Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia
Identifieur interne : 000476 ( Pmc/Checkpoint ); précédent : 000475; suivant : 000477Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia
Auteurs : Syahrul Sazliyana Shaharir [Malaisie] ; Mohd Shahrir Mohamed Said [Malaisie] ; Rozita Mohd [Malaisie] ; Rizna Abdul Cader [Malaisie] ; Ruslinda Mustafar [Malaisie] ; Rahana Abdul Rahman [Malaisie]Source :
- PLoS ONE [ 1932-6203 ] ; 2019.
Abstract
Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.
Url:
DOI: 10.1371/journal.pone.0222343
PubMed: 31539383
PubMed Central: 6754159
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last="Mohamed Said">Mohd Shahrir Mohamed Said</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Mohd, Rozita" sort="Mohd, Rozita" uniqKey="Mohd R" first="Rozita" last="Mohd">Rozita Mohd</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Nephrology Unit, 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wicri:step="Checkpoint">000476</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia</title><author><name sortKey="Shaharir, Syahrul Sazliyana" sort="Shaharir, Syahrul Sazliyana" uniqKey="Shaharir S" first="Syahrul Sazliyana" last="Shaharir">Syahrul Sazliyana Shaharir</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Mohamed Said, Mohd Shahrir" sort="Mohamed Said, Mohd Shahrir" uniqKey="Mohamed Said M" first="Mohd Shahrir" last="Mohamed Said">Mohd Shahrir Mohamed Said</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Mohd, Rozita" sort="Mohd, Rozita" uniqKey="Mohd R" first="Rozita" last="Mohd">Rozita Mohd</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Abdul Cader, Rizna" sort="Abdul Cader, Rizna" uniqKey="Abdul Cader R" first="Rizna" last="Abdul Cader">Rizna Abdul Cader</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Mustafar, Ruslinda" sort="Mustafar, Ruslinda" uniqKey="Mustafar R" first="Ruslinda" last="Mustafar">Ruslinda Mustafar</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Abdul Rahman, Rahana" sort="Abdul Rahman, Rahana" uniqKey="Abdul Rahman R" first="Rahana" last="Abdul Rahman">Rahana Abdul Rahman</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Uramoto, Km" uniqKey="Uramoto K">KM Uramoto</name></author><author><name sortKey="Michet, Cj" uniqKey="Michet C">CJ Michet</name></author><author><name sortKey="Thumboo, J" uniqKey="Thumboo J">J Thumboo</name></author><author><name sortKey="Sunku, J" uniqKey="Sunku J">J Sunku</name></author><author><name sortKey="O Fallon, Wm" uniqKey="O Fallon W">WM O'Fallon</name></author><author><name sortKey="Gabriel, Se" uniqKey="Gabriel S">SE Gabriel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsokos, Gc" uniqKey="Tsokos G">GC Tsokos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Manson, Jj" uniqKey="Manson J">JJ Manson</name></author><author><name sortKey="Rahman, A" uniqKey="Rahman A">A Rahman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey=" Stensen, M" uniqKey=" Stensen M">M. Østensen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cervera, R" uniqKey="Cervera R">R Cervera</name></author><author><name sortKey="Font, J" uniqKey="Font J">J Font</name></author><author><name sortKey="Carmona, F" uniqKey="Carmona F">F Carmona</name></author><author><name sortKey="Balasch, J" uniqKey="Balasch J">J Balasch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wong, Kl" uniqKey="Wong K">KL Wong</name></author><author><name sortKey="Chan, Fy" uniqKey="Chan F">FY Chan</name></author><author><name sortKey="Lee, Cp" uniqKey="Lee C">CP Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author><author><name sortKey="Howard, D" uniqKey="Howard D">D Howard</name></author><author><name sortKey="Repke, J" uniqKey="Repke J">J Repke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruiz Irastorza, G" uniqKey="Ruiz Irastorza G">G Ruiz-Irastorza</name></author><author><name sortKey="Lima, F" uniqKey="Lima F">F Lima</name></author><author><name sortKey="Alves, J" uniqKey="Alves J">J Alves</name></author><author><name sortKey="Khamashta, Ma" uniqKey="Khamashta M">MA Khamashta</name></author><author><name sortKey="Simpson, J" uniqKey="Simpson J">J Simpson</name></author><author><name sortKey="Hughes, Gr" uniqKey="Hughes G">GR Hughes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clowse, Me" uniqKey="Clowse M">ME Clowse</name></author><author><name sortKey="Magder, Ls" uniqKey="Magder L">LS Magder</name></author><author><name sortKey="Witter, F" uniqKey="Witter F">F Witter</name></author><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nossent, Hc" uniqKey="Nossent H">HC Nossent</name></author><author><name sortKey="Swaak, Tj" uniqKey="Swaak T">TJ Swaak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tincani, A" uniqKey="Tincani