1
|
Zhou Y, Hu C, Qi W, Long Y, Huang C, Wang Q, Tian X, Zhao J, Li M, Zeng X. Anti-β2GPI-domain I antibody is associated with extra-criteria manifestations in a large prospective antiphospholipid syndrome cohort in China. Lupus Sci Med 2023; 10:e000924. [PMID: 37607781 PMCID: PMC10445380 DOI: 10.1136/lupus-2023-000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Anti-β2GPI-domain I (β2GPI-DI) antibody is pathogenic in patients with antiphospholipid syndrome (APS), but its additional clinical associations and diagnostic value are controversial. METHODS A total of 378 patients were included, of which 119 patients diagnosed with primary APS, 50 with APS secondary to SLE (SAPS group), 209 with SLE without APS (SLE group). Serum anti-β2GPI-DI IgG was measured using chemiluminescent immunoassay. Extra-criteria manifestations were analysed, including thrombocytopenia, autoimmune haemolytic anaemia, valvular lesions, APS nephropathy and non-vascular neurological manifestations. RESULTS In 169 patients with APS, 55 (32.5%) were positive for anti-β2GPI-DI IgG, accounting for 77.5% of those with anti-β2GPI IgG positivity. It is shown that 96.4% of those with anti-β2GPI-DI IgG also showed triple positivity in classic antiphospholipid antibodies (aPLs). The positivity of anti-β2GPI-DI IgG was significantly associated with recurrent thrombosis before APS diagnosis (p=0.015), microvascular thrombosis (p=0.038), but not with pregnancy morbidity (PM). Notably, patients with extra-criteria manifestations showed significantly higher positivity (p=0.001) and titres (p<0.001) in anti-β2GPI-DI IgG, especially for thrombocytopenia and APS nephropathy. In multivariable analysis, anti-β2GPI-DI IgG positivity (OR 2.94, 95% CI 1.29 to 6.70), secondary APS, arterial hypertension and Coombs' test positivity independently predicted extra-criteria manifestations (C-index 0.83, 95% CI 0.77 to 0.90). After a median follow-up of 25 months, patients with anti-β2GPI-DI IgG also showed a tendency of more extra-criteria events, but not thrombotic events. Anti-β2GPI-DI was positive among 8.1% of the SLE controls, and showed high specificity (91.9%) in diagnosing SAPS among patients with SLE as compared with classic aPLs. CONCLUSION Anti-β2GPI-DI IgG was associated with extra-criteria manifestations in patients with APS. Further studies are warranted to validate its predictive values and potential role in daily practice.
Collapse
Affiliation(s)
- Yangzhong Zhou
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
| | - Chaojun Hu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
| | - Wanting Qi
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
| | - Yin Long
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
| | - Can Huang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| |
Collapse
|
2
|
Analysis of Serbian Primary Antiphospholipid Syndrome Patients Confirmed a Strong Association Between Livedo Reticularis and Arterial Thrombosis: A National Cross-Sectional Cohort Study. J Clin Rheumatol 2022; 28:362-366. [PMID: 35697016 DOI: 10.1097/rhu.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is characterized by antiphospholipid antibodies (aPLs) associated with thrombosis (arterial and/or venous) and/or obstetrical manifestations. However, various manifestations, which are considered to be noncriteria manifestations, are frequently found in APS. AIM The purpose of this study was to evaluate whether noncriteria manifestations may be found more frequently in subjects with thrombotic and/or obstetrical APS ("criteria" manifestations) in a population of patients with primary APS (PAPS). This study presents the results from our national cohort. PATIENTS AND METHODS This is a cross-sectional study of 360 PAPS patients. Data regarding the presence of thrombocytopenia, livedo reticularis, chorea, and valvulopathy were analyzed. The aPL analysis included the detection of anticardiolipin antibodies (aCLs: immunoglobulin G [IgG]/IgM), anti-β 2 glycoprotein I (IgG/IgM), and lupus anticoagulant positivity. RESULTS In our cohort, livedo reticularis was significantly related to arterial thromboses in the same way as valvular manifestations (valvular vegetations and valvular thickening and dysfunction not related to age) ( p = 0.0001, p = 0.013, respectively). Age was strongly related to all the noncriteria manifestations analyzed. Thrombocytopenia was significantly related to β 2 glycoprotein I IgG and lupus anticoagulant positivity ( p = 0.043, p = 0.030, respectively), as well as to double and triple aPL positivity ( p = 0.041, p = 0.013 respectively). Moreover, in a multivariate model, livedo reticularis was strongly and independently related to arterial thrombosis in our cohort (odds ratio, 2.010; confidence interval, 1.229-3.288; p = 0.005). CONCLUSION This cross-sectional analysis of a large cohort of Serbian PAPS patients confirmed a strong relationship between livedo reticularis and arterial thrombosis, suggesting a more cautious approach regarding the presence of noncriteria manifestations, especially livedo reticularis, in APS.
