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

Laura Andreoli, Maria Chiara Gerardi, Melissa Fernandes, Alessandra Bortoluzzi, Silvia Bellando-Randone, Antonio Brucato, Roberto Caporali, Cecilia Beatrice Chighizola, Maria Sole Chimenti, Paola Conigliaro, Maurizio Cutolo, Maria Stefania Cutro, Salvatore D'Angelo, Andrea Doria, Elena Elefante, Micaela Fredi, Mauro Galeazzi, Maria Gerosa, Marcello Govoni, Annamaria IulianoMaddalena Larosa, Maria Grazia Lazzaroni, Marco Matucci-Cerinic, Marianna Meroni, Pier Luigi Meroni, Marta Mosca, Massimo Patanè, Giulia Pazzola, Monica Pendolino, Roberto Perricone, Véronique Ramoni, Carlo Salvarani, Gian Domenico Sebastiani, Carlo Selmi, Francesca Romana Spinelli, Guido Valesini, Carlo Alberto Scirè, Angela Tincani

Research output: Contribution to journalReview article

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.

Original languageEnglish
Pages (from-to)164-176
Number of pages13
JournalAutoimmunity Reviews
Volume18
Issue number2
DOIs
Publication statusPublished - Feb 2019

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Andreoli, L., Gerardi, M. C., Fernandes, M., Bortoluzzi, A., Bellando-Randone, S., Brucato, A., Caporali, R., Chighizola, C. B., Chimenti, M. S., Conigliaro, P., Cutolo, M., Cutro, M. S., D'Angelo, S., Doria, A., Elefante, E., Fredi, M., Galeazzi, M., Gerosa, M., Govoni, M., ... Tincani, A. (2019). Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies. Autoimmunity Reviews, 18(2), 164-176. https://doi.org/10.1016/j.autrev.2018.08.008