A">A Tincani</name></author><author><name sortKey="Faden, D" uniqKey="Faden D">D Faden</name></author><author><name sortKey="Tarantini, M" uniqKey="Tarantini M">M Tarantini</name></author><author><name sortKey="Lojacono, A" uniqKey="Lojacono A">A Lojacono</name></author><author><name sortKey="Tanzi, P" uniqKey="Tanzi P">P Tanzi</name></author><author><name sortKey="Gastaldi, A" uniqKey="Gastaldi A">A Gastaldi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Georgiou, Pe" uniqKey="Georgiou P">PE Georgiou</name></author><author><name sortKey="Politi, En" uniqKey="Politi E">EN Politi</name></author><author><name sortKey="Katsimbri, P" uniqKey="Katsimbri P">P Katsimbri</name></author><author><name sortKey="Sakka, V" uniqKey="Sakka V">V Sakka</name></author><author><name sortKey="Drosos, Aa" uniqKey="Drosos A">AA Drosos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lima, F" uniqKey="Lima F">F Lima</name></author><author><name sortKey="Buchanan, Nm" uniqKey="Buchanan N">NM Buchanan</name></author><author><name sortKey="Khamashta, Ma" uniqKey="Khamashta M">MA Khamashta</name></author><author><name sortKey="Kerslake, S" uniqKey="Kerslake S">S Kerslake</name></author><author><name sortKey="Hughes, Gr" uniqKey="Hughes G">GR Hughes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carmona, F" uniqKey="Carmona F">F Carmona</name></author><author><name sortKey="Font, J" uniqKey="Font J">J Font</name></author><author><name sortKey="Cervera, R" uniqKey="Cervera R">R Cervera</name></author><author><name sortKey="Munoz, F" uniqKey="Munoz F">F Munoz</name></author><author><name sortKey="Cararach, V" uniqKey="Cararach V">V Cararach</name></author><author><name sortKey="Balasch, J" uniqKey="Balasch J">J Balasch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mintz, G" uniqKey="Mintz G">G Mintz</name></author><author><name sortKey="Niz, J" uniqKey="Niz J">J Niz</name></author><author><name sortKey="Gutierrez, G" uniqKey="Gutierrez G">G Gutierrez</name></author><author><name sortKey="Garcia Alonso, A" uniqKey="Garcia Alonso A">A Garcia-Alonso</name></author><author><name sortKey="Karchmer, S" uniqKey="Karchmer S">S Karchmer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baer, An" uniqKey="Baer A">AN Baer</name></author><author><name sortKey="Witter, Fr" uniqKey="Witter F">FR Witter</name></author><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Andrade, Rm" uniqKey="Andrade R">RM Andrade</name></author><author><name sortKey="Mcgwin, G" uniqKey="Mcgwin G">G McGwin</name></author><author><name sortKey="Alarcon, Gs" uniqKey="Alarcon G">GS Alarcon</name></author><author><name sortKey="Sanchez, Ml" uniqKey="Sanchez M">ML Sanchez</name></author><author><name sortKey="Bertoli, Am" uniqKey="Bertoli A">AM Bertoli</name></author><author><name sortKey="Fernandez, M" uniqKey="Fernandez M">M Fernandez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruiz Irastorza, G" uniqKey="Ruiz Irastorza G">G Ruiz-Irastorza</name></author><author><name sortKey="Khamashta, Ma" uniqKey="Khamashta M">MA Khamashta</name></author><author><name sortKey="Gordon, C" uniqKey="Gordon C">C Gordon</name></author><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author><author><name sortKey="Johns, Kr" uniqKey="Johns K">KR Johns</name></author><author><name sortKey="Sammaritano, L" uniqKey="Sammaritano L">L Sammaritano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buyon, Jp" uniqKey="Buyon J">JP Buyon</name></author><author><name sortKey="Kalunian, Kc" uniqKey="Kalunian K">KC Kalunian</name></author><author><name sortKey="Ramsey Goldman, R" uniqKey="Ramsey Goldman R">R Ramsey-Goldman</name></author><author><name sortKey="Petri, Ma" uniqKey="Petri M">MA Petri</name></author><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author><author><name sortKey="Ruiz Irastorza, G" uniqKey="Ruiz Irastorza G">G Ruiz-Irastorza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lateef, A" uniqKey="Lateef A">A Lateef</name></author><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carvalheiras, G" uniqKey="Carvalheiras G">G Carvalheiras</name></author><author><name sortKey="Vita, P" uniqKey="Vita P">P Vita</name></author><author><name sortKey="Marta, S" uniqKey="Marta S">S Marta</name></author><author><name sortKey="Trovao, R" uniqKey="Trovao R">R Trovão</name></author><author><name sortKey="Farinha, F" uniqKey="Farinha F">F Farinha</name></author><author><name sortKey="Braga, J" uniqKey="Braga J">J Braga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shaharir, Ss" uniqKey="Shaharir S">SS Shaharir</name></author><author><name sortKey="Hussein, H" uniqKey="Hussein H">H Hussein</name></author><author><name sortKey="Rajalingham, S" uniqKey="Rajalingham S">S