Collapse
|
3
|
Huang C, Hu C, Zhao J, Wang Q, Tian X, Li M, Zeng X. Extra-criteria clinical manifestations of antiphospholipid antibody should not be ignored. Chin Med J (Engl) 2022; 135:2251-2252. [PMID: 35838406 PMCID: PMC9771157 DOI: 10.1097/cm9.0000000000002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 01/26/2023] Open
Affiliation(s)
- Can Huang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Chaojun Hu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| |
Collapse
|
4
|
Djokovic A, Stojanovich L, Stanisavljevic N, Djokic S, Filipovic B, Matic P, Milanovic M, Apostolovic S, Saponjski J. Cardiac manifestations in primary antiphospholipid syndrome and their association to antiphospholipid antibodies' types and titers-cross-sectional study of Serbian cohort. Clin Rheumatol 2022; 41:1447-1455. [PMID: 35018582 DOI: 10.1007/s10067-022-06056-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/28/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Antiphospholipid syndrome (APS) is multisystem autoimmune coagulopathy with antiphospholipid antibodies (aPL) in its ground, manifested as a primary disease (PAPS) or in the setting of other conditions, most commonly systemic lupus erythematosus. The objective of this cross-sectional study was to investigate various cardiac manifestations and their possible relation to aPL type and titer in a Serbian cohort of PAPS patients. METHODS A total of 360 PAPS patients were analyzed and aPL analysis included detection of anticardiolipin antibodies (aCL: IgG/IgM), anti-ß2glycoprotein I (ß2GPI: IgG/IgM), and lupus anticoagulant (LA). Cardiac manifestations investigated were valvular lesions (comprehending valvular thickening and dysfunction not related to age and pseudoinfective endocarditis), coronary artery disease (CAD) with specific insight for myocardial infarction (MI), chronic cardiomyopathy (CMP), and acute decompensated heart failure (ADHF) as well as pulmonary hypertension (PH) and intracardiac thrombus presence. RESULTS The prevalence of cardiac manifestations overall was 19.6%. There was a strong association between age and the majority of cardiac manifestations, as well as standard atherosclerotic risk factors. aCL IgG-positive patients had a higher prevalence of valvular lesions (p = 0.042). LA presence was significantly related to MI (p = 0.031) and PH (p = 0.044). CMP and ADHF were significantly related to higher titers of aCl IgG (p = 0.033, p = 0.025 respectively). Age and smoking were independent risk predictors for MI in PAPS with meaningful risk for LA positivity (OR 2.567 CI 0.671-9.820 p = 0.168). CONCLUSIONS Certain cardiac manifestations in PAPS were related to certain aPL type and/or titer levels, imposing confirmation in prospective studies. Preventive actions, comprehending proper anticoagulant/antithrombotic therapy, and intense action against standard atherosclerotic risk factors are of utmost importance in this group of patients. Key Points • In Serbian patients with primary antiphospholipid syndrome (PAPS), prevalence of non-criteria cardiac manifestations was 19.6% and they were significantly related to certain antiphospholipid antibodies and titers. • Lupus anticoagulant was a meaningful predictor of myocardial infarction, enabling possible risk stratification and proper preventive and therapeutical strategies in this subgroup of PAPS patients. • Patients with high titers of aCL IgG are more prone to acute decompensated heart failure occurence, imposing careful follow-up of these patients • Based on the analysis of the Serbian PAPS cohort, even being non-criterial, cardiology manifestations are significantly present and inclusion of cardiologists in treatment and follow-up of these patients should be implied from the diagnosis establishment.
