Neonatal Lupus — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeNeonatal LupusSCE Rheumatology

A 28-year-old woman with systemic lupus erythematosus is positive for anti-Ro/SSA antibodies. During pre-pregnancy counselling, she asks about manifestations of neonatal lupus. Which manifestation, if it occurs, is typically irreversible rather than resolving as transplacentally acquired maternal antibodies are cleared?

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Correct answer: C — Complete congenital atrioventricular block

Maternal anti-Ro/SSA antibodies cross the placenta and can cause neonatal lupus. Complete congenital atrioventricular block is the key permanent manifestation: antibody-mediated inflammation and fibrosis damage the fetal cardiac conduction system, so established complete block is generally irreversible and many affected children ultimately require pacing. By contrast, the annular photosensitive rash usually resolves within the first several months as maternal antibodies disappear. Haematological abnormalities, including thrombocytopenia and neutropenia, are also usually transient. Hepatic involvement commonly presents with transient biochemical liver-function abnormalities. Therefore, complete congenital atrioventricular block is the single best answer.

Reference: NHS Greater Glasgow and Clyde, Anti-Ro & Anti-La antibodies: Guideline for the management of babies born to mothers with systemic lupus erythematosus and other autoimmune disorders, sections 1 and 3.1, reviewed 2024. https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/neonatology/anti-ro-anti-la-antibodies-guideline-for-the-management-of-babies-born-to-mothers-with-systemic-lupus-erythematosus-sle-and-other-autoimmune-disorders-698/?searchTerm=Buy+Clomid+in+Munich+%7C+Telegram%3A+%E2%86%AA+%40RoidTG+%E2%86%A9+K4L9M7R.Zcoe