Rajalingham</name></author><author><name sortKey="Mohamed Said, Ms" uniqKey="Mohamed Said M">MS Mohamed Said</name></author><author><name sortKey="Abdul Gafor, Ah" uniqKey="Abdul Gafor A">AH Abdul Gafor</name></author><author><name sortKey="Mohd, R" uniqKey="Mohd R">R Mohd</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yap, Dyh" uniqKey="Yap D">DYH Yap</name></author><author><name sortKey="Chan, Tm" uniqKey="Chan T">TM Chan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, D" uniqKey="Chen D">D Chen</name></author><author><name sortKey="Lao, M" uniqKey="Lao M">M Lao</name></author><author><name sortKey="Zhang, J" uniqKey="Zhang J">J Zhang</name></author><author><name sortKey="Zhan, Y" uniqKey="Zhan Y">Y Zhan</name></author><author><name sortKey="Li, W" uniqKey="Li W">W Li</name></author><author><name sortKey="Cai, X" uniqKey="Cai X">X Cai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhan, Z" uniqKey="Zhan Z">Z Zhan</name></author><author><name sortKey="Yang, Y" uniqKey="Yang Y">Y Yang</name></author><author><name sortKey="Zhan, Y" uniqKey="Zhan Y">Y Zhan</name></author><author><name sortKey="Chen, D" uniqKey="Chen D">D Chen</name></author><author><name sortKey="Liang, L" uniqKey="Liang L">L Liang</name></author><author><name sortKey="Yang, X" uniqKey="Yang X">X Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ku, M" uniqKey="Ku M">M Ku</name></author><author><name sortKey="Guo, S" uniqKey="Guo S">S Guo</name></author><author><name sortKey="Shang, W" uniqKey="Shang W">W Shang</name></author><author><name sortKey="Li, Q" uniqKey="Li Q">Q Li</name></author><author><name sortKey="Zeng, R" uniqKey="Zeng R">R Zeng</name></author><author><name sortKey="Han, M" uniqKey="Han M">M Han</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wu, J" uniqKey="Wu J">J Wu</name></author><author><name sortKey="Ma, J" uniqKey="Ma J">J Ma</name></author><author><name sortKey="Bao, C" uniqKey="Bao C">C Bao</name></author><author><name sortKey="Di, W" uniqKey="Di W">W Di</name></author><author><name sortKey="Zhang, W H" uniqKey="Zhang W">W-H Zhang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yang, Mj" uniqKey="Yang M">MJ Yang</name></author><author><name sortKey="Chen, Cy" uniqKey="Chen C">CY Chen</name></author><author><name sortKey="Chang, Wh" uniqKey="Chang W">WH Chang</name></author><author><name sortKey="Tseng, Jy" uniqKey="Tseng J">JY Tseng</name></author><author><name sortKey="Yeh, Cc" uniqKey="Yeh C">CC Yeh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yang, H" uniqKey="Yang H">H Yang</name></author><author><name sortKey="Liu, H" uniqKey="Liu H">H Liu</name></author><author><name sortKey="Xu, D" uniqKey="Xu D">D Xu</name></author><author><name sortKey="Zhao, L" uniqKey="Zhao L">L Zhao</name></author><author><name sortKey="Wang, Q" uniqKey="Wang Q">Q Wang</name></author><author><name sortKey="Leng, X" uniqKey="Leng X">X Leng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ko, Hs" uniqKey="Ko H">HS Ko</name></author><author><name sortKey="Ahn, Hy" uniqKey="Ahn H">HY Ahn</name></author><author><name sortKey="Jang, Dg" uniqKey="Jang D">DG Jang</name></author><author><name sortKey="Choi, S K" uniqKey="Choi S">S-K Choi</name></author><author><name sortKey="Park, Y G" uniqKey="Park Y">Y-G Park</name></author><author><name sortKey="Park, Iy" uniqKey="Park I">IY Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hochberg, Mc" uniqKey="Hochberg M">MC Hochberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author><author><name sortKey="Orbai, Am" uniqKey="Orbai A">AM Orbai</name></author><author><name sortKey="Alarcon, Gs" uniqKey="Alarcon G">GS Alarcon</name></author><author><name sortKey="Gordon, C" uniqKey="Gordon C">C Gordon</name></author><author><name sortKey="Merrill, Jt" uniqKey="Merrill J">JT Merrill</name></author><author><name sortKey="Fortin, Pr" uniqKey="Fortin P">PR Fortin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tan, Em" uniqKey="Tan E">EM Tan</name></author><author><name sortKey="Cohen, As" uniqKey="Cohen A">AS Cohen</name></author><author><name sortKey="Fries, Jf" uniqKey="Fries J">JF Fries</name></author><author><name sortKey="Masi, At" uniqKey="Masi A">AT Masi</name></author><author><name sortKey="Mcshane, Dj" uniqKey="Mcshane D">DJ McShane</name></author><author><name sortKey="Rothfield, Nf" uniqKey="Rothfield N">NF Rothfield</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miyakis, S" uniqKey="Miyakis S">S Miyakis</name></author><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author><author><name sortKey="Atsumi, T" uniqKey="Atsumi T">T Atsumi</name></author><author><name sortKey="Branch, Dw" uniqKey="Branch D">DW Branch</name></author><author><name sortKey="Brey, Rl" uniqKey="Brey R">RL