Karen Schreiber

• Doctor of Medicine
• MD MRCP at Danish Hospital for Rheumatic Diseases

Objectives To comprehensively compare the disease burden among patients with RA, PsA and AS using Patient-Reported Outcome Measurement Information System (PROMIS) scores and to identify distinct patient clusters based on comorbidity profiles and PROMIS outcomes. Methods Data from the global COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 e-s...

The role of classification criteria is particularly important in rheumatic diseases compared with other medical disorders, as the complexity and overlapping symptoms of these conditions make diagnosis challenging. Moreover, the absence of established diagnostic criteria further complicates diagnosing patients. Classification criteria can assist hea...

BACKGROUND Patients with immune-mediated inflammatory disease (IMID), including autoimmunity, fared significantly worse than the general population during the COVID-19 pandemic both in terms of infection outcomes and levels of life disruption. Despite this, COVID-19 vaccine uptake has not been universal. The absence of IMID patients from clinical t...

Rheumatic diseases are autoimmune and inflammatory diseases affecting the musculoskeletal system as well as internal organs. The term encompasses over 200 different diseases spanning from several types of arthritis to systemic connective tissue diseases [1].

Notwithstanding the wealth of literature on COVID-19, studies focusing on young adults with autoimmune diseases (AD) are lacking. To determine early (within 7 days) and late (after 7 days) anti-SARS-CoV-2 vaccine-related adverse events (AEs), post-vaccine disease flares, COVID-19 severity and breakthrough infections (B-INFs) in young people with rh...

Background Patients with autoimmune diseases (AD) are often at risk of severe COVID manifestations and post COVID syndrome (PCS). Pregnant and breastfeeding (PB) women with AD are an even more vulnerable population, though little is known about the prevalence and characteristics of PCS. Objectives We explored the frequency and characteristics of P...

Background Rheumatic and musculoskeletal diseases (RMDs) encompass a variety of chronic conditions, which most often affect women of childbearing age. Most RMDs require long-term treatment with disease modifying anti-rheumatic drugs (DMARDs): Disease quiescence is vital to reduce complications in pregnancy in the mother and the offspring. Clinical...

Background Rheumatic and musculoskeletal diseases (RMDs) frequently affect individuals of childbearing age. During pregnancy, disease control is vital, as disease activity leads to adverse outcomes for both the mother and the baby. Clinical guidance documents on the use of anti-rheumatics in pregnancy by the European Alliance of Associations in Rhe...

Background Danish Centre for Expertise in Rheumatology (CeViG) at the Danish Hospital for Rheumatic Disease (DG) in Sønderborg is a unique national institution, which aims at sharing knowledge with stakeholders that play an important professional role for people with inflammatory arthritis (IA). We postulate that co-creation and cross-sectoral coop...

COVID-19 has been suggested as a possible trigger of disease flares in patients with rheumatoid arthritis (RA). However, factors associated with disease flares remain unknown. This study aimed to identify factors associated with breakthrough infection (BIs) and disease flares in patients with RA following COVID-19. We analysed data from RA patients...

Objectives: We investigated COVID-19 vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Methods: Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares (DF), and AID-related treatment modifications were analyzed upon diagnosis of...

Background The COVID-19 pandemic caused concerns whether patients with rheumatic musculoskeletal disease (RMD) treated with conventional (cs) or biologic (b) disease modifying drugs (DMARDs) and/or prednisolone exhibit an adequate immune response to the applied SARS-CoV2 vaccines. Objectives We established the DECODIR study to assess and compare t...

Background COVID-19 vaccine hesitancy among pregnant and breastfeeding women with autoimmune diseases (AID) is often attributed to the fear of adverse events (AE) and disease flares (DF). No data are available regarding COVID-19 vaccine safety in this population. Objectives We aimed at describing delayed-onset (>7 days) vaccine-related AE (minor a...

