Study During Pregnancy of Expression of miRNAs in RA or SLE
Condition: Rheumatoid Arthritis; Systemic Lupus Erythematosus
MeSH terms: Arthritis; Arthritis, Rheumatoid; Lupus Erythematosus, Systemic
Study type: Observational

Summary: 
      Rheumatoid arthritis (RA) is a systemic disease, which mainly targets joints and results in
      osteoarticular destruction and serious disability. When clinical symptoms (painful and
      swollen joints) occur, the innate and adaptive immune responses against self antigens have
      already been largely amplified. This might explain that even when RA patients are treated
      very early and aggressively, a remission of the disease can only be obtained in approximately
      half of them. This proportion of remission under treatment can only be achieved using treat
      to target strategies involving biologics, such as anti-TNF. Unfortunately, less than 20% of
      patients remain in remission after treatment discontinuation. Thus, despite the availability
      of 5 different types of biologics, there are still therapeutic unmet needs. However, a
      spontaneous, drug-free decrease of disease activity can be observed in a physiological
      condition, pregnancy. Although most of treatments of RA have to be discontinued during
      pregnancy, a marked improvement, and sometimes remission, can be observed during pregnancy,
      with frequent post-partum flares. The situation is the opposite with an increased risk of
      flares in systemic lupus erythematosus (SLE), a rare systemic autoimmune disease which
      generally progresses in flares-up and can affect nearly any organ (the skin, joints, kidneys,
      the brain, the heart, …). The course of the disease remains unpredictable for a given
      patient, and very few biomarkers are available to help clinicians to identify patients a risk
      of flares. Thus, safe therapeutic options remain limited, especially in patients with serious
      complications. A specific concern in SLE is the fact that the disease usually starts in women
      entering their sexual and reproductive life. Even with a stable condition (i.e : lupus
      without recent flares and no impaired renal or cardiac function) as it is medically
      recommended before getting pregnant, up to 40% of SLE patients flare up during pregnancy.

      We hypothesize disease-specific and pregnancy-induced epigenetic changes, especially those
      regarding the pattern and levels of microRNAs, could explain the clinical improvement and the
      risk of flares in RA and SLE, respectively. A better understanding of the underlying
      mechanisms could help to identify new biomarkers, notably those predicting flares in SLE, and
      therapeutic targets, by trying to mimicking or amplifying micro-RNA changes observed in RA
      and targeting them in SLE.
    


Intervention name(s): Collection of biological samples
Intervention type(s): Other
Intervention description(s): collection of biologic samples ( blood and urine) befor and after woman pregnacy
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Pregnant women suffering from RA or SLE compared wiht pregnant woman in good health
      
Biospecimen description: 
      The samples that will be analyzed in the present application are serum, urine, placenta,
      blood monocytes.
    
Keywords: Pregnancy; miRNA; Rheumatoid Arthritis (RA); Systemic Lupus Erythematosus (SLE)