[Therapeutic plasmapheresis for the prevention of congenital complete heart block associated with anti-SS-A/Ro antibody and anti-SS-B/La antibody].
OBJECTIVE
Neonatal lupus erythematosus is characterized by transient lupus abnormalities, various systemic and hematological abnormalities, and congenital complete heart block (CCHB). It is well known that anti-SS-A/Ro antibody (52 kD/60 kD) and anti-SS-B/La antibody are associated with CCHB. This study was conducted to evaluate the effects of the removal of anti-SS-A/Ro antibody (52 kD/60 kD) and anti-SS-B/La antibody from plasma in pregnant women whose fetuses are at a high risk of developing CCHB.


METHODS
Fifteen pregnant patients positive for anti-SS-A/Ro antibody and anti-SS-B/Laantibody were subjected weekly to double filtration plasmapheresis to remove both antibodies. Antibody titers were measured by double immunodiffusion (DID) and ELISA.


RESULTS
As a result, all women gave birth to live babies, but CCHB was recognized in one baby. No transient lupus abnormalities were recognized in any of the babies. Fourteen patients showed decreased antibody titers by ELISA during plasmapheresis. However, the patient who was delivered of a baby with CCHB showed an increase of antibody titers by ELISA while the DID method showed a decrease of antibody titers.


CONCLUSIONS
Our study suggested that plasmapheresis prevents CCHB associated with anti-SS-A/Ro and anti-SS-B/La antibody. Also, it is important to monitor the antibody titer regularly during the course of pregnancy, because it may increase due to worsening of the mother's primary disease.
Miyakata
S
S
Department of Rheumatology and Internal Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo.
Takeuchi
K
K
Yamaji
K
K
Kanai
Y
Y
Tsuda
H
H
Takasaki
Y
Y
D000328:Adult; D000974:Antibodies, Antinuclear / Q000276:immunology*; D005260:Female; D006327:Heart Block / Q000151:congenital* / Q000517:prevention & control*; D006801:Humans; D010956:Plasmapheresis; D011247:Pregnancy / Q000276:immunology*
D000974:Antibodies, Antinuclear; C035356:SS-A antibodies; C035357:SS-B antibodies