Reumatizam, Vol. 70 No. 2, 2023.
Pregledni rad
https://doi.org/10.33004/reumatizam-70-2-6
Antiphospholipid syndrome and pregnancy
Željka Kardum
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* Autor za dopisivanje.
Sažetak
Antiphospholipid syndrome (APS) is a chronic autoimmune disease characterized by the presence of antiphospholipid autoantibodies, such as anticardiolipin antibodies (aCL), antiβ2 glycoprotein 1 antibodies (aβ2GP1), and circulating lupus anticoagulant (LA). The clinical festures include recurrent thrombosis of the arteries, veins, and microvasculature, which are the main features of vascular APS (vAPS), and/or obstetric complications that are part of obstetric APS (oAPS). Obstetric complications have a direct effect on maternal and fetal morbidity, causing recurrent pregnancy miscarriages, fetal death, and signs of placental insufficiency that include preeclampsia, intrauterine growth restriction, and HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome. In APS, thrombosis is the most prominent feature of the disease. In oAPS, the main pathological findings include impaired spiral artery remodeling, decidua inflammation with neutrophil infiltration, local tumor necrosis factor (TNF) -α production, deposition of complement split products, and placental infarction, which suggest a state of thrombo-inflammation. Antiphospholipid antibodies have both a direct embryotoxic and an effect on the placenta, causing a pro-inflammatory state, disrupting trophoblast development and implantation, and impaired spiral artery remodeling.
Standard oAPS therapy includes low-molecular-weight heparin and low-dose aspirin. Approximately 20–30% of oAPS patients do not benefit from standard treatment, and additional therapeutic options are necessary in those refractory cases, which may include small doses of prednisolone, hydroxychloroquine, plasmapheresis, immunoglobulins, TNF-α inhibitors, statins, and eculizumab.
Ključne riječi
Hrčak ID:
320042
URI
Datum izdavanja:
8.8.2024.
Posjeta: 0 *