Polymyositis anti-SRP antibodies and pregnancy about 2 cases

Anti-SRP myopathy represents 4 to 6% of all the inflammatory myopathies. It has been described since the 80s and its influence on pregnancy and vice versa has been highlighted recently. We report two cases of anti-SRP myopathy associated with pregnancy. In the first case, the initial manifestations of the disease started in post partum and the second case was an anti-SRP myopathy patient before pregnancy. In both cases we objectified outbreaks during post-partum. Pregnancy seems to promote outbreaks. The inactive myopathy seems to presents no serious maternal-fetal complications as well as the usual dose of corticosteroids. The treatment (corticosteroid) during pregnancy is indicated given the risk of worsening during the post-partum.


Introduction
Anti-SRP myopathies are rare, they represent 4-6% of all inflammatory myopathies [1]. This is a condition characterized by symmetrically impairment of the proximal muscles with severe heterogeneous evolution, refractory to corticosteroid [2]. The association with pregnancy including post partum is rarely described in fact the first case was reported recently [2]. We report two cases of anti-SRP myopathy whose outbreaks occurred in the post-partum leading to the question of the role of pregnancy on their onset and vice versa. Indeed few studies have been done about this form. mg. The treatment has been well tolerated clinically and biologically, without muscle paresis improvement. She has been discharged on corticosteroid and associated treatment.

Discussion
The diagnosis of anti-SRP antibody myopathy was done based on the conditions chosen by Authier [3]: high CPK level; positive serum anti-SRP antibodies; a more proximal muscle weakness; no skin and joint manifestations; results of EMG, MRI and histology. The anti-SRP antibody myopathy only affects adults with a median age of 36 years (36 to 72 years). It is more common in women with a sex ratio of 0.2. [4] The association pregnancy and anti-SRP antibody myopathy has been rarely reported, the first case has been reported by Resseguier A.S. et al in 2013 [2]. This is seems to be due to the rarity of these conditions and high frequency of occurrence after 40 years [5]. Only 14% of patients are childbearing age at the diagnosis [6] but also by the severity of symptoms which can lead to advice against pregnancy. About 60 cases of pregnancies have been describe in patients with myopathies of different etiology [2].
Our first observation was anti-SRP antibodies myopathy whose signs with dermatomyositis and polymyositis and concluded that most myositis is active during pregnancy , the greater the risk of fetal complications is high [7]. Indeed, in case of remission, proceeds without complication generally unlike the active phase where it can be noted complicated with intrauterine growth retardation, prematurity [2]. This is consistent with our observation because none of our patients had no complications and maternal / fetal or. Treatment with corticosteroids usual dose in case of risk of maternal and fetal complications can be implemented [8]. Indeed the complications of this treatment may frequently [2] and the occurrence of postpartum pushed is a reality, our two patients had presented a pushed to the waning of childbirth with a worsening of symptoms in Case N o 2. the main complications of corticosteroids are not different from those observed in the general population with mainly diabetes, high blood pressure and infections [2]. Polymyositis does not increase labor complications in our patients because all have 2 vaginal delivery of a healthy child if that had required a cesarean is a woman 39 years old. [2]. A notable feature lab can probably reflect the active myopathic process was the determination of CPK returning higher.
[9] This examination can be used to assess disease activity for therapeutic adjustment and reduce the risks driven in these patients. The anti-SRP antibodies appear to be correlated with CPK [10].

Conclusion
Pregnancy seems to be a cause of genesis of outbreaks of polymyositis with anti-SRP antibodies. Given this fact and the possibility of maternal and fetal complications setting corticosteroids during pregnancy is an alternative for these patients.