Background Even though the health benefits of breast milk are well established, only a small number of research have looked at breastfeeding in people with systemic lupus erythematosus, with mixed findings. In a previous multicenter cohort investigating 119 SLE pregnancies, one-third of patients did not breastfeed after giving birth. Objectives To...

Background Some maternal systemic connective tissue diseases (CTD) and their associated antibodies are linked with adverse fetal outcomes, including increased risk of congenital heart diseases (CHD) [1,2] . Whether this increased risk also applies to less severe structural or functional cardiac abnormalities in the fetus is currently unknown. Obje...

A syndemic is the co-existence of two or more health problems (including both social and biological features) that adversely influence each other with negative consequences on disease outcomes and perpetuation of inequalities. The syndemic approach can be applied to better understand the course of rheumatic musculoskeletal diseases (RMD) involving...

Dear Editor, In response to the new BSR guidelines on prescribing drugs in pregnancy and breastfeeding: ‘immunomodulatory anti-rheumatic drugs and corticosteroids’ and ‘comorbidity medications used in rheumatology practice’ [1, 2] we would like to add further data on the important topic of the rates of congenital abnormalities in pregnancies in wom...

Dear Editor, Patients with idiopathic inflammatory myopathies (IIMs) represent a high-risk group for adverse pregnancy outcomes (APOs), and post COVID-19 vaccination disease flares have been speculated. However, data on vaccine-associated adverse events (ADEs) in the antenatal period and APOs in this vulnerable group are virtually non-existent, lim...

Objective To assess predicting factors that might influence Systemic lupus erythematosus (SLE) disease activity in women in an extended follow-up period of 2 years after giving birth and clinical assessment every three months. Methods The study was design as an international retrospective study, enrolling 119 women with a first birth and with a 2...

People with inflammatory arthritis (IA) treated with immunosuppressive disease-modifying anti-rheumatic drugs (DMARDs) were initially considered to have an increased risk of severe illness from the SARS-CoV-2 virus compared to the general population. The aim of this study was to explore how people with IA experienced restrictions during the pandemi...

Background People with inflammatory arthritis (IA) treated with conventional or biological immunosuppressive disease-modifying anti rheumatic drugs (DMARDs), were initially considered to have an increased risk of severe illness from SARS-CoV-19 (COVID-19) infection compared to the general population. Although resent studies have not confirmed this,...

Background Systemic lupus erythematosus (SLE) often affects women in their childbearing years, and pregnancy may affect SLE disease activity during pregnancy and post-partum (1,2). Limited data assessing the likelihood and characteristics of SLE activity in an extended time period post-partum which may be relevant as patients may wish further pregn...

Background During the COVID-19 pandemic, it remains a major concern whether patients with rheumatic musculoskeletal disease treated with conventional (cs) or biologic (b) disease modifying drugs (DMARDs) exhibit an adequate immune response to the currently available SARS-CoV2 vaccines. There remains an urgent need for more data on SARS-CoV-2 vaccin...

Objective: To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Methods: Following European League against Rheumatism (EULAR) standardised...

Background/Purpose: In light of the current COVID-19 pandemic, whether patients with rheumatic musculoskeletal disease (RMD) treated with conventional (cs) or biologic (b) disease-modifying drugs (DMARDs) exhibit an adequate immune response to the currently available SARS-CoV-2 vaccinations remains a major concern. There is an urgent need for more...

Objective We aimed to investigate the impact of applying the 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) in a previously described cohort of women with undifferentiated connective tissue disease (UCTD). Methods This study inclu...

Background Patients with chronic inflammatory diseases (CIDs) may encounter challenges in their family planning journey. Here, we report on the access to family planning and pregnancy (FPP) information and the concerns among patients in Denmark with CIDs.Methods Patients aged 18–50 years with CIDs participated in an online survey. Patients were rec...

Hydroxychloroquine (HCQ) is an antimalarial agent with pleiotropic effects and now represents a cornerstone in the management of patients with autoimmune conditions. While clinical series suggest anti-thrombotic properties, the way in which HCQ exerts this effect remains to be fully explained. Following a 24-h incubation of human umbilical vein end...

