1
|
Dar S, Koirala S, Khan A, Bellary MD, Patel AV, Mathew B, Singh R, Baigam N, Razzaq W, Abdin ZU, Khawaja UA. A Comprehensive Literature Review on Managing Systemic Lupus Erythematosus: Addressing Cardiovascular Disease Risk in Females and Its Autoimmune Disease Associations. Cureus 2023; 15:e43725. [PMID: 37727166 PMCID: PMC10505685 DOI: 10.7759/cureus.43725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
This review aimed to evaluate the mechanism of premature cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) patients, particularly in the female population, and emphasize the need for early management interventions; explore the association between SLE and two autoimmune diseases, myasthenia gravis (MG) and antiphospholipid antibody syndrome (APS), and their management strategies; and evaluate the effectiveness of pharmacological and non-pharmacological interventions in managing SLE, focusing on premenopausal females, females of childbearing age, and pregnant patients. We conducted a comprehensive literature review to achieve these objectives using various databases, including PubMed, Google Scholar, and Cochrane. The collected data were analyzed and synthesized to provide an evidence-based overview of SLE, its management strategies as an independent disease, and some disease associations. The treatment should be focused on remission, preventing organ damage, and improving the overall quality of life (QOL). Extensive emphasis should also be focused on diagnosing SLE and concurrent underlying secondary diseases timely and managing them appropriately.
Collapse
Affiliation(s)
- Saleha Dar
- Department of Adult Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sabina Koirala
- Department of Medicine, Gandaki Medical College, Pokhara, NPL
| | - Arooba Khan
- Department of Internal Medicine, Khyber Medical College, Peshawar, PAK
| | | | - Arya V Patel
- Department of Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Bejoi Mathew
- Department of Internal Medicine, Sri Devaraj Urs Medical College, Kolar, IND
| | - Rahul Singh
- Department of Medicine, Armed Forces Medical College, Pune, IND
| | - Nahida Baigam
- Department of Medicine, Association of Physicians of Pakistani Descent of North America (APPNA), Westmont, USA
| | - Waleed Razzaq
- Department of Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Zain U Abdin
- Department of Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Uzzam Ahmed Khawaja
- Department of Pulmonary and Critical Care Medicine, Jinnah Medical and Dental College, Karachi, PAK
- Department of Clinical and Translational Research, Dr. Ferrer BioPharma, South Miami, USA
| |
Collapse
|
2
|
Hughes G. What's still unresolved in Hughes syndrome? Lupus 2023:9612033231180362. [PMID: 37263798 DOI: 10.1177/09612033231180362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Graham Hughes
- London Lupus Centre, London Bridge Hospital, London, UK
| |
Collapse
|
3
|
Schofield JR, Hassell KL. What you need to know about migraine in Hughes syndrome patients. Lupus 2023; 32:319-324. [PMID: 36708185 DOI: 10.1177/09612033231153790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Headache, often migrainous, is common in patients with antiphospholipid antibodies, whether or not they meet Sydney criteria for a definite diagnosis of Hughes syndrome. Migraine may be a harbinger of stroke in this patient population and even refractory migraine may be highly responsive to antithrombotic therapy in this clinical context. PURPOSE To summarize what is known to date about managing this important manifestation of the immune-mediated hypercoagulable Hughes syndrome. RESULTS We provide a suggested management algorithm for refractory headache in this unique patient population. CONCLUSION Most neurologists don't see or recognize many aPL-positive patients in their practice, so hematologists and rheumatologists who see these patients should recognize that refractory headache may be a manifestation of their immune-mediated hypercoagulable disorder and understand that the potential risks of not addressing this issue may be high.