Brey</name></author><author><name sortKey="Cervera, R" uniqKey="Cervera R">R Cervera</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author><author><name sortKey="Genovese, M" uniqKey="Genovese M">M Genovese</name></author><author><name sortKey="Engle, E" uniqKey="Engle E">E Engle</name></author><author><name sortKey="Hochberg, M" uniqKey="Hochberg M">M Hochberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Medina Qui Ones, Cv" uniqKey="Medina Qui Ones C">CV Medina-Quiñones</name></author><author><name sortKey="Ramos Merino, L" uniqKey="Ramos Merino L">L Ramos-Merino</name></author><author><name sortKey="Ruiz Sada, P" uniqKey="Ruiz Sada P">P Ruiz-Sada</name></author><author><name sortKey="Isenberg, D" uniqKey="Isenberg D">D Isenberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Ye" uniqKey="Chen Y">YE Chen</name></author><author><name sortKey="Korbet, Sm" uniqKey="Korbet S">SM Korbet</name></author><author><name sortKey="Katz, Rs" uniqKey="Katz R">RS Katz</name></author><author><name sortKey="Schwartz, Mm" uniqKey="Schwartz M">MM Schwartz</name></author><author><name sortKey="Lewis, Ej" uniqKey="Lewis E">EJ Lewis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruperto, N" uniqKey="Ruperto N">N Ruperto</name></author><author><name sortKey="Hanrahan, Lm" uniqKey="Hanrahan L">LM Hanrahan</name></author><author><name sortKey="Alarcon, Gs" uniqKey="Alarcon G">GS Alarcon</name></author><author><name sortKey="Belmont, Hm" uniqKey="Belmont H">HM Belmont</name></author><author><name sortKey="Brey, Rl" uniqKey="Brey R">RL Brey</name></author><author><name sortKey="Brunetta, P" uniqKey="Brunetta P">P Brunetta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clowse, Me" uniqKey="Clowse M">ME Clowse</name></author><author><name sortKey="Magder, L" uniqKey="Magder L">L Magder</name></author><author><name sortKey="Witter, F" uniqKey="Witter F">F Witter</name></author><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eudy, A" uniqKey="Eudy A">A Eudy</name></author><author><name sortKey="Siega Riz, Am" uniqKey="Siega Riz A">AM Siega-Riz</name></author><author><name sortKey="Engel, S" uniqKey="Engel S">S Engel</name></author><author><name sortKey="Franceschini, N" uniqKey="Franceschini N">N Franceschini</name></author><author><name sortKey="Howard, Ag" uniqKey="Howard A">AG Howard</name></author><author><name sortKey="Clowse, M" uniqKey="Clowse M">M Clowse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clowse, Me" uniqKey="Clowse M">ME Clowse</name></author><author><name sortKey="Magder, Ls" uniqKey="Magder L">LS Magder</name></author><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clowse, Meb" uniqKey="Clowse M">MEB Clowse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ateka Barrutia, O" uniqKey="Ateka Barrutia O">O Ateka-Barrutia</name></author><author><name sortKey="Nelson Piercy, C" uniqKey="Nelson Piercy C">C Nelson-Piercy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moroni, G" uniqKey="Moroni G">G Moroni</name></author><author><name sortKey="Quaglini, S" uniqKey="Quaglini S">S Quaglini</name></author><author><name sortKey="Banfi, G" uniqKey="Banfi G">G Banfi</name></author><author><name sortKey="Caloni, M" uniqKey="Caloni M">M Caloni</name></author><author><name sortKey="Finazzi, S" uniqKey="Finazzi S">S Finazzi</name></author><author><name sortKey="Ambroso, G" uniqKey="Ambroso G">G Ambroso</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carvalheiras, G" uniqKey="Carvalheiras G">G Carvalheiras</name></author><author><name sortKey="Vita, P" uniqKey="Vita P">P Vita</name></author><author><name sortKey="Marta, S" uniqKey="Marta S">S Marta</name></author><author><name sortKey="Trovao, R" uniqKey="Trovao R">R Trovao</name></author><author><name sortKey="Farinha, F" uniqKey="Farinha F">F Farinha</name></author><author><name sortKey="Braga, J" uniqKey="Braga J">J Braga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buyon, Jp" uniqKey="Buyon J">JP Buyon</name></author><author><name sortKey="Kim, My" uniqKey="Kim M">MY Kim</name></author><author><name sortKey="Guerra, Mm" uniqKey="Guerra M">MM Guerra</name></author><author><name sortKey="Laskin, Ca" uniqKey="Laskin C">CA Laskin</name></author><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Teh, Cl" uniqKey="Teh C">CL Teh</name></author><author><name sortKey="Wan, Sa" uniqKey="Wan S">SA Wan</name></author><author><name sortKey="Cheong, Yk" uniqKey="Cheong Y">YK Cheong</name></author><author><name sortKey="Ling, Gr" uniqKey="Ling G">GR Ling</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Bandt, M" uniqKey="De Bandt M">M De Bandt</name></author><author><name sortKey="Palazzo, E" uniqKey="Palazzo E">E Palazzo</name></author><author><name