New medical evidence suggests that women with the autoimmune diseases lupus and antiphospholipid syndrome (APS) may be at risk of reduced fertility and pregnancy complications.
Many people are familiar with lupus, the chronic autoimmune disease in which the body’s immune system attacks normal, healthy tissues. Antiphospholipid syndrome or APS is not as recognized among the general population. Antiphospholipid syndrome, often referred to as Hughes syndrome, is an immune condition that leads to an increased risk of blood clots. This could mean blood clots in the legs, in the arteries leading to the heart, or blood clots in the brain.
Women with lupus and APS at risk of reduced fertility, pregnancy complications
For reasons unknown, both lupus and antiphospholipid syndrome tend to affect more women than men. Normally, these conditions strike in women’s fertile years, leaving them open to pregnancy complications. An antiphospholipid syndrome pregnancy can cause pre-eclampsia, fetal growth problems, as well as fetal loss.
The European League Against Rheumatism (EULAR) has developed recommendations for women with lupus and antiphospholipid syndrome who are planning on getting pregnant. They say they should be counseled and managed after a risk assessment that takes into consideration disease activity and medication use.
Here are some of the other suggestions from the EULAR:
- Disease activity and special monitoring tests should be used to check for adverse outcomes and disease flares during pregnancy.
- Contraceptive measures should be used by lupus and APS patients based on disease activity and presence of APS antibodies.
- Fertility preservation methods should be considered prior to the use of alkylating agents.
- Assisted reproduction techniques can be used with inactive or stable disease as long as measures are offered to limit the risk of flare-ups.
Antiphospholipid syndrome causes and symptoms
Antiphospholipid syndrome causes are still under investigation, but here is what we do know. When you have APS, your body produces antibodies against proteins that bind a type of fat (phospholipids) that is present in your blood and plays an important role in clotting. When antibodies attack your binding proteins, your blood can clot.
People can get primary antiphospholipid syndrome or Hughes syndrome, which means there is no underlying reason for the condition, such as an autoimmune disease. Then there is secondary antiphospholipid syndrome, which means the APS is an underlying condition of lupus, perhaps, or some other autoimmune disease. It could also be due to infections, such as HIV, Hepatitis C, or Lyme disease. Some medications, including those for high blood pressure and irregular heartbeat, have been known to increase the risk of APS. Although no solid evidence exists that antiphospholipid syndrome is hereditary, some research suggests that relatives of people with the syndrome are more likely to have the antibodies.
Antiphospholipid syndrome symptoms can vary person to person, but the most common signs are blood clots in the legs, blood clots in the arms, stroke, miscarriage, stillbirth, high blood pressure during pregnancy, and premature delivery. In some cases, people experience neurological problems, such as chronic, severe headaches or a rash. In other cases, bleeding can occur from the nose or gums.
Antiphospholipid syndrome (APS) treatment and diagnosis
Antiphopholipid syndrome treatment focuses on reducing the chances of more blood clots. In most instances, anticoagulants are prescribed. Anticoagulants basically interrupt the process that creates blood clots. They are sometimes referred to as “blood thinners”. Antiplatelet medications work much the same as anticoagulants and are also prescribed to APS patients.
If you are pregnant, treatment will likely be different. Many of the traditional medications used to treat the syndrome could be harmful to the fetus, so other therapies will be applied. Some doctors prescribe a daily dose of aspirin. Others suggest an injectable blood thinner, called heparin. The approach all depends on whether or not you have a history of blood clots.
Blood clots can be serious, so a diagnosis of antiphospholipid syndrome is important. If APS is suspected, blood tests along with a medical assessment can likely detect it. The blood test will look for the antibodies responsible for the formation of blood clots. If a first blood test is positive for APS antibodies, normally, a second blood test will be taken just to confirm that the antibodies are still present. The doctor will then go over medical history to determine if you have any related symptoms, which could include unexplained miscarriages.
Many people with APS appear perfectly fine, but the truth is, it is a life-long syndrome and requires life-long treatment. It is important to maintain routine check-ups with a doctor if you have anitphospholipid syndrome. It is also important to have support from family, friends, and outside resources.
The APS Foundation of America set up a place on the Internet for people with the syndrome to share experiences and information about the chronic disease. If you suffer from APS, you can reach out to others just like you through the following link: http://www.apsforum.com
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