Collapse
Affiliation(s)
- J R Schofield
- Center for Multisystem Disease, Denver, CO, USA.,Department of Medicine, 129263University of Colorado, Aurora, CO, USA
| | - K L Hassell
- Department of Medicine, Division of Hematology, 12225University of Colorado, Aurora, CO, USA
| |
Collapse
|
4
|
Stewart S, Brenton-Rule A, Dalbeth N, Aiyer A, Frampton C, Rome K. Foot and ankle characteristics in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:847-859. [PMID: 30093237 DOI: 10.1016/j.semarthrit.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/14/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine characteristics of the foot and ankle in people with systemic lupus erythematosus (SLE). METHODS Medline, CINAHL, Sports-Discus, Scopus and Cochrane Library databases were searched up to January 2018. Studies reporting foot- and ankle-related outcomes in the following domains were included: vascular, neurological, musculoskeletal, cutaneous (skin and nail) or pain/function. The Quality Index tool was used to assess methodological quality. Where appropriate, odds ratio (OR) and mean difference meta-analyses were conducted for case-control studies; and pooled mean prevalence meta-analyses for studies assessing characteristics in SLE. RESULTS Forty-nine studies were included with mean (range) quality scores of 75% (38-100%). Twenty-three studies assessed vascular characteristics, followed by musculoskeletal (n = 16), neurological (n = 11), cutaneous (n = 5) and pain/function (n = 4). Foot and ankle characteristics in people with SLE included impaired vascular supply, abnormal nerve function, musculoskeletal pathology, skin and nail pathology, and pain and functional disability. Twenty-four studies were included in meta-analyses. Pooled OR for abnormal ankle brachial index was 3.08 for SLE compared with controls. Pooled mean difference in brachial-ankle pulse-wave velocity between SLE and controls was significant (161.39 cm/s, P = 0.004). Pooled prevalence was 0.54 for intermittent claudication, 0.50 for Raynaud's phenomenon, 0.28 for chilblains, 0.00 for gangrene, 0.30 for hallux valgus, 0.15 for onychomycosis, 0.76 for history of foot pain, and 0.36 for current foot pain. CONCLUSION People with SLE experience a wide range of foot and ankle manifestations. Published research highlights the impact of peripheral arterial disease, peripheral neuropathy, musculoskeletal deformity, skin and nail pathology and patient-reported foot pain and disability.
Collapse
Affiliation(s)
- Sarah Stewart
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Angela Brenton-Rule
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Department of Rheumatology, Auckland District Health Board, New Zealand
| | - Ashok Aiyer
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Christopher Frampton
- Biostatistics Department, University of Otago, PO Box 7343, Wellington South, New Zealand
| | - Keith Rome
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| |
Collapse
|
5
|
Canella C, Costa F, Danowisk A, de Melo ASA, Marchiori E. Stress fracture and osteomyelitis in a patient with systemic lupus erythematosus. Radiol Bras 2018; 51:277-278. [PMID: 30202140 PMCID: PMC6124598 DOI: 10.1590/0100-3984.2017.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2024] Open
Affiliation(s)
- Clarissa Canella
- Clínica de Diagnóstico Por Imagem (CDPI), Rio de
Janeiro, RJ, e Universidade Federal Fluminense (UFF), Niterói, RJ,
Brazil
| | - Flavia Costa
- Clínica de Diagnóstico Por Imagem (CDPI), Rio de
Janeiro, RJ, Brazil
| | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
| |
Collapse
|
6
|
Affiliation(s)
- M H A Noureldine
- 1 Department of Neurosurgery, Lebanese American University Medical Center, Beirut, Lebanon
| | - I Uthman
- 2 Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
7
|
Vasoo S, Sangle S, Zain M, D'Cruz D, Hughes G. Orthopaedic manifestations of the antiphospholipid (Hughes) syndrome. Lupus 2016; 14:339-45. [PMID: 15934432 DOI: 10.1191/0961203305lu2146rr] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The antiphospholipid (Hughes) syndrome (APS), is characterized by arterial and/or venous thrombosis and pregnancy morbidity in association with antiphospholipid antibodies (aPL). Since its classical description 21 years ago, the clinical spectrum of Hughes syndrome has embraced the realms of obstetrics, nephrology, cardiology, neurology, gastroenterology and now, possibly orthopaedics. This is not surprising, given that this disease can affect virtually any organ system and blood vessel of any size and nature. Just as venous thrombosis may affect limbs and internal organs, arterial thrombosis has been shown to affect organs such as the brain, eye, heart, kidney, liver and may also involve the skeleton. In this review, the skeletal aspects of Hughes syndrome, postulated pathogenesis and possible implications of anticoagulation will be discussed. Finally, the approach to APS patients undergoing orthopaedic surgery shall also be outlined.