Rheumatic and autoimmune diseases are often present in women during the childbearing years and as such, correct management of pregnancy throughout its course is of significance to all those affected. Previously women with systemic rheumatic diseases were counselled against pregnancy as the majority of medications carried potential or perceived tera...

The COVID-19 pandemic has resulted in more than 2 million deaths globally. Two interconnected stages of disease are generally recognised; an initial viral stage and a subsequent immune response phase with the clinical characteristics of hyperinflammation associated with acute respiratory distress syndrome. Therefore, many immune modulators and immu...

In view of the COVID-19 pandemic, there is an unmet clinical need for the guidelines on vaccination of patients with autoimmune inflammatory rheumatic diseases (AIIRD). This position paper summarises the current data on COVID-19 infection in patients with AIIRD and development of vaccines against COVID-19, discusses the aspects of efficacy and safe...

Women account for roughly 90% of patients with systemic lupus erythematosus (SLE) and they are typically diagnosed when they are in their childbearing age. Patients with SLE are at increased risk of premature cardiovascular disease (CVD) representing the major cause of morbidity and mortality in this patient group. Premature CVD is significantly pr...

Antiphospholipid syndrome (APS) is characterized by arterial and/or venous thromboses and/or obstetric morbidity in patients persistently positive for moderate to high titres of antiphospholipid antibodies (aPL) according to the current classification criteria. Pregnancy morbidity includes unexplained consecutive recurrent 1st trimester pregnancy l...

A variety of autoantibodies associated with Rheumatic diseases have been associated with adverse maternal and foetal pregnancy outcomes. For instance, pregnancy morbidity in women with antiphospholipid antibodies (aPL) include unexplained consecutive recurrent 1st trimester pregnancy loss (<10 weeks’ gestation), any 2nd or 3rd trimester pregnancy l...

Women account for roughly 90% of patients with systemic lupus erythematosus (SLE) and they are typically diagnosed when they are in their childbearing age. Patients with SLE are at increased risk of premature cardiovascular disease (CVD) representing the major cause of morbidity and mortality in this patient group. Premature CVD is significantly pr...

Specialists from different medical specialties need to gain familiarity with reproductive health issues in women with chronic rheumatic diseases of childbearing age. Health care providers must have easy access to summary recommendations for management of pregnancy, antenatal care, and care in the postpartum period. This book is intended as a quick-...

Objectives: To validate the global antiphospholipid syndrome score (GAPSS) in a cohort of women with systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPL). Methods: This retrospective study included 143 women ever pregnant with SLE who presented in our outpatient clinic were included. Data on cardiovascular risk factors and aP...

Purpose of review: Pregnancies in women with antiphospholipid antibodies (aPL) are associated with several pregnancy complications. The current treatment to prevent obstetric aPL-mediated morbidity is largely based on low-dose aspirin (LDA) and low-molecular-weight heparin (LMWH). Alternative treatment regimens to prevent obstetric aPL-related mor...

Background Patients affected by chronic inflammatory diseases of the skin or joints (CIDs; including psoriasis [PSO], rheumatoid arthritis [RA], juvenile idiopathic arthritis [JIA], psoriatic arthritis [PsA], non-radiographic axial spondyloarthritis [nr-axSpA; reported in the survey as ‘axSpA’], or ankylosing spondylitis [AS]) may be challenged in...

Objective The aim of the study is to perform a systematic review on the recent available evidence on antiphosphatidylserine/prothrombin (aPS/PT) antibodies and their association with clinical manifestations of the antiphospholipid syndrome (APS). Methods A detailed literature search was applied a priori to Ovid MEDLINE, In-Process and Other Non-Ind...

Background: The current treatment to prevent pregnancy morbidity (PM) associated with antiphospholipid antibodies (aPL) is based on the use of low dose aspirin and low molecular weight heparin (henceforth defined as standard of care (SoC) treatment). Despite the SoC, up to 30% of women with aPL continue to have pregnancy complications. The global...