sortKey="Belmatoug, N" uniqKey="Belmatoug N">N Belmatoug</name></author><author><name sortKey="M Bappe, P" uniqKey="M Bappe P">P M'Bappe</name></author><author><name sortKey="Hayem, G" uniqKey="Hayem G">G Hayem</name></author><author><name sortKey="Kahn, Mf" uniqKey="Kahn M">MF Kahn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kobayashi, N" uniqKey="Kobayashi N">N Kobayashi</name></author><author><name sortKey="Yamada, H" uniqKey="Yamada H">H Yamada</name></author><author><name sortKey="Kishida, T" uniqKey="Kishida T">T Kishida</name></author><author><name sortKey="Kato, Eh" uniqKey="Kato E">EH Kato</name></author><author><name sortKey="Ebina, Y" uniqKey="Ebina Y">Y Ebina</name></author><author><name sortKey="Sakuragi, N" uniqKey="Sakuragi N">N Sakuragi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mokbel Amg, A" uniqKey="Mokbel Amg A">A. Mokbel AMG</name></author><author><name sortKey="Aboelgheit, S" uniqKey="Aboelgheit S">S. AboElgheit</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Urowitz, Mb" uniqKey="Urowitz M">MB Urowitz</name></author><author><name sortKey="Gladman, Dd" uniqKey="Gladman D">DD Gladman</name></author><author><name sortKey="Farewell, Vt" uniqKey="Farewell V">VT Farewell</name></author><author><name sortKey="Stewart, J" uniqKey="Stewart J">J Stewart</name></author><author><name sortKey="Mcdonald, J" uniqKey="Mcdonald J">J McDonald</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chakravarty, Ef" uniqKey="Chakravarty E">EF Chakravarty</name></author><author><name sortKey="Col N, I" uniqKey="Col N I">I Colón</name></author><author><name sortKey="Langen, Es" uniqKey="Langen E">ES Langen</name></author><author><name sortKey="Nix, Da" uniqKey="Nix D">DA Nix</name></author><author><name sortKey="El Sayed, Yy" uniqKey="El Sayed Y">YY El-Sayed</name></author><author><name sortKey="Genovese, Mc" uniqKey="Genovese M">MC Genovese</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moroni, G" uniqKey="Moroni G">G Moroni</name></author><author><name sortKey="Quaglini, S" uniqKey="Quaglini S">S Quaglini</name></author><author><name sortKey="Banfi, G" uniqKey="Banfi G">G Banfi</name></author><author><name sortKey="Caloni, M" uniqKey="Caloni M">M Caloni</name></author><author><name sortKey="Finazzi, S" uniqKey="Finazzi S">S Finazzi</name></author><author><name sortKey="Ambroso, G" uniqKey="Ambroso G">G Ambroso</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saavedra, Ma" uniqKey="Saavedra M">MA Saavedra</name></author><author><name sortKey="Sanchez, A" uniqKey="Sanchez A">A Sánchez</name></author><author><name sortKey="Morales, S" uniqKey="Morales S">S Morales</name></author><author><name sortKey="Navarro Zarza, Je" uniqKey="Navarro Zarza J">JE Navarro-Zarza</name></author><author><name sortKey="Angeles, U" uniqKey="Angeles U">U Ángeles</name></author><author><name sortKey="Jara, Lj" uniqKey="Jara L">LJ Jara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ku, M" uniqKey="Ku M">M Ku</name></author><author><name sortKey="Guo, S" uniqKey="Guo S">S Guo</name></author><author><name sortKey="Shang, W" uniqKey="Shang W">W Shang</name></author><author><name sortKey="Li, Q" uniqKey="Li Q">Q Li</name></author><author><name sortKey="Zeng, R" uniqKey="Zeng R">R Zeng</name></author><author><name sortKey="Han, M" uniqKey="Han M">M Han</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hussein Aly, Ea" uniqKey="Hussein Aly E">EA Hussein Aly</name></author><author><name sortKey="Mohamed Riyad, R" uniqKey="Mohamed Riyad R">R Mohamed Riyad</name></author><author><name sortKey="Nabil Mokbel, A" uniqKey="Nabil Mokbel A">A Nabil Mokbel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tandon, A" uniqKey="Tandon A">A Tandon</name></author><author><name sortKey="Ibanez, D" uniqKey="Ibanez D">D Ibanez</name></author><author><name sortKey="Gladman, Dd" uniqKey="Gladman D">DD Gladman</name></author><author><name sortKey="Urowitz, Mb" uniqKey="Urowitz M">MB Urowitz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Petri, M" uniqKey="Petri M">M. Petri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carmona, F" uniqKey="Carmona F">F Carmona</name></author><author><name sortKey="Font, J" uniqKey="Font J">J Font</name></author><author><name sortKey="Cervera, R" uniqKey="Cervera R">R Cervera</name></author><author><name sortKey="Mu Oz, F" uniqKey="Mu Oz F">F Muñoz</name></author><author><name sortKey="Cararach, V" uniqKey="Cararach V">V Cararach</name></author><author><name sortKey="Balasch, J" uniqKey="Balasch J">J Balasch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levy, Ra" uniqKey="Levy R">RA Levy</name></author><author><name sortKey="Vilela, Vs" uniqKey="Vilela V">VS Vilela</name></author><author><name