Collapse
Affiliation(s)
- S Vasoo
- The Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK
| | | | | | | | | |
Collapse
|
8
|
Noureldine MHA, Khamashta MA, Merashli M, Sabbouh T, Hughes GRV, Uthman I. Musculoskeletal manifestations of the antiphospholipid syndrome. Lupus 2016; 25:451-62. [DOI: 10.1177/0961203316636467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/01/2016] [Indexed: 11/17/2022]
Abstract
The scope of clinical and laboratory manifestations of the antiphospholipid syndrome (APS) has increased dramatically since its discovery in 1983, where any organ system can be involved. Musculoskeletal complications are consistently reported in APS patients, not only causing morbidity and mortality, but also affecting their quality of life. We reviewed all English papers on APS involvement in the musculoskeletal system using Google Scholar and Pubmed; all reports are summarized in a table in this review. The spectrum of manifestations includes arthralgia/arthritis, avascular necrosis of bone, bone marrow necrosis, complex regional pain syndrome type-1, muscle infarction, non-traumatic fractures, and osteoporosis. Some of these manifestations were reported in good quality studies, some of which showed an association between aPL-positivity and the occurrence of these manifestations, while others were merely described in case reports.
Collapse
Affiliation(s)
- M H A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - M A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College University, London, UK
| | - M Merashli
- Division of Rheumatology, The Royal London Hospital, London, UK
| | - T Sabbouh
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - G R V Hughes
- London Lupus Center, London Bridge Hospital, London, UK
| | - I Uthman
- Division of Rheumatology, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
9
|
Hughes GRV. Hughes syndrome/APS. 30 years on, what have we learnt? Opening talk at the 14th International Congress on antiphospholipid antibodies Rio de Janiero, October 2013. Lupus 2014; 23:400-6. [PMID: 24619623 DOI: 10.1177/0961203314522341] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
Feasibility of measurement of bone turnover markers in female patients with systemic lupus erythematosus. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 55:133-9. [PMID: 25583000 DOI: 10.1016/j.rbr.2014.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/04/2014] [Accepted: 10/06/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of bone turnover markers (BTMs) for the assessment of bone metabolism in patients with systemic lupus erythematosus (SLE), according to the guidelines of the International Osteoporosis Foundation and the International Federation of Clinical Chemistry and Laboratory Medicine. METHODS The study included 43 female SLE patients. Serum procollagen type I N propeptide (PINP), C-terminal telopeptide of type I collagen (CTX), osteocalcin, PTH, 25(OH)D, anti-cardiolipin, anti-dsDNA, and anti-nucleosome levels were measured. RESULTS PINP and CTX levels were elevated in SLE patients aged > 45 in comparison to those aged < 45, although with borderline significance (p = 0.05, respectively). Correlations were found between BTMs: the strongest being between PINP and osteocalcin (τ = 0.69, p < 0.05). PINP and osteocalcin were found to be associated with PTH (τ = 0.3, τ = 0.29, respectively, p < 0.05). Age correlated with PINP (τ = 0.23, p < 0.05). Elevated PINP was found more frequently than elevated osteocalcin or CTX, both in patients aged < 45 (p = 0.001) and > 45 (p < 0.001). No significant difference in PINP, osteocalcin or CTX levels was found with respect to season, neither in the entire SLE group, nor in the under-45 or over-45 groups. Previous glucocorticoid treatment was not associated with difference in BTMs. CONCLUSIONS Increased BTMs in SLE appear to predominantly reflect the pattern of bone remodeling related to age. Increased PINP is expected to be the most frequent outcome among BTMs. Better diagnoses of bone disturbances with BTMs performed in accordance with international reference standards need to be included in the approach to SLE patients, in addition to bone mineral density assessment.
Collapse
|
11
|
O'Neill BJ, Sweeney LA, Moroney PJ, Mulhall KJ. Atypical stress-avulsion fracture of the Lisfranc joint complex. Foot Ankle Spec 2014; 7:155-8. [PMID: 24521754 DOI: 10.1177/1938640014521832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury.
Collapse
Affiliation(s)
- Barry J O'Neill
- Department of Trauma and Orthopaedics, Mater Misericordiae University Hospital, Ireland
| | | | | | | |
Collapse
|
12
|
Schofield JR, Blitshteyn S, Shoenfeld Y, Hughes GRV. Postural tachycardia syndrome (POTS) and other autonomic disorders in antiphospholipid (Hughes) syndrome (APS). Lupus 2014; 23:697-702. [DOI: 10.1177/0961203314524468] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/28/2014] [Indexed: 12/29/2022]
Abstract
Background Antiphospholipid syndrome (APS) is an autoimmune hypercoagulable disorder that has been shown to cause a large number of cardiac and neurological manifestations. Two recent studies have demonstrated abnormalities in cardiovascular autonomic function testing in APS patients without other cardiovascular or autoimmune disease. However, an association between autonomic disorders such as postural tachycardia syndrome and APS has not previously been described. Methods and results Data were obtained by retrospective chart review. We identified 15 patients who have been diagnosed with APS and an autonomic disorder. The median age of the patients at the time of data analysis was 39 years. The autonomic disorders seen in these patients included postural tachycardia syndrome, neurocardiogenic syncope and orthostatic hypotension. The majority of patients (14/15) were female and the majority (14/15) had non-thrombotic neurological manifestations of APS, most commonly migraine, memory loss and balance disorder. Many also had livedo reticularis (11/15) and Raynaud’s phenomenon (nine of 15). In some patients, the autonomic manifestations improved with anticoagulation and/or anti-platelet therapy; in others they did not. Two patients with postural tachycardia syndrome who failed to improve with the usual treatment of APS have been treated with intravenous immunoglobulin with significant improvement in their autonomic symptoms. Conclusion We believe that autonomic disorders in APS may represent an important clinical association with significant implications for treatment.