Collapse
Affiliation(s)
- Aleksandra Djokovic
- Department of Cardiology, Division of Interventional Cardiology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Ljudmila Stojanovich
- Department of Rheumatology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - Natasa Stanisavljevic
- Department of Hematology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - Sandra Djokic
- Clinical Center of Serbia, Pulmonology Clinic, Belgrade, Serbia
| | - Branka Filipovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Gastroenterology, University Hospital Medical Center Dr Dragisa Misovic - Dedinje, Belgrade, Serbia
| | - Predrag Matic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Milomir Milanovic
- Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia
| | - Svetlana Apostolovic
- Department of Professional and Scientific Training, Cardiology Clinic, Clinical Center of Nis, Nis, Serbia.,School of Medicine, University of Nis, Nis, Serbia
| | - Jovica Saponjski
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Interventional Cardiology, Emergency Room, Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
5
|
Niznik S, Rapoport MJ, Avnery O, Lubetsky A, Shavit R, Ellis MH, Agmon-Levin N. Long Term Follow up of Patients With Primary Obstetric Antiphospholipid Syndrome. Front Pharmacol 2022; 13:824775. [PMID: 35529433 PMCID: PMC9068935 DOI: 10.3389/fphar.2022.824775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Primary obstetric antiphospholipid syndrome (OAPS) is defined by specific morbidities and/or losses of pregnancy in the presence of persistent antiphospholipid antibodies (aPL). This variant of APS is usually treated during pregnancy and the post-partum period. Data on occurrence of thrombotic event during long term follow-up of OAPS patients is limited. Methods: A multi-centre retrospectively cohort of female patients with primary APS (pAPS) was assembled during 2004–2019. Patients were grouped according to disease presentation as pure OAPS or thrombotic APS (tAPS) for those presenting with thrombosis. Clinical and serological data were compared between groups. Results: Of 219 pAPS female patients 67 (30.6%) were diagnosed with OAPS and 152 (69.4%) with tAPS. During >10 years of follow-up 24/67 (35.8%) OAPS and 71/152 (50%) tAPS suffered a new thrombotic event (p = 0.06), while obstetric morbidity was more likely in the OAPS group (31.3 vs. 10.5%, p < 0.001) respectively. Among patients with OAPS at presentation heart valve disease and the presence of ANA were related to thrombosis following diagnosis (25 vs. 4.7%, p = 0.02; and 45.8 vs. 20.8%, p = 0.04 respectively). Conclusion: Thrombotic event following diagnosis were common among female patients with pAPS regardless of disease presentation. Heart valve disease and ANA positivity may be risk factors for thrombosis during follow-up of patients presenting with pure OAPS.
Collapse
Affiliation(s)
- Stanley Niznik
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Micha J. Rapoport
- Department of Internal Medicine “C”, Shamir Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Avnery
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel
| | - Aharon Lubetsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The National Hemophilia Center and Thrombosis Unit, Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - Ronen Shavit
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Martin H. Ellis
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Nancy Agmon-Levin,
| |
Collapse
|
6
|
Udry S, Peréz SM, Belizna C, Aranda F, Esteve-Valverde E, Wingeyer SP, Fernández-Romero DS, Latino JO, de Larrañaga G, Alijotas-Reig J. Clinical and therapeutic value of the adjusted Global Antiphospholipid Syndrome Score in primary obstetric antiphospholipid syndrome. Lupus 2022; 31:354-362. [PMID: 35157809 DOI: 10.1177/09612033221078223] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To assess the clinical utility of the adjusted global antiphospholipid syndrome score (aGAPSS) to predict new obstetric events during follow-up in primary obstetric antiphospholipid syndrome (POAPS) patients under standard-of-care treatment (SC) based on the use of low-dose aspirin (LDA) + heparin and (2) to study the risk of a first thrombotic event and to evaluate whether stratification according to this score could help to identify POAPS patients who would benefit from long-term thromboprophylaxis. METHODS This is a retrospective, multicentre study. 169 women with POAPS were evaluated for the presence of a new obstetric event and/or a first thrombotic event during follow-up [time period: 2008-2020, median: 7 years (6-12 years)]. The outcomes of 107 pregnancies from these POAPS patients with SC were studied to evaluate relapses. Simple and multivariable logistic regression analyses were performed. RESULTS Regarding obstetric morbidity, only triple positivity for antiphospholipid antibodies (aPLs) [OR = 8.462 (95% CI: 2.732-26.210); p < 0.0001] was found to be a strong risk factor independently associated with treatment failure. On the other hand, triple positivity for aPLs [OR=10.44 (95% CI: 2.161-50.469), p = 0.004] and an aGAPSS ≥7 [OR = 1.621 (95% CI: 1.198-2.193), p = 0.002] were independent risk factors associated with a first thrombotic event. LDA was marginally associated with a decrease in the risk of thrombosis only in patients with aGAPSS ≥ 7 (p = 0.048). CONCLUSION aGAPSS appears to be useful in predicting the occurrence of a first thrombotic event in POAPS patients, and these stratification of patients could be helpful in selecting patients who would benefit from thromboprophylaxis with LDA.