Objectives: To investigate fetal/perinatal and maternal outcomes from a large multicentre cohort of women diagnosed with UCTD. Methods: This multicentre retrospective cohort study describes the outcomes of 224 pregnancies in 133 consecutive women with a diagnosis of UCTD, positive for ANA and aged <45 years old at study inclusion. Results: Of...

Pregnancy loss is a common and devastating pregnancy complication. Recurrent early miscarriage (REM) isdefined as two or more consecutive pregnancy losses during the first trimester of pregnancy. It is a distinct entity and in approximately 50% of these patients, the underlying cause is never established. REM can be idiopathic, i.e. of unknown caus...

Objective This article aims to analyse the rate of antiphospholipid antibodies (aPL) negativisation in patients with antiphospholipid syndrome (APS), and to evaluate potential new clinical manifestations after negativisation and/or aPL fluctuations in a long-term follow-up. Methods Inclusion criteria are (1) any patients with an APS diagnosis accor...

Antiphospholipid syndrome (APS) is an autoimmune disease characterised by the presence of antiphospholipid antibodies (aPL). The antibodies currently included in the classification criteria include lupus anticoagulant (LA), anticardiolipin antibodies (aCL) and anti-^2-glycoprotein 1 antibodies (^2GPI). APS can present with a variety of clinical phe...

Aim To present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations. Methods An SLR was performed according to the standard operating procedures for EULAR-e...

Objectives The aims of this study were to update the evidence on the incidence and prevalence rates of vaccine preventable infections (VPI) in patients with autoimmune inflammatory rheumatic diseases (AIIRD) and compare the data to the general population when available. Methods A literature search was performed using Medline, Embase and Cochrane l...

To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenici...

Background Current standard of care (SoC) in pregnancy for patients with Systemic lupus erythematosus (SLE) and/or aPL positivity includes treatment with low dose aspirin (75–100mg/day) and low molecular heparin or unfractionated heparin. However, up to 30% of women continue to have pregnancy complications despite SoC. Therefore, identifying patien...

Objectives: In this study we aimed to investigate foetal and maternal pregnancy outcomes from a large multicentre cohort of women diagnosed with MCTD and anti-U1RNP antibodies. Methods: This multicentre retrospective cohort study describes the outcomes of 203 pregnancies in 94 consecutive women ever pregnant who fulfilled the established criteri...

Background Current standard of care (SoC) in pregnancy for patients with Systemic lupus erythematosus (SLE) and/or aPL positivity includes treatment with low dose aspirin (75100 mg/day) and low molecular heparin or unfractionated heparin. However, up to 30% of women continue to have pregnancy complications despite SoC(1). We aimed to assess the val...

Figure S1 All bleeding events in women aged under 50 years in the hokusai‐VTE trial.

Table S2. Baseline characteristics of all women less than 50 years of age in the Hokusai‐VTE study

Table S1. Classification of clinical presentation and course of major and clinically relevant nonmajor bleeding events

Objective: to investigate the characteristics and outcome of abnormal vaginal bleeding in women receiving edoxaban or warfarin for treatment of venous thromboembolism (VTE). Design and setting: post-hoc analysis of the Hokusai-VTE study, a multicentre, randomized, double-blind trial comparing edoxaban with for acute symptomatic VTE. Population:...

Background The presence of antiphospholipid antibodies (aPL) are associated with pregnancy complications. There is a lack of validated pregnancy questionnaires to assess previous pregnancy morbidity reliably in aPL positive patients. We therefore designed the pregnancy morbidity questionnaire (PMQ). Objectives To validate the pregnancy morbidity q...

Background Systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPL) are associated with pregnancy complications. Objectives To validate the global antiphospholipid syndrome score (GAPSS) in a cohort of women with SLE. Methods 143 women ever pregnant with SLE who presented in our outpatient clinic were included (table 1). Data on c...