Collapse
Affiliation(s)
- JR Schofield
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - S Blitshteyn
- Department of Neurology, State University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Y Shoenfeld
- Sackler Faculty in Medicine, Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - GRV Hughes
- The London Lupus Centre, London Bridge Hospital, London, UK
| |
Collapse
|
13
|
|
14
|
Villiers J, Khamashta M, Hepburn A. Recurrent atraumatic metatarsal, rib and sacral insufficiency fractures in a woman with the antiphospholipid syndrome. BMJ Case Rep 2013; 2013:bcr-2013-201311. [PMID: 24172778 DOI: 10.1136/bcr-2013-201311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Antiphospholipid syndrome (APS) is characterised by recurrent arterial and/or venous thromboses and recurrent late miscarriages in the presence of antiphospholipid antibodies, and can be a hugely debilitating disorder. While the commonest thrombotic manifestations of this condition such as deep vein thrombosis and stroke are well documented, there has been increasing recognition of numerous less common complications in most organ systems. We present a female patient with APS and a lupus-like illness who had atraumatic sacral fractures as well as multiple spontaneous fractures affecting her ribs and the metatarsals in both her feet.
Collapse
|
15
|
Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD. Manifestations of systemic lupus erythematosus. MAEDICA 2011; 6:330-336. [PMID: 22879850 PMCID: PMC3391953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic, multifaceted autoimmune inflammatory disease that can affect any part of the body. SLE is a disease of unknown aetiology with a variety of presenting features and manifestations. Interest in the disease has been stimulated in recent years, and improved methods of diagnosis have resulted in a significant increase in the number of cases recognized. It is apparent that it can no longer be regarded as a rare disease. The majority of the pathology in SLE is related to deposits of immune complexes in various organs, which triggers complement and other mediators of inflammation. Symptoms vary from person to person, and may come and go, depend on what part of the body is affected, can be mild, moderate, or severe. Diagnosis can be difficult because lupus mimics many other diseases; it requires clinical and serologic criteria.
Collapse
Affiliation(s)
- Manole Cojocaru
- "Titu Maiorescu" University, Faculty of Medicine, Department of Physiology, Center for Rheumatic Diseases, Bucharest
| | | | | | | |
Collapse
|
16
|
Hughes syndrome (the antiphospholipid syndrome): a disease of our time. Inflammopharmacology 2010; 19:69-73. [PMID: 21132565 DOI: 10.1007/s10787-010-0071-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
Abstract
A pro-thrombotic condition was described in 1983 which was characterised by the presence of circulating antiphospholipid antibodies, as well as peripheral thrombosis (e.g. DVT), a tendency to internal organ involvement, repeated miscarriage, and, occasionally, thrombocytopenia (aPL) (Hughes, Br Med J 287:1088-1089, 1983). Previously, there had been a number of observations, mainly in patients with lupus having "false positive" tests for syphilis, miscarriage and circulating lupus anticoagulants. The description in 1983 had three notable features (a) a detailed comprehensive clinical picture of the syndrome; (b) this description differed from other coagulopathies in showing a propensity for arterial thrombosis (e.g. stroke and heart attack); and (c) this was a syndrome quite independent from lupus. There are indications that the primary antiphospholipid syndrome will turn out to be more common than lupus, though this could still be a reflection of referral practice.
Collapse
|
17
|
Abstract
This year in Galveston, Texas, Silvia Pierangeli hosts the 13th International Congress on Antiphospholipid Antibodies. Twenty-six years after the first antiphospholipid syndrome meeting, the number of interested colleagues has multiplied, and the subject has become more scientifically understood. So also has the clinical picture. In this short contribution, I will highlight a number of clinical observations which may, or may not, contribute to our understanding of antiphospholipid syndrome.