sortKey="Cataldo, Mj" uniqKey="Cataldo M">MJ Cataldo</name></author><author><name sortKey="Ramos, Rc" uniqKey="Ramos R">RC Ramos</name></author><author><name sortKey="Duarte, Jl" uniqKey="Duarte J">JL Duarte</name></author><author><name sortKey="Tura, Br" uniqKey="Tura B">BR Tura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cortes Hernandez, J" uniqKey="Cortes Hernandez J">J Cortes-Hernandez</name></author><author><name sortKey="Ordi Ros, J" uniqKey="Ordi Ros J">J Ordi-Ros</name></author><author><name sortKey="Paredes, F" uniqKey="Paredes F">F Paredes</name></author><author><name sortKey="Casellas, M" uniqKey="Casellas M">M Casellas</name></author><author><name sortKey="Castillo, F" uniqKey="Castillo F">F Castillo</name></author><author><name sortKey="Vilardell Tarres, M" uniqKey="Vilardell Tarres M">M Vilardell-Tarres</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mohd Yusoff, Z" uniqKey="Mohd Yusoff Z">Z Mohd Yusoff</name></author><author><name sortKey="Amat, A" uniqKey="Amat A">A Amat</name></author><author><name sortKey="Naim, D" uniqKey="Naim D">D Naim</name></author><author><name sortKey="Othman, S" uniqKey="Othman S">S Othman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jamal, J A Gza" uniqKey="Jamal J">J.A. GZA Jamal</name></author><author><name sortKey="Husain, K" uniqKey="Husain K">K Husain</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lewis, Mj" uniqKey="Lewis M">MJ Lewis</name></author><author><name sortKey="Jawad, As" uniqKey="Jawad A">AS Jawad</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruiz Irastorza, G" uniqKey="Ruiz Irastorza G">G Ruiz-Irastorza</name></author><author><name sortKey="Khamashta, Ma" uniqKey="Khamashta M">MA Khamashta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lima, F" uniqKey="Lima F">F Lima</name></author><author><name sortKey="Buchanan, Nmm" uniqKey="Buchanan N">NMM Buchanan</name></author><author><name sortKey="Khamashta, Ma" uniqKey="Khamashta M">MA Khamashta</name></author><author><name sortKey="Kerslake, S" uniqKey="Kerslake S">S Kerslake</name></author><author><name sortKey="Hughes, Grv" uniqKey="Hughes G">GRV Hughes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chakravarty, Ef" uniqKey="Chakravarty E">EF Chakravarty</name></author><author><name sortKey="Col N, I" uniqKey="Col N I">I Colón</name></author><author><name sortKey="Langen, Es" uniqKey="Langen E">ES Langen</name></author><author><name sortKey="Nix, Da" uniqKey="Nix D">DA Nix</name></author><author><name sortKey="El Sayed, Yy" uniqKey="El Sayed Y">YY El-Sayed</name></author><author><name sortKey="Genovese, Mc" uniqKey="Genovese M">MC Genovese</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buyon, Jp" uniqKey="Buyon J">JP Buyon</name></author><author><name sortKey="Kim, My" uniqKey="Kim M">MY Kim</name></author><author><name sortKey="Guerra, Mm" uniqKey="Guerra M">MM Guerra</name></author><author><name sortKey="Laskin, Ca" uniqKey="Laskin C">CA Laskin</name></author><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eudy, Am" uniqKey="Eudy A">AM Eudy</name></author><author><name sortKey="Siega Riz, Am" uniqKey="Siega Riz A">AM Siega-Riz</name></author><author><name sortKey="Engel, Sm" uniqKey="Engel S">SM Engel</name></author><author><name sortKey="Franceschini, N" uniqKey="Franceschini N">N Franceschini</name></author><author><name sortKey="Howard, Ag" uniqKey="Howard A">AG Howard</name></author><author><name sortKey="Clowse, Meb" uniqKey="Clowse M">MEB Clowse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Surita, Fgdc" uniqKey="Surita F">FGdC Surita</name></author><author><name sortKey="Parpinelli, Ma" uniqKey="Parpinelli M">MÂ Parpinelli</name></author><author><name sortKey="Yonehara, E" uniqKey="Yonehara E">E Yonehara</name></author><author><name sortKey="Krupa, F" uniqKey="Krupa F">F Krupa</name></author><author><name sortKey="Cecatti, Jg" uniqKey="Cecatti J">JG Cecatti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wong, K L" uniqKey="Wong K">K-L Wong</name></author><author><name sortKey="Chan, F Y" uniqKey="Chan F">F-Y Chan</name></author><author><name sortKey="Lee, C P" uniqKey="Lee C">C-P Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ko, Hs" uniqKey="Ko H">HS Ko</name></author><author><name sortKey="Ahn, Hy" uniqKey="Ahn H">HY Ahn</name></author><author><name sortKey="Jang, Dg" uniqKey="Jang D">DG Jang</name></author><author><name sortKey="Choi, Sk" uniqKey="Choi S">SK Choi</name></author><author><name sortKey="Park, Yg" uniqKey="Park Y">YG Park</name></author><author><name sortKey="Park, Iy" uniqKey="Park I">IY Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yang, M J" uniqKey="Yang M">M-J Yang</name></author><author><name sortKey="Chen, C Y" uniqKey="Chen C">C-Y