Therapeutic Challenges in Systemic Lupus Erythematosus Patient with Pregnancy, Osteoporosis, and Severe Thrombocytopenia: A Case Report and Review of Literature
DOI:
https://doi.org/10.21776/ub.jkb.2021.031.03.6Keywords:
Osteoporosis, pregnancy, systemic lupus erythematosus, thrombocytopeniaAbstract
Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that requires long-term corticosteroid treatment that may lead to osteoporosis characterized by low bone mass and microarchitectural deterioration of the trabecular and cortical skeletal. This study presents a severe case of thrombocytopenia in a 25-year old woman with SLE and osteoporosis who underwent routine therapy and was pregnant for the first time. The complexity of pregnancy and autoimmune conditions create therapeutic challenges that need to be considered in SLE patients with pregnancy, osteoporosis, and severe thrombocytopenia.
Downloads
References
Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis & Rheumatology. 2017; 69(8): 1521-1537.
Perhimpunan Reumatologi Indonesia. Rekomendasi Perhimpunan Reumatologi Indonesia: Diagnosis dan Pengelolaan Lupus Eritematosus Sistemik. Jakarta: Perhimpunan Reumatologi Indonesia; 2019.
Yun KY, Han SE, Kim SC, Joo JK, and Lee KS. Pregnancy-Related Osteoporosis and Spinal Fractures. Obstetrics & Gynecology Science. 2017; 60(1): 133-137.
Levy S, Fayez I, Taguchi, N Han, et al. Pregnancy Outcome Following in Utero Exposure to Bisphosphonates. Bone. 2009; 44(3): 428–430.
Djokanovic N, Klieger-Grossmann C, and Koren G. Does Treatment with Bisphosphonates Endanger the Human Pregnancy? Journal of Obstetrics and Gynaecology Canada. 2008; 30(12): 1146-1148.
Hong N and Yumie Rhee. Comparison of Efficacy of Pharmacologic Treatments in Pregnancy and Lactation-Associated Osteoporosis. Clinical Reviews in Bone and Mineral Metabolism. 2019; 17: 86-93.
Sarıkaya S, Özdolap Ş, Açıkgöz G, and Erdem CZ. Pregnancy-Associated Osteoporosis with Vertebral Fractures and Scoliosis. Joint Bone Spine. 2004; 71(1): 84–85.
Allali F, Guedirra N, and Hajjaj-Hassouni N. A Case of Post-Pregnancy Osteoporosis-Related Spinal Fractures in Association with Ankylosing Spondylitis. Clinical Rheumatology. 2005; 24(4): 435–436.
Grizzo FMF, da Silva Martins J, Pinheiro MM, Jorgetti V, Carvalho MDB, and Pelloso SM. Pregnancy and Lactation-Associated Osteoporosis: Bone Histomorphometric Analysis and Response to Treatment with Zoledronic Acid. Calcified Tissue International. 2015; 97(4): 421-425.
Zhang M, Chen P, Li B, Du J, Pan T, and Chen J. Approach to the Patient with Pregnancy and Lactation-Associated Osteoporosis: A Case Report and a Review of the Literature. Medicine (Baltimore). 2017; 96(46): e8671.
Polat SB, Evranos B, Aydin C, Cuhaci N, Ersoy R, and Cakir B. Treatment of Severe Pregnancy and Lactation-Related Osteoporosis with Teriparatide: Case Report and Review of the Literature. Gynecological Endocrinology. 2015; 31(7): 522-525.
Ijuin A, Yoshikata H, Asano R, Tsuburai T, Kikuchi R, and Sakakibara H. Teriparatide And Denosumab Treatment For Pregnancy And Lactation-Associated Osteoporosis With Multiple Vertebral Fractures: A Case Study. Taiwanese Jjournal of Obstetrics & Gynecology. 2017; 56(6): 863-866.
Winarno A, Kyvernitakis I, and Hadji P. Successful Treatment of 1-34 Parathyroid Hormone (PTH) after Failure of Bisphosphonate Therapy in a Complex Case of Pregnancy Associated Osteoporosis and Multiple Fractures. Zeitschrift Für Geburtshilfe Und Neonatologie. 2014; 218(4): 171–173.
Pickar JH, MacNeil T, and Ohleth K. SERMs: Progress and Future Perspectives. Maturitas. 2010; 67(2): 129-138.
McClung MR. Romosozumab for the Treatment of Osteoporosis. Osteoporosis and Sarcopenia. 2018; 4(1); 11–15.
World Health Organization. Guideline: Vitamin D Supplementation in Pregnant Women. Geneva: World Health Organization; 2012.
Royal College of Obstetricians and Gynaecologists. Vitamin D in Pregnancy. London: Scientific Impact Paper No. 43 June 2014; 2014; p. 1-11
Sanz-Salvador L, Ãngel GarcÃa-Pérez M, TarÃn JJ, and Cano A. Bone Metabolic Changes during Pregnancy: A Period of Vulnerability to Osteoporosis and Fracture. European Journal of Endocrinology. 2015; 172(2): R53–R65.
Caprio M, Infante M, Calanchini M, Mammi C, and Fabbri A. Vitamin D: Not Just the Bone. Evidence for Beneficial Pleiotropic Extraskeletal Effects. Eating and Weight Disorder. 2017; 22(1): 27–41.
De-Regil LM, Palacios C, Ansary A, Kulier R, and Peña-Rosas JP. Vitamin D Supplementation for Women during Pregnancy. The Cochrane Database of Systematic Reviews. 2013; 2: 1-55.
Saputra BA, Rodiani, and Puspita RD. Kehamilan dengan Trombositopenia. Medula. 2018; 8(1): 94-101.
Ciobanu AM, Colibaba S, Cimpoca B, Peltecu G, and Panaitescu AM. Thrombocytopenia in Pregnancy. MAEDICA-Journal of Clinical Medicine. 2016; 11(1): 55-60.
Lubis AM, Sudoyo AW, Effendy S, TB Djumhana, and Harimurti K. Hubungan Antibodi Anti Trombosit terhadap Respon Transfusi Trombosit pada Pasien Hemato-Onkologi yang Mendapatkan Multitransfusi Trombosit di RS Dr. Cipto Mangunkusomo. Jurnal Penyakit Dalam Indonesia. 2015; 2(4): 1-8
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).