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Cutaneous neonatal lupus predicts cardiac lupus in subsequent child

NEW YORK (Reuters Health) - Cutaneous neonatal lupus in an older sibling is a risk factor for congenital heart block in later-born siblings, researchers report in the January 21st online issue of Arthritis and Rheumatism.

Complicating matters is the fact that the neonatal lupus rash is usually transient, appearing when the infant is around 6 weeks of age and disappearing by approximately 6 months, as the mother's lupus antibodies are cleared from the baby's circulation.

"While the cutaneous lesions of neonatal lupus are themselves benign, they may be an important risk factor for more serious disease in subsequent offspring," lead author Dr. Peter M. Izmirly, of New York University School of Medicine, told Reuters Health by email.

Dr. Izmirly and his colleagues analyzed recurrence rates of neonatal lupus in 58 affected families, with a particular focus on rates of the cardiac form of the disease. Each family had a mother with anti-SSA/Ro antibodies and at least one child born subsequent to a child with cutaneous neonatal lupus.

Among all 77 pregnancies that followed the birth of a child with cutaneous neonatal lupus, the overall recurrence rate of all manifestations of the disease was 49%, the authors report.

Fourteen infants (18%) had 2nd- or 3rd-degree congenital heart block, a nearly 10-fold increase over the rate reported in families without an affected child, according to the authors. Twenty-three children (30%) had cutaneous disease, and one child (1%) had isolated hematological/hepatic abnormalities.

"These data suggest that women whose children have any manifestation of neonatal lupus should be followed closely in a next pregnancy for any signs of cardiac abnormalities in the fetus," Dr. Izmirly said. "This may involve serial fetal echocardiograms."

"We expect that these data will serve for family counseling," Dr. Izmirly said. "In addition, the numbers will allow for a more accurate design of clinical trials aimed at prevention."