Testing for antibody to double-stranded DNA antigen (anti-dsDNA) and antibody to Sm nuclear antigen (anti-Sm) may be helpful in patients who have a positive ANA test but do not meet full criteria for the diagnosis of systemic lupus erythematosus. AntidsDNA and anti-Sm, particularly in high titers, have high specificity for systemic lupus erythematosus, although their sensitivity is low. Therefore, a positive result helps to establish the diagnosis of the disease, but a negative result does not rule it out. 46 The CAP guideline recommends against testing for other autoantibodies in ANA-positive patients, because there is little evidence that these tests are of benefit. 46
Successful pregnancy is possible. It should be planned when the disease is stable to avoid complications. Teratogenic medication should be stopped. Close monitoring, multidisciplinary care and individually tailored treatment are needed. Reflux is the most common problem. The most dangerous complication is scleroderma renal crisis. ACE inhibitors may be used in pregnancy if renal crisis is suspected. Outcomes on the whole are good although there is a risk of prematurity. Pregnancy should be avoided in the presence of PAH, in severe organ involvement or in the early stages of rapidly progressive diffuse disease as these situations are associated with high risk.