Understanding and Managing Pregnancy in Patients with Lupus

Table 2

Type of SLE flare during pregnancy, manifestations, risk factor, and conduction.

Type of SLE flare during pregnancy	Manifestations	Risk factor	Management
Mucocutaneous	High inflammatory rash often sparing the nasolabial folds	Anti-Ro/SSA, previous involvement	Topical corticosteroids or oral prednisone, HCQ
Articular	Arthralgia, arthritis, carpal tunnel syndrome (related to pregnancy edema)	Anti-dsDNA positivity	HCQ, NSAID until 28th week, prednisone throughout
Hematological	Cytopenias	aPL, Coombs, previous involvement	Leukopenia: discard drug-related; hemolytic anemia: high dose prednisone and azathioprine; thrombocytopenia: high dose prednisone and azathioprine may use IVIG and rituximab
Renal	Hypertension, edema, proteinuria	aDNA, low C3 and C4 differentiate between APS microangiopathy and preeclampsia, previous involvement	Immunosuppressive treatment with corticosteroids; pulse-methyl prednisolone
CNS	Wide range including depression and psychosis	CNS manifestation provided pregnancy	Antidepressants; pulse-methyl prednisolone
Vascular	Cutaneous vasculitis	Previous involvement	Prednisone and azathioprine

aPL: antiphospholipid antibodies; APS: antiphospholipid syndrome; CNS: central nervous system; HCQ: hydroxychloroquine; IVIG: intravenous immunoglobulin.