Collapse
Affiliation(s)
- Sebastián Udry
- Autoimmune, Thrombophilic Diseases and Pregnancy Section, Ringgold:62886Acute Hospital "Dr. Carlos G. Durand", City of Buenos Aires, Argentina.,Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
| | - Stephanie Morales Peréz
- Internal Medicine Department, Althaia Healthcare University Network of Manresa, Systemic Autoimmune Disease Unit, Manresa, Barcelona
| | - Cristina Belizna
- Internal Medicine Department Clinique de l'Anjou, Angers, Vascular and Coagulation Department, University Hospital Angers, Angers, France.,UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Federico Aranda
- Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
| | - Enrique Esteve-Valverde
- Internal Medicine Department, Althaia Healthcare University Network of Manresa, Systemic Autoimmune Disease Unit, Manresa, Barcelona
| | - Silvia Perés Wingeyer
- Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
| | - Diego S Fernández-Romero
- Autoimmune, Thrombophilic Diseases and Pregnancy Section, Ringgold:62886Acute Hospital "Dr. Carlos G. Durand", City of Buenos Aires, Argentina
| | - José O Latino
- Autoimmune, Thrombophilic Diseases and Pregnancy Section, Ringgold:62886Acute Hospital "Dr. Carlos G. Durand", City of Buenos Aires, Argentina
| | - Gabriela de Larrañaga
- Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, and Vall d'Hebron Research Unit, Vall d'Hebron University Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW To review the recent available evidence on epidemiology, pathogenesis, clinical phenotypes, and management of antiphospholipid syndrome (APS) and summarize potential future research perspectives. RECENT FINDINGS Accumulating evidence has further expanded our understanding of the disease, including new data about the incidence and prevalence of APS, novel pathways supporting the role of thrombo-inflammation in APS including platelet, monocyte and endothelial cell activation, pro-inflammatory cytokine and chemokine production, complement activation, neutrophil extracellular trap release, and type I interferon gene expression that could yield to new potential treatment targets, better identification of criteria and non-criteria clinical phenotypes, antiphospholipid antibody profiles and their associations with clinical outcomes, prognostic tools, and treatment strategies based on recent evidence-based recommendations for patients with thrombotic and obstetric APS, with or without systemic lupus erythematosus. Ongoing research efforts and international collaborations enhance our knowledge of this rare and often devastating syndrome and help improve patient care and health outcomes.
Collapse
Affiliation(s)
- Eleni Xourgia
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Department of Propaedeutic Internal Medicine, Medical School, Rheumatology UnitJoint Academic Rheumatology Program - EULAR Centre of Excellence'Laiko' Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma str, 11527, FirstAthens, Greece.
| |
Collapse
|
8
|
Ricard L, Laurent C, Papo M, Deriaz S, Catano J, Alamowitch S, Kayem G, Chasset F, De Moreuil C, Boffa JJ, Gerotziafas G, Elalamy I, Bornes M, Maillot F, Audemard-Verger A, Planche V, Ballot E, Fain O, Mekinian A. Clinical and prognostic significance of antinuclear antibodies in primary antiphospholipid syndrome: A multicenter retrospective study. Joint Bone Spine 2021; 89:105297. [PMID: 34656751 DOI: 10.1016/j.jbspin.2021.105297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The antiphospholipid syndrome (APS) (1) is defined by the development of vascular thrombosis, or pregnancy morbidity in the presence of persistent antiphospholipid antibodies (aPL). Antinuclear antibodies (ANA) can be detected in primary APS patients without any clinical systemic autoimmune disease. The presence of ANA antibodies could confer a specific phenotype in primary APS. OBJECTIVE To evaluate the characteristics of APS patients with antinuclear antibodies without other autoimmune disease (ANA positive APS patients) in comparison with primary APS without ANA or secondary APS patients with associated systemic lupus erythematosus (SLE). METHODS Clinical and biologic data from 195 APS were retrospectively collected and patients were classified as primary APS with positive ANA (ANA-positive APS), primary APS without any ANA (ANA-negative APS), and SLE-associated APS (SLE-APS). RESULTS Fourty patients (21%) were classified into ANA-positive APS group, 77 (39%) in ANA-negative APS and 78 (40%) in SLE-APS. In ANA-positive APS patients, 20 patients (51%) had arterial thrombosis, 14 (41%) had veinous thrombosis and 19% had obstetrical complications. There was no difference between the three groups for the frequency of thrombotic manifestations and obstetrical complications. ANA-positive APS patients had more non-criteria manifestations than ANA-negative APS (48% versus 25%; P≤0.01). ANA-positive APS had more triple aPL positivity (59% versus 18%; P<0.001) and more thrombosis and obstetrical recurrences (63% versus 