Background Mixed connective tissue disease (MCTD) is characterised by signs and symptoms of a combination of disorders, primarily systemic lupuserythematosus (SLE), scleroderma and polymyositis and is characterised by the presence of high titre antibodies to U1-ribonucleoprotein (RNP). When planning a pregnancy in patients with connective tissue di...

Background In addition to glomerular lesions, renal vascular involvement is an important prognostic marker of lupus nephritis (LN). Among patients with various vascular changes, individuals with thromboticmicroangiopathy (TMA) present with severe clinical manifestations and have a high mortality. Objectives We sought to assess renalout comes and r...

Background Persisting antiphospholipid antibodies (aPL) are associated with adverse obstetric events including recurrent miscarriage, late fetal loss or early delivery due to pre-eclampsia or placental insufficiency (obstetric APS) and also thrombosis. We are a tertiary referral centre for those with aPL, and have a management protocol for women wi...

This corrects the article DOI: 10.1038/nrdp.2017.103.

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies, such as lupus anticoagulant, anticardiolipin antibodies and anti-β2-glycoprotein 1 antibodies. APS can present with a variety of clinical phenotypes, including thrombosis in the veins, arteries and microvasculature as well as obste...

Background: The most common neurological manifestation of APS is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, we aimed to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patients who presented with new onset symptoms sugg...

Objectives: HCQ has been described as having a beneficial effect in patients with APS but its mechanism of action is unclear. We hypothesized that HCQ may have effects on subnormal angiogenesis, inflammation and haemostatic biomarkers seen in APS. The aim of our study was to assess laboratory markers [annexin A5 (AnxA5) anticoagulant activity, tis...

Anticoagulation in patients with impaired kidney function can be challenging since drugs’ pharmacokinetics and bioavailability are altered in this setting. Patients with chronic kidney disease (CKD) treated with conventional anticoagulant agents [vitamin K antagonist (VKA), low-molecular weight heparin (LMWH) or unfractionated heparin (UFH)] are at...

Purpose of review: Antiphospholipid syndrome (APS) is defined as the association of thrombotic events and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies (aPL). In this review, we will highlight the most important clinical presentations of APS with a focus on the obstetric morbidity, the current management...

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

Women with antiphospholipid antibodies (aPL) are at risk of adverse pregnancy outcomes, including recurrent first-trimester pregnancy loss and late pregnancy complications such as preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, premature delivery, intrauterine growth restriction, placental abruption,...

Background The region of Odisha in India has a population of over 40 million people and 45% are living in poverty. Approximately one percent of the population is affected by inflammatory rheumatoid diseases. In order to provide early diagnosis and adequate treatment initiation to prevent long term disability, patients require easily accessible basi...

Background Young adults with acute myocardial infarction are a critical group to examine for the purpose of risk factors stratification and modification [1]. In the setting of underlying systemic autoimmune diseases, premature cardiovascular disease deserves even more attention in these conditions, such as antiphospholipid syndrome (APS), the most...

Background Antiphospholipid syndrome (APS) is characterized by venous, microvascular and/or arterial and/or obstetric morbidity (obstetric APS) in patients who are persistently positive for antiphospholipid antibodies (aPL)[1]. The mainstay of treatment is based on anticoagulation therapy; however, increasing interest is currently received by the a...

Background The most frequent manifestation of arterial thrombosis in patients affected by Antiphospholipid syndrome (APS) is ischaemic stroke, especially in young adults (less than 50 years old) [1]. Young adults affected by APS are a group of patients at greater risk of developing serious stroke events and recurrences of thrombosis. Therefore, ris...

Introduction: The optimal management of oral contraception and menstrual bleeding during treatment of venous thromboembolism (VTE) is largely unknown. We aimed to elicit expert opinion and compare that to current practice as assessed by a world-wide international web-based survey among physicians. Methods: 10 international thrombosis experts and...