Collapse
Affiliation(s)
- G R V Hughes
- The London Lupus Centre, London Bridge Hospital, London, UK.
| |
Collapse
|
18
|
Alecsandru D, Fernandez-Cruz E, Carbone J. Non-traumatic metatarsal fracture: Uncommon complication of primary antiphospholipid syndrome. Rev Clin Esp 2010; 210:310-1. [DOI: 10.1016/j.rce.2009.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 07/30/2009] [Accepted: 10/07/2009] [Indexed: 01/29/2023]
|
19
|
Mialdea M, Sangle SR, D'Cruz DP. Antiphospholipid (Hughes) syndrome: beyond pregnancy morbidity and thrombosis. JOURNAL OF AUTOIMMUNE DISEASES 2009; 6:3. [PMID: 19454015 PMCID: PMC2689867 DOI: 10.1186/1740-2557-6-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 05/19/2009] [Indexed: 11/10/2022]
Abstract
The antiphospholipid syndrome is an autoimmune disease characterised by recurrent arterial or venous thrombosis, pregnancy morbidity and the persistence of positive antiphospholipid antibodies. Many other clinical manifestations may occur including heart valve disease, livedo reticularis, thrombocytopenia and neurological manifestations such as migraine and seizures. We review a number of other manifestations including stenotic lesions, coronary artery disease and accelerated atherosclerosis, skeletal disorders and the concept of seronegative antiphospholipid syndrome.
Collapse
Affiliation(s)
- Maria Mialdea
- The Lupus Research Unit, The Rayne Institute, 4thFloor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Shirish R Sangle
- The Lupus Research Unit, The Rayne Institute, 4thFloor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - David P D'Cruz
- The Lupus Research Unit, The Rayne Institute, 4thFloor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| |
Collapse
|
20
|
PAGALAVAN L. Antiphospholipid syndrome: a systemic and multidisciplinary disease. Int J Rheum Dis 2008. [DOI: 10.1111/j.1756-185x.2008.00343.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Orthopedic involvement in antiphospholipid syndrome. Clin Rev Allergy Immunol 2008; 32:167-71. [PMID: 17916988 DOI: 10.1007/s12016-007-0006-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 10/23/2022]
Abstract
Antiphospholipid syndrome (APS) is a common autoimmune disease, manifested by vascular thrombosis and fetal loss in the presence of antiphospholipid antibodies. Orthopedic involvement is a relatively novel and under-recognized feature of APS. In this article we review the association of primary, secondary, and catastrophic APS with diverse orthopedic conditions, including osteonecrosis in adult and pediatric patients, bone marrow necrosis, nontraumatic fractures, and some other disorders.
Collapse
|
22
|
Edwards CJ, Hughes GRV. Hughes syndrome (the antiphospholipid syndrome): 25 years old. Mod Rheumatol 2008; 18:119-24. [PMID: 18317878 DOI: 10.1007/s10165-008-0042-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 12/11/2007] [Indexed: 11/29/2022]
Abstract
The antiphospholipid (Hughes) syndrome (APS) is a unique thrombotic disorder, causing both arterial and venous thrombosis, linked to the presence of antibodies directed against phospholipid-protein complexes. The first papers describing the syndrome were published in 1983 and, over the next two years, a series of publications described in detail the various clinical manifestations of the syndrome. Laboratory standardisation workshops were also set up and, in 1984, the first "world" symposium on APS was held. The international APS conferences have continued to grow in numbers and in stature. The APS has already had an impact in obstetrics, in medicine, in psychiatry, and in surgery. The approximate figure of 1 in 5 is a useful guide -- 1 in 5 of all young strokes, 1 in 5 recurrent miscarriages, 1 in 5 DVTs. More precise data will become available in the worlds of epilepsy, migraine, Alzheimer's, and MS. The advent of newer "biologic" immunosuppressives such as rituximab may offer help in selected cases. Intravenous immunoglobulin has proved successful, especially in the emergency setting.
Collapse
Affiliation(s)
- C J Edwards
- Department of Rheumatology, Southampton University Hospitals, Southampton, UK
| | | |
Collapse
|
23
|
Abstract
Systemic lupus erythematosus is an autoimmune connective-tissue disorder with a wide range of clinical features, which predominantly affects women, especially from certain ethnic groups. Diagnosis is based on clinical assessment supported by investigations, including the finding of autoantibodies. Treatments range from antimalarial agents to corticosteroids and immunosuppressive agents. This Seminar draws attention to advances in the epidemiology, genetics, cardiovascular risks, lupus nephritis, CNS disease, the antiphospholipid syndrome, assessment of disease activity and damage, and pregnancy related and quality of life issues. New therapeutic approaches, such as biological agents and mycophenolate mofetil, will also be discussed.
