who have lupus.

3) Reversible drug induce lupus
a) procainamide ,hydralazine, isoniazid hydralazine, b) drgu to treat rheumatoid arthritis, etanercept, infliximab and adalimumab. etanercept, adalimumab.

Genetic susceptibility
involvement of human leucocyte antigen (HLA) class II gene polymorphisms. presence of anti-small nuclear ribonuclear protein, anti-nuclear ribonuclear protein and anti-DNA antiantiantiantibodies.

Increase in estrogen lead to B cell differentiation & In vitro apoptosis of PBMCs & TNF production, This will leads to B cell hyperactivity and the production of pathogenic autoantibodies. autoantibodies.

Disturbances of the immune response
Environmental antigens and self antigens are taken up by antigen presenting cells (APCs). process the antigens into peptides & present them to T cells through their surface HLA molecules. The activated T cells in turn stimulate the B cells to produce pathogenic autoantibodies. autoantibodies.

Effects of pregnancy on SLE
Lupus flare are frequent in pregnancy Any trimester or postpartum The flares are generally with arthritis, and cutaneous manifestation

Effect of SLE on pregnancy
Fertility in general, SLE does not affect the fertility of patients When and how to time pregnancy planned pregnancy counseled about various type of contraception method women who have completed their families can safely undergo BTL

In general, pregnancy outcome is better if: - lupus activities has been quiescent for at least 6 months before conception - there is no active renal involvement manifest by proteinuria or renal dysfunction - superimposed preeclampsia does not develop -There is no evidence of antiphospholipid antibody activity

Cont .
Obstetric issues during pregnancy increase risk of pre-eclampsia (5-38%) pre(5- risk factor for pre-eclampsia include preprepreexisting hypertension, nephritis, and present of anti-phospholipid antibodies (aPL) anti-

Fetal issues - higher rate of abortion (6-35%) (6- stillbirth (0-22%) (0- prematurity - IUGR - IUFD - congenital heart block

Management during pregnancy
Monitoring the clinical conditions of both maternal and fetus. Maternal laboratory values Monitoring of lupus activity Fetus should be closely observed for adverse effect Unless hypertension develops, or there is evidence of fetal decompromise or growth restriction, pregnancy is allowed to progress to term

Pharmacological treatment
Arthralgia and serositis are managed by NSAIDs Low dose aspirin safe throughout gestation Corticosteroids Immunosuppressive and cytotoxic agents such as azathioprin (safe in pregnancy) Control of hypertension such as methlydopa

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