Systemic Lupus Erythematosus (SLE) is an autoimmune disease which has very broad range of clinical manifestations and may involve people of various ages. It is indeed important to establish and maintain SLE databases to increase significance, awareness, early diagnosis, and better management of the disease. Because of the complexity of this disease, patients with SLE should have multidisciplinary approach starting from the primary healthcare and further involve other subspecialities like rheumatology and nephrology.
Patients with SLE often require therapies for prolonged periods of time. The outcome of the disease is a lot depends on the early diagnosis and treatment. Patients’ willingness to accept the diagnosis and their compliance to the treatment regime will ensure better prognosis. While initiating the treatment, it is vital to understand patients’ beliefs and perceptions about the disease and its therapy, which are influenced by their ethnic background, as this is likely to influence adherence and outcome.
In addition, there must be agreement or co-operation general between rheumatologist and primary healthcare regarding the management and monitoring of the patient. Medical education should be readily available and it will increase efficiency of rheumatology referral.
Other related articles:
• Systemic Lupus Erythematosus (SLE)
• Clinical manifestations of SLE
• Evaluation of SLE
• Criteria for the classification of SLE
• Management of SLE
• SLE and in vitro fertilization (IVF)
• SLE and oral contraceptive pills (OCP)
• Living with SLE
• Role of primary healthcare in SLE
• Overall view of SLE
One very important complication of systemic lupus erythematosus (SLE) is infertility problem. Some patients may have children; others may have difficulty to sustain the pregnancy. In fact, some patients only come for medical attention due to recurrent abortion. The abortion usually occurs at first trimester. However, there is also possibility of intrauterine death (IUD).
In terms of in vitro fertilization (IVF) in SLE patients, although ovulation induction (OI) and IVF can be successful in SLE and primary antiphospholipid syndrome (APS) patients, rates of fetal and maternal complications are high (1). However, it found that ovarian stimulation for ovulation induction and IVF seems to be safe and successful in well-selected women with SLE and antiphospholipid syndrome.
There are some highlighted situations where assisted reproductive technology (ART) should be discouraging (2). The situations include SLE in acute flares, badly controlled arterial hypertension and pulmonary hypertension. Others situations are advanced renal disease, severe valvulopathy or heart disease, and major previous thrombotic events. However, most flares are manageable and we should not deny the treatment option for selected patients (3).
If safety approach is taken during the IVF, it will ensure better outcome of IVF among SLE patients (2).The safest approaches include friendly ovarian stimulation, single embryo transfer and avoidance of ovarian hyperstimulation syndrome (OHSS). Other approaches include administration of coadjuvant therapy and use of natural estrogen or progesterone through a non oral route (3).
The conclusion is we should not deny assisted reproductive technology among this group of patients. IVF is worth to be considered in selected patients and safe measures should be taken during the procedure. However, for those who are not suitable for ART, adoption should come next to their mind.
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Reference:
- Guballa N, Sammaritano L, Schwartzman S, Buyon J, Lockshin MD. Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome Arthritis & Rheumatism. 1999; 43(3): 550-556.
- Bellver J. Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome. 2009 Jul 24
- Handa R, Kumar U, Wali JP, Systemic Lupus Erythematosus and Pregnancy.Supplement to JAPI. 2006 June; 54:19-21.
