Pinal-Fernandez Iago, Selva-O'Callaghan Albert, Fernandez-Codina Andreu, Martinez-Gomez Xavier, Rodrigo-Pendas Jose, Perez-Lopez Jordi, Vilardell-Tarres Miquel
Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Vall d׳Hebron University Hospital, Barcelona, Spain.
Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Vall d׳Hebron University Hospital, Barcelona, Spain.
Semin Arthritis Rheum. 2014 Oct;44(2):234-40. doi: 10.1016/j.semarthrit.2014.05.004. Epub 2014 May 9.
Idiopathic inflammatory myopathies (IIM) are systemic diseases, characterized by the presence of an inflammatory muscle infiltrate. Although more frequent in women, its relationship with pregnancy has not been extensively studied. Our goal was to analyze the interaction between pregnancy and myositis in a cohort of IIM women from a single center.
A total of 51 patients from a historical cohort of IIM diagnosed between 1983 and 2013 were interviewed with a specific questionnaire. Comparisons between pregnancies occurring before and after the onset of the disease were performed using generalized mixed-effect models with normal and binomial distributions adjusted for confounding factors and clustering.
A total of 102 pregnancies from 51 patients (41 with dermatomyositis and 10 with polymyositis) were analyzed. A total of 14 pregnancies from 8 patients occurred after disease onset; statistically significant (p = 0.02) clinical improvement during gestation was evident in 7 pregnancies (4 patients), 5 of them (from 2 patients) experienced a relapse of IIM symptoms afterwards, while in the rest, there was no influence of pregnancy on the disease. No disease flare associated with pregnancy was observed. Two patients were diagnosed within the first 6 months after delivery and none during pregnancy. No evidence was found to support pregnancy as a trigger for myopathy (p = 0.71).
Pregnancy does not seem to carry a worse prognosis for the mother nor for the fetus in patients with IIM; on the contrary, nearly half of the patients in our series improved clinically when they became pregnant, a relapse of IIM symptoms being common afterwards. Pregnancy does not appear to be a trigger for IIM.
特发性炎性肌病（IIM）是一种全身性疾病，其特征为存在炎性肌肉浸润。尽管在女性中更为常见，但其与妊娠的关系尚未得到广泛研究。我们的目标是分析来自单一中心的一组IIM女性患者中妊娠与肌炎之间的相互作用。
对1983年至2013年间确诊的IIM历史队列中的51名患者进行了特定问卷调查。使用广义混合效应模型对疾病发作前后发生的妊娠进行比较，该模型采用正态分布和二项分布，并对混杂因素和聚类进行了调整。
共分析了51名患者的102次妊娠（41例皮肌炎和10例多发性肌炎）。8名患者的14次妊娠发生在疾病发作后；7次妊娠（4例患者）在妊娠期间有明显的统计学显著（p = 0.02）临床改善，其中5次（来自2例患者）之后出现了IIM症状复发，而其余患者中，妊娠对疾病没有影响。未观察到与妊娠相关的疾病发作。两名患者在分娩后的前6个月内被诊断出，妊娠期间无人被诊断出。没有证据支持妊娠是肌病的触发因素（p = 0.71）。
对于IIM患者，妊娠似乎对母亲和胎儿都没有更差的预后；相反，在我们的系列中，近一半的患者在怀孕时临床症状改善，之后IIM症状复发很常见。妊娠似乎不是IIM的触发因素。
