Autoimmune congenital heart block and primary Sjogren's syndrome: characterisation and outcomes of 49 cases

Sjogren Big Data Consortium, P. Brito-Zeron, S. G. Pasoto, A. Robles-Marhuenda, T. Mandl, A. Vissink, B. Armagan, S. Praprotnik, G. Nocturne, A. Sebastian, V. Fernandes Moca Trevisani, S. Retamozo, N. Acar-Denizli, P. Wiland, A. Siso-Almirall, H. Bootsma, X. Mariette, M. Ramos-Casals*, B. Kostov

*Corresponding author for this work

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Abstract

Objective. To characterise autoimmune congenital heart block (CHB) associated with a maternal diagnosis of primary Sjogren's syndrome (pSS) confirmed either before, concomitant or after the first pregnancy complicated with CHB.

Methods. The following inclusion criteria were applied: (i) Mothers with positive Ro/La autoantibodies detected previously or at the time of diagnosis of the first case of CHB; (ii) diagnosis of CHB confirmed by fetal echocardiography; (iii) AV block diagnosed in uterus, at birth or within the neonatal period (0-27 days after birth) (8); (iv) absence of anatomical cardiac abnormalities which might be causal of AV block; and (v) maternal fulfillment of the 2002 SS criteria before, during or after having a pregnancy complicated with CHB.

Results. We identified 49 cases of autoimmune CHB in children born from 44 mothers who had a mean age at the time of pregnancy of 30.3 years (range 18 to 41). At the time of diagnosis of autoimmune CHB, all mothers had positive anti-Ro antibodies and 28/ 44 (64%) were positive for anti-La antibodies. Only 10 (22%) mothers with affected pregnancies had a diagnosis of primary SS at the time of diagnosis of the first pregnancy complicated by CHB (a mean of 4 years before, ranging from 1 to 10 years). In 6 (14%) mothers, primary SS was diagnosed during pregnancy or less than 12 months after the delivery/termination. In the remaining 28 ( 64%) mothers, pSS was confirmed 1-5 years after CHB diagnosis (n=19, 68%), 6-10 years after (n= 2, 7%), or more than 10 years after the first case of CHB was diagnosed (n=7, 25%). CHB was diagnosed in uterus in all cases but two. AV block was initially incomplete in 11 fetuses and complete in 36 (no available data in 2 cases). Among the 35 (71%) surviving children with CHB, 5 (14%) developed other features of neonatal lupus. After the index pregnancy, 12 women had 20 subsequent pregnancies: five were complicated by a CHB ( recurrence rate of CHB of 25%). The 4 women who had recurrent CHB were double-positive for anti-Ro and anti-La antibodies, and all had a confirmed pSS before having the first index case of CHB.

Conclusion. In pSS, autoimmune CHB could be one of the first "indirect" signs of the disease in women of childbearing-age, in whom the diagnosis is confirmed several years later. Some maternal characteristics could be related with recurrent CHB, such as having an already-confirmed diagnosis of pSS and carrying the two Ro/La autoantibodies.

Original languageEnglish
Pages (from-to)S95-S102
Number of pages8
JournalClinical and Experimental Rheumatology
Volume38
Issue number4
Publication statusPublished - 2021

Keywords

  • autoimmune congenital heart block
  • primary Sjogren's syndrome
  • neonatal lupus
  • anti-Ro antibodies
  • SYSTEMIC-LUPUS-ERYTHEMATOSUS
  • NEONATAL LUPUS
  • MOTHERS
  • CHILDREN
  • MANIFESTATIONS
  • CLASSIFICATION
  • AUTOANTIBODIES
  • CRITERIA
  • ONSET

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