Chen</name></author><author><name sortKey="Chang, W H" uniqKey="Chang W">W-H Chang</name></author><author><name sortKey="Tseng, J Y" uniqKey="Tseng J">J-Y Tseng</name></author><author><name sortKey="Yeh, C C" uniqKey="Yeh C">C-C Yeh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wu, J" uniqKey="Wu J">J Wu</name></author><author><name sortKey="Ma, J" uniqKey="Ma J">J Ma</name></author><author><name sortKey="Bao, C" uniqKey="Bao C">C Bao</name></author><author><name sortKey="Di, W" uniqKey="Di W">W Di</name></author><author><name sortKey="Zhang, W H" uniqKey="Zhang W">W-H Zhang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, D" uniqKey="Chen D">D Chen</name></author><author><name sortKey="Lao, M" uniqKey="Lao M">M Lao</name></author><author><name sortKey="Zhang, J" uniqKey="Zhang J">J Zhang</name></author><author><name sortKey="Zhan, Y" uniqKey="Zhan Y">Y Zhan</name></author><author><name sortKey="Li, W" uniqKey="Li W">W Li</name></author><author><name sortKey="Cai, X" uniqKey="Cai X">X Cai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gilda Parastandechehr, Stf" uniqKey="Gilda Parastandechehr S">STF Gilda Parastandechehr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author><author><name sortKey="Reinitz, E" uniqKey="Reinitz E">E Reinitz</name></author><author><name sortKey="Druzin, Ml" uniqKey="Druzin M">ML Druzin</name></author><author><name sortKey="Murrman, M" uniqKey="Murrman M">M Murrman</name></author><author><name sortKey="Estes, D" uniqKey="Estes D">D Estes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meehan, Rt" uniqKey="Meehan R">RT Meehan</name></author><author><name sortKey="Dorsey, Jk" uniqKey="Dorsey J">JK Dorsey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author><author><name sortKey="Howard, D" uniqKey="Howard D">D Howard</name></author><author><name sortKey="Repke, J" uniqKey="Repke J">J Repke</name></author><author><name sortKey="Goldman, Dw" uniqKey="Goldman D">DW Goldman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rubbert, A" uniqKey="Rubbert A">A Rubbert</name></author><author><name sortKey="Pirner, K" uniqKey="Pirner K">K Pirner</name></author><author><name sortKey="Wildt, L" uniqKey="Wildt L">L Wildt</name></author><author><name sortKey="Kalden, Jr" uniqKey="Kalden J">JR Kalden</name></author><author><name sortKey="Manger, B" uniqKey="Manger B">B Manger</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31539383</article-id><article-id pub-id-type="pmc">6754159</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0222343</article-id><article-id pub-id-type="publisher-id">PONE-D-19-11470</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Clinical Medicine</subject><subj-group><subject>Clinical Immunology</subject><subj-group><subject>Autoimmune Diseases</subject><subj-group><subject>Lupus Erythematosus</subject><subj-group><subject>Systemic Lupus Erythematosus</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Clinical Immunology</subject><subj-group><subject>Autoimmune Diseases</subject><subj-group><subject>Lupus Erythematosus</subject><subj-group><subject>Systemic Lupus Erythematosus</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Clinical Immunology</subject><subj-group><subject>Autoimmune Diseases</subject><subj-group><subject>Lupus Erythematosus</subject><subj-group><subject>Systemic Lupus Erythematosus</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Rheumatology</subject><subj-group><subject>Systemic Lupus Erythematosus</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Women's Health</subject><subj-group><subject>Maternal Health</subject><subj-group><subject>Pregnancy</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Women's Health</subject><subj-group><subject>Obstetrics and Gynecology</subject><subj-group><subject>Pregnancy</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Population Groupings</subject><subj-group><subject>Ethnicities</subject><subj-group><subject>Malay People</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Hematology</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Population Groupings</subject><subj-group><subject>Ethnicities</subject><subj-group><subject>Chinese People</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Clinical Medicine</subject><subj-group><subject>Clinical Immunology</subject><subj-group><subject>Autoimmune Diseases</subject><subj-group><subject>Lupus Nephritis</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Clinical Immunology</subject><subj-group><subject>Autoimmune Diseases</subject><subj-group><subject>Lupus Nephritis</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Clinical Immunology</subject><subj-group><subject>Autoimmune Diseases</subject><subj-group><subject>Lupus