36%; P<0.01) in comparison with ANA-negative APS patients. ANA-positive APS had more triple aPL positivity than SLE-APS patients (54% versus 33%; P<0.05). ANA-positive APS and SLE-APS patients had similar clinical manifestations, and recurrences. Despite a limited follow-up (28 months (11-50)) none of the ANA-positive APS develop SLE. Antiplatelet and anticoagulant therapies were similar for the three groups. SLE-APS patients received more immunomodulatory therapies. CONCLUSION ANA positivity in patients with APS enables to individualize a subset of patients with a more severe phenotype. Whereas the ANA positivity does not seem to be associated with the risk to develop SLE, prospective studies with a longer follow-up are necessary, in particular to evaluate the effect of additional therapies in this subset of APS.
Collapse
Affiliation(s)
- Laure Ricard
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Charlotte Laurent
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Matthias Papo
- Médecine interne institut e3m, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Sophie Deriaz
- Médecine interne, CHRU Hôpitaux de Tours, Tours, France
| | - Jennifer Catano
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Sonia Alamowitch
- Service de neurologie et d'urgences neurovasculaires, hôpital Saint-Antoine, Paris, France
| | - Gilles Kayem
- Obstétrique, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - François Chasset
- Service de dermatologie, faculté de médecine, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | | | | | - Grigorios Gerotziafas
- Inserm UMR-S938 Cancer Biology and Therapeutics, Research Group "Cancer-Hemostasis-Angiogenesis" CRSA, institut universitaire de Cancérologie, Sorbonne université, Paris, France; Department of thrombosis and haemostasis, service d'hématologie Biologique, faculté de médecine, hôpital Tenon, hôpitaux universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France
| | - Ismail Elalamy
- Inserm UMR-S938 Cancer Biology and Therapeutics, Research Group "Cancer-Hemostasis-Angiogenesis" CRSA, institut universitaire de Cancérologie, Sorbonne université, Paris, France; I M Sechenov First Moscow State Medical University, Department of Obstetrics and Gynecology, Moscow, Russia
| | - Marie Bornes
- Department of thrombosis and haemostasis, service d'hématologie Biologique, faculté de médecine, hôpital Tenon, hôpitaux universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France
| | | | | | | | - Eric Ballot
- Immunologie biologique, hôpital Saint-Antoine, Paris, France
| | - Olivier Fain
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - Arsène Mekinian
- Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France.
| |
Collapse
|
9
|
Gkrouzman E, Sevim E, Finik J, Andrade D, Pengo V, Sciascia S, Tektonidou MG, Ugarte A, Chighizola CB, Belmont HM, Lopez-Pedrera C, Ji L, Fortin P, Efthymiou M, de Jesus GR, Branch DW, Nalli C, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Bertolaccini ML, Cohen H, Rand J, Erkan D. Antiphospholipid Antibody Profile Stability Over Time: Prospective Results From the APS ACTION Clinical Database and Repository. J Rheumatol 2021; 48:541-547. [PMID: 33259328 PMCID: PMC10727093 DOI: 10.3899/jrheum.200513] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The APS ACTION Registry studies long-term outcomes in persistently antiphospholipid antibody (aPL)-positive patients. Our primary objective was to determine whether clinically meaningful aPL profiles at baseline remain stable over time. Our secondary objectives were to determine (1) whether baseline characteristics differ between patients with stable and unstable aPL profiles, and (2) predictors of unstable aPL profiles over time. METHODS A clinically meaningful aPL profile was defined as positive lupus anticoagulant (LAC) test and/or anticardiolipin (aCL)/anti-β2 glycoprotein-I (anti-β2-GPI) IgG/M ≥ 40 U. Stable aPL profile was defined as a clinically meaningful aPL profile in at least two-thirds of follow-up measurements. Generalized linear mixed models with logit link were used for primary objective analysis. RESULTS Of 472 patients with clinically meaningful aPL profile at baseline (median follow-up 5.1 yrs), 366/472 (78%) patients had stable aPL profiles over time, 54 (11%) unstable, and 52 (11%) inconclusive. Time did not significantly affect odds of maintaining a clinically meaningful aPL profile at follow-up in univariate (P = 0.906) and multivariable analysis (P = 0.790). Baseline triple aPL positivity decreased (OR 0.25, 95% CI 0.10-0.64, P = 0.004) and isolated LAC test positivity increased (OR 3.3, 95% CI 1.53-7.13, P = 0.002) the odds of an unstable aPL profile over time. CONCLUSION Approximately 80% of our international cohort patients with clinically meaningful aPL profiles at baseline remain stable at a median follow-up of 5 years; triple aPL-positivity increase the odds of a stable aPL profile. These results will guide future validation studies of stored blood samples through APS ACTION Core Laboratories.
