Neurologic Manifestations of Systemic Immunopathological Diseases

OPINION STATEMENT: Systemic immunopathological diseases with prominent neurological features include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sj?gren's Syndrome (SS), and the systemic vasculitides. These systemic conditions can affect the nervous system in diverse ways. In many cases, the neurological disease heralds the onset of the systemic condition. Recognizing the pattern of neurological and systemic features of these conditions is critical in order to uncover the systemic condition in a timely manner. Although treatment of these conditions is usually directed at the underlying systemic disease, discovery of certain types of neurological involvement such as rapidly progressive mononeuritis multiplex may often necessitate more robust immunosuppressive therapy. The larger treatment trials addressing optimal therapy in these conditions are coordinated by rheumatologists and rarely address the neurological complications in isolation. As such, the evidence supporting neurology-specific therapy regimens is generally an extrapolation of findings that apply to the systemic condition as a whole and cannot be considered as Class I. Less severe neurological manifestations are often treated with glucocorticoids and immunosuppressive treatments such as azathioprine as a steroid-sparing strategy. More severe neurological involvement requires early and aggressive therapy with powerful immunosuppressive agents, often in combination with glucocorticoids and plasma exchange. Cyclophosphamide is the most established immunosuppressive therapy in this context but is limited by its toxicity. Rituximab is emerging as a highly promising alternative although its high cost is a major limitation.     

Pregnancy outcome in women with polycystic ovary syndrome in relation to second-trimester testosterone levels

Research questionDo women with polycystic ovary syndrome (PCOS) have higher testosterone levels during pregnancy and what role does high testosterone play in the development of obstetric complications?DesignRetrospective cohort study from Uppsala University Hospital, Sweden. The study population consisted of women with PCOS (n = 159) and a comparison group of women without PCOS matched for body mass index (n = 320). Plasma testosterone levels were measured in the early second trimester by liquid chromatography with tandem mass spectrometry, and women with PCOS were grouped into tertiles according to their testosterone levels. Possible associations with obstetric complications, maternal metabolic factors and offspring birth weight were explored by multivariable logistic and linear regression models.ResultsCompared with women who do not have PCOS, women with PCOS had higher total testosterone (median 1.94, interquartile range [IQR] 1.21–2.64 versus 1.41, IQR 0.89–1.97; P < 0.001), and free androgen index (median 0.25, IQR 0.15–0.36 versus 0.18, IQR 0.11–0.28; P < 0.001). Women with PCOS who had the highest levels of testosterone had increased risk for preeclampsia, even when adjusted for age, parity, country of birth and smoking (adjusted OR 6.16, 95% CI 1.82 to 20.91). No association was found between high testosterone in women with PCOS and other obstetric complications.ConclusionsWomen with PCOS have higher levels of total testosterone and free androgen index during pregnancy than women without PCOS matched for body mass index. Preliminary evidence shows that women with PCOS and the highest maternal testosterone levels in early second trimester had the highest risk of developing preeclampsia. This finding, however, is driven by a limited number of cases and should be interpreted with caution.     

Idiopathic early ovarian aging: is there a relation with premenopausal accelerated biological aging in young women with diminished response to ART?

Journal of Assisted Reproduction and Genetics - To evaluate whether young women with idiopathic early ovarian aging, as defined by producing fewer oocytes than expected for a given age over...