Nephritis</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Women's Health</subject><subj-group><subject>Maternal Health</subject><subj-group><subject>Pregnancy</subject><subj-group><subject>Pregnancy Complications</subject><subj-group><subject>Miscarriage</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Women's Health</subject><subj-group><subject>Obstetrics and Gynecology</subject><subj-group><subject>Pregnancy</subject><subj-group><subject>Pregnancy Complications</subject><subj-group><subject>Miscarriage</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Diagnostic Medicine</subject><subj-group><subject>Signs and Symptoms</subject><subj-group><subject>Proteinuria</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Signs and Symptoms</subject><subj-group><subject>Proteinuria</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia</article-title><alt-title alt-title-type="running-head">Relapse of SLE in pregnancy and post-partum</alt-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0002-9068-8114</contrib-id><name><surname>Shaharir</surname><given-names>Syahrul Sazliyana</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Writing – original draft</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Mohamed Said</surname><given-names>Mohd Shahrir</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Project administration</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mohd</surname><given-names>Rozita</given-names></name><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Abdul Cader</surname><given-names>Rizna</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Writing – original draft</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0001-8423-707X</contrib-id><name><surname>Mustafar</surname><given-names>Ruslinda</given-names></name><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Project administration</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Abdul Rahman</surname><given-names>Rahana</given-names></name><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Petry</surname><given-names>Clive J.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of Cambridge, UNITED KINGDOM</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="other" id="econtrib001"><p>‡ These authors also contributed equally to this work.</p></fn><corresp id="cor001">* E-mail: <email>ssazliyana@gmail.com</email>, <email>syahrul.sazliyana.shaharir@ppukm.ukm.edu.my</email></corresp></author-notes><pub-date pub-type="epub"><day>20</day><month>9</month><year>2019</year></pub-date><pub-date pub-type="collection"><year>2019</year></pub-date><volume>14</volume><issue>9</issue><elocation-id>e0222343</elocation-id><history><date date-type="received"><day>23</day><month>4</month><year>2019</year></date><date date-type="accepted"><day>27</day><month>8</month><year>2019</year></date></history><permissions><copyright-statement>© 2019 Shaharir et al</copyright-statement><copyright-year>2019</copyright-year><copyright-holder>Shaharir et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pone.0222343.pdf"></self-uri><abstract><p>Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.</p></abstract><funding-group><funding-statement>The author(s) received no specific funding for this work.</funding-statement></funding-group><counts><fig-count count="0"></fig-count><table-count count="5"></table-count><page-count count="16"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the manuscript and its Supporting Information files.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the manuscript and its Supporting Information files.</p></notes></front></pmc><affiliations><list><country><li>Malaisie</li></country></list><tree><country name="Malaisie"><noRegion><name sortKey="Shaharir, Syahrul Sazliyana" sort="Shaharir, Syahrul Sazliyana" uniqKey="Shaharir S" first="Syahrul Sazliyana" last="Shaharir">Syahrul Sazliyana Shaharir</name></noRegion><name sortKey="Abdul Cader, Rizna" sort="Abdul Cader, Rizna" uniqKey="Abdul Cader R" first="Rizna" last="Abdul Cader">Rizna Abdul Cader</name><name sortKey="Abdul Rahman, Rahana" sort="Abdul Rahman, Rahana" uniqKey="Abdul Rahman R" first="Rahana" last="Abdul Rahman">Rahana Abdul Rahman</name><name sortKey="Mohamed Said, Mohd Shahrir" sort="Mohamed Said, Mohd Shahrir" uniqKey="Mohamed Said M" first="Mohd Shahrir" last="Mohamed Said">Mohd Shahrir Mohamed Said</name><name sortKey="Mohd, Rozita" sort="Mohd, Rozita" uniqKey="Mohd R" first="Rozita" last="Mohd">Rozita Mohd</name><name sortKey="Mustafar, Ruslinda" sort="Mustafar, Ruslinda" uniqKey="Mustafar R" first="Ruslinda" last="Mustafar">Ruslinda Mustafar</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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