Collapse
Affiliation(s)
- David P D'Cruz
- Lupus Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK. david.d'
| | | | | |
Collapse
|
24
|
|
25
|
Hughes G. Hughes Syndrome: the antiphospholipid syndrome--a clinical overview. Clin Rev Allergy Immunol 2007; 32:3-12. [PMID: 17426356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 05/14/2023]
Abstract
In 1983, a detailed clinical description of a new syndrome was published. This prothrombotic syndrome was initially called the anticardiolipin syndrome and subsequently the antiphospholipid syndrome (APS), or Hughes Syndrome. Almost uniquely, it results in arterial as well as venous thrombosis and is marked by the presence of circulating antiphospholipid antibodies. Clinical features are protean, ranging from peripheral deep vein thrombosis (DVT) to involvement of internal organs such as the liver, kidneys, and adrenals. Likewise, arterial thrombosis can result in life-threatening infarction of organs such as the heart. The nervous system is frequently affected, with migraine, memory loss, balance disorders, stroke, and atypical multiple sclerosis being prominent. Other features include recurrent miscarriage, thrombocytopenia, and livedo reticularis. More recent observations have included ischemic bone fractures, renal and celiac artery stenosis, and a possible tendency toward accelerated atherosclerosis. The condition is seen in patients with lupus, but, significantly, occurs without associated lupus ("primary" APS)-indeed, increasing clinical recognition of Hughes Syndrome suggests that this condition will overtake lupus in prevalence. Treatment at present is by anticoagulation. The mechanisms for thrombosis are being worked out; it has been suggested that in some situations (e.g., pregnancy loss), an inflammatory component as well as thrombosis may play a part.
Collapse
Affiliation(s)
- Graham Hughes
- London Lupus Centre, London Bridge Hospital, London, United Kingdom.
| |
Collapse
|
26
|
Ben-Ami D, Bar-Meir E, Shoenfeld Y. Stenosis in antiphospholipid syndrome: a new finding with clinical implications. Lupus 2007; 15:466-72. [PMID: 16898184 DOI: 10.1191/0961203306lu2335oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a variety of clinical manifestations. Recent studies suggest arterial stenosis is involved in APS. Furthermore, arterial stenosis may be a relevant and treatable cause for hypertension, renal, CNS and gastrointestinal manifestations of APS. Our objective was to overview the published data regarding arterial stenosis in APS--the clinical presentation, diagnosis, suggested therapies and the possible mechanisms. We searched PUBMED (1951-2006) reference lists for the role of arterial stenosis in APS. APS patients might present with arterial stenosis. Its recognition has important diagnostic and therapeutic implications. Articles suggest that anticoagulation treatment with INR above three may reverse the artery stenosis and achieve subsequent clinical improvement. Currently, there are no specific guidelines for the management of APS patients with arterial stenosis. The exact mechanism of arterial stenosis in APS patients remains unclear.
Collapse
Affiliation(s)
- D Ben-Ami
- Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center (affiliated to Tel-Aviv University), Tel-Hashomer, Israel
| | | | | |
Collapse
|
27
|
Tektonidou MG, Moutsopoulos HM. Osteoarticular Manifestations of Antiphospholipid Syndrome. Rheum Dis Clin North Am 2006; 32:523-35. [PMID: 16880082 DOI: 10.1016/j.rdc.2006.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In conclusion, arthralgias represent a rather common osteoarticular manifestation of primary and secondary APS, while arthritis is mainly described in SLE-related APS. Osteonecrosis is frequently described in association with aPL in patients with and without autoimmune disorders. The presence of osteonecrosis in primary APS patients in the absence of corticosteroid use suggests an association between osteonecrosis and APS. Clinicians should be aware of this possible clinical manifestation of APS, because early diagnosis may lead to early management. A systematic screening for aPL in all cases with diagnosed osteonecrosis in the absence of precipitating factors should be considered.
Collapse
Affiliation(s)
- Maria G Tektonidou
- Department of Pathophysiology, Medical School, National University of Athens, 75 Mikras Asias str, Athens 11527, Greece.
| | | |
Collapse
|
28
|
Rosenