Pregnancy in dermatomyositis and polymyositis

##plugins.themes.academic_pro.article.sidebar##

Published Sep 12, 2012
Download
pdf
Vol. 90 No. 8 (2012): Issue Aug 2012

##plugins.themes.academic_pro.article.main##

Neila Kaddour
Mouna snoussi
Sameh Marzouk
Faten Frikha
Moez Jallouli
Makram Frigui
Hatem Masmoudi
Mohamed Guermazi
Zouhir Bahloul

Abstract

Aim: To determine the incidence of pregnancies during the inflammatory myopathy (IM), its influence on this disease and the influence of IM on the pregnancy’s outcome.
Methods: From 1979 to 2007 we have collected retrospectively 67cases of IM (53 women and 14 men) in the department of internal medicine CHU Hedi Chaker of Sfax (Tunisia). Diagnosis criteria were those and Peter. We have included pregnancies occurring after diagnosis of DM or PM and cases of IM occurring during pregnancy or postpartum.
Results: Five women (4DM and PM), average age 30.6 years (range 26 - 41years) conducted 10 pregnancies (9.4%). The fertility rate is 2 pregnancies per patient. Nine pregnancies occurred after the diagnosis of myositis in 4 women. IM was inactive at conception in all this cas.No flare-up in IM has been noted during these
pregnancies. The DM was revealed to the 10th day post-partum in one patient. Therapeutic interruption of pregnancy was needed in 3 cases. 4 pregnancies were completed without incident and resulted in the birth of healthy newborns. Foetal complications were observed in the other two pregnancies occurring in one patient who also presents an APS associated with DM. It was a foetal death in utero and premature delivery of a newborn who died in 3rd day after birth.
Conclusion: Pregnancy in the MI is rare. Its influence on the activity of the disease is variable, both during the pregnancy than postpartum. The foetal prognosis is good when the the disease is in remission. However foetal complications are important in case of active IM.

Keywords:

Inflammatory myopathy, Dermatomyositis, Polymyositis, Pregnancy

##plugins.themes.academic_pro.article.details##

References

  1. Dimitri D, Pagnoux C. Grossesse et myopathies inflammatoires. Presse Med 2008 ;37 :1652-56
  2. Bohan A, Peter JB. Polymositis and dermatomyositis . [First of two parts]. N Engl J Med 1975; 292:344-7
  3. Gutiérrez G, Dagnino R, Mintz G. Polymyositis / dermatomyositis and pregnancy. Arthritis and Rheumatism 1984; 27: 291-94
  4. Silva C.A, Sultan S.M, Isenberg D.A. Pregnancy outcome in adult-onset idiopathic inflammatory myopathy. Rheumatology 2003; 42:1168-72
  5. King CR, Chow S. Dermatomyositis and pregnancy. Obstet Gynecol 1985; 66:589-92
  6. Steiner I, Averrbuch-Heller L, Abramsky O, Raz E. Postpartum idiopathic polymyositis. Lancet 1992; 339:256.
  7. VÃ ncsa A, Ponyi A, Constantin T, Zeher M. Pregnancy outcome in idiopathic inflammatory myopathy. Rheumatol Int 2007;27:435-39
  8. Bauer KA, Siegler M, Lindheimer MA. Polymyositis complicating pregnancy. Arch Intern Med 1979;139:449.
  9. Pinheiro Gda R, Goldenberg J, Atra E, Pereira RB, Camano L, Schmidt B. Juvenile dermatomyositis and pregnancy: report and literature review. J Rheumatol 1992; 19:1798-801
  10. Harris A, Webley M, Usherwood M, Burge S. Dermatomyositis presenting in pregnancy. Br J Dermatol 1995; 133:783-5
  11. Solomon JE, D'Alton ME. Dermatomyositis in pregnancy. Curr Opin Obstet Gynecol 1996; 8:83-6
  12. Park IW, Suh YJ, Han JH et al. Dermatomyositis developing in the first trimester of pregnancy. Korean J Intern Med 2003; 18:196-8
  13. Williams L, Chang PY, Park E, Gorson KC, Bayer-Zwirello L. Successful treatment of dermatomyositis during pregnancy with intravenous immunoglobulin monotherapy. Obstet Gynecol 2007; 109:561-3
  14. Nozaki Y, Ikoma S, Funauchi M, Kinoshita K. Respiratory muscle weakness with dermatomyositis during pregnancy: successful treatment with intravenous immunoglobulin therapy.J Rheumatol 2008; 35:11
  15. Moribara K, Katob N, Hirano S, Kisbimoto S. Amyopathic dermatomyositis presenting during pregnancy. J Am Acad Dermatol 2004; 838-40.
  16. Rosenzweig BA, Rotmensch S, Binette S, Phillippe M. Primary idiopathie polymyositis and dermatomyositis complications in pregnancy: diagnosis and treatment. Obstet Gynecol Surv 1989; 44:162-9
  17. Ishikawa S, Takei Y, Maruyama T, Koyama S, Hanyu N. A case of polymyositis presenting pregnancy with acute respiratory failure (abstract seulement - article en japonais). Rinsho Shinkeigaku 2000; 40:140-4.
  18. Hung NA, Jackson C, Nicholson M, Highton J. Pregnancy related polymyositis and massive perivillous fibrin deposition in the placenta: are they pathogenetically related? Arthritis Rheum 2006; 55:154-6
  19. Nelson JL. Pregnancy, immunology and autoimmune disease. J Report Med 1998; 43:335-40
  20. Clark AL. Clinical uses of intravenous immunoglobulin in pregnancy. Clin Obstet Gynecol 1999; 42 :368-80
  21. Hachulla E, Launay D. Complications maternelles graves des maladies systémiques auto-immunes. Réanimation 2007 ; 16 :393-402
  22. England MJ, Perlmann T, Veriava Y. Dermatomyositis in pregnancy. J Reprod Med 1986;31:633-5.