A broader perspective on anti-Ro antibodies and their fetal consequences. A case report and literature review

Abstract

The presence of maternal Anti ]Ro/Anti ]La antibodies causes a passively acquired autoimmunity that may be associated with serious fetal complications. The classic example is the autoimmune ]mediated congenital heart block (CHB) which is due in most cases to the transplacental passage of Anti ]Ro/Anti ]La antibodies. The exact mechanisms through which these pathologic events arise are linked to disturbances in calcium channels function, impairment of calcium homeostasis and ultimately apoptosis, inflammation and fibrosis. CHB still represents a challenging diagnosis and a source of debate regarding the best management. As the third ]degree block is usually irreversible, the best strategy is risk awareness and prevention. Although CHB is a rare occurrence, it affects one in 20,000 live births, with a high overall mortality rate (up to 20%, with 70% of in utero deaths). There is also concern over the lifelong consequences, as most babies need a pacemaker. This review aims to offer, apart from the data needed for a better understanding of the issue at hand, a broader perspective of the specialists directly involved in managing this pathology: The rheumatologist, the maternal.fetal specialist and the cardiologist. To better illustrate the theoretical facts presented, we also include a representative clinical case.