Collapse
Affiliation(s)
- Elena Gkrouzman
- E. Gkrouzman, MD, MS, Hospital for Special Surgery, New York, New York, USA;
| | - Ecem Sevim
- E. Sevim, MD, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, New York, USA
| | - Jackie Finik
- J. Finik, MPH, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danieli Andrade
- D. Andrade, MD, PhD, University of São Paulo, São Paulo, Brazil
| | | | - Savino Sciascia
- S. Sciascia, MD, PhD, Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Maria G Tektonidou
- M.G. Tektonidou, MD, PhD, National and Kapodistrian University of Athens, Athens, Greece
| | - Amaia Ugarte
- A. Ugarte, MD, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Cecilia B Chighizola
- C.B. Chighizola, MD, PhD, Clinical Immunology & Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - H Michael Belmont
- H.M. Belmont, MD, Hospital for Joint Diseases, New York University, New York, New York, USA
| | - Chary Lopez-Pedrera
- C. Lopez-Pedrera, PhD, Rheumatology Service, IMIBIC/Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Lanlan Ji
- L. Ji, MD, Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - Paul Fortin
- P. Fortin, MD, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Maria Efthymiou
- M. Efthymiou, PhD, H. Cohen, MD, Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - D Ware Branch
- D.W. Branch, MD, University of Utah and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Cecilia Nalli
- C. Nalli, MD, Rheumatology and Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michelle Petri
- M. Petri, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esther Rodriguez
- E. Rodriguez, MD, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ricard Cervera
- R. Cervera, MD, PhD, FRCP, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jason S Knight
- J.S. Knight, MD, PhD, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tatsuya Atsumi
- T. Atsumi, MD, PhD, Hokkaido University Hospital, Sapporo, Japan
| | - Rohan Willis
- R. Willis, MD, Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Maria Laura Bertolaccini
- M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Hannah Cohen
- M. Efthymiou, PhD, H. Cohen, MD, Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Jacob Rand
- J. Rand, MD, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Doruk Erkan
- D. Erkan, MD, MPH, Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
10
|
El Hasbani G, Taher AT, Sciascia S, Uthman I. Antiphospholipid syndrome: the need for new international classification criteria. Expert Rev Clin Immunol 2021; 17:385-394. [PMID: 33682558 DOI: 10.1080/1744666x.2021.1900733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: As soon as the association of lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL) with thrombosis and miscarriages was described in the 1980s, the definition of the antiphospholipid syndrome (APS) became a need. Early descriptions of the disease by members of the Graham Hughes team included broad categories and unexplained laboratory inclusions. Over time, new clinical and experimental data refined the criteria, especially the obstetric manifestations, as well as the laboratory criteria.Areas covered: The authors performed a review of the literature using the PubMed database, and the following keywords were used: 'antiphospholipid antibody', 'antiphospholipid syndrome', and 'criteria of antiphospholipid'. The history of antiphospholipid criteria, clinical and experimental advancements, and other expert opinions were included in this paper.Expert opinion: It has been 14 years since an international congress on antiphospholipid antibodies has generated new classification based on the recent extensive research performed in the field. Currently, there is a need to update the international APS classification taking into consideration the inclusion of new clinical criteria such as aPL-related nephropathy as well as new standardized antibody specificities (e.g., anti-phosphatidylserine/prothrombin antibodies) with the adoption of a standardized scoring system that can stratify APS patients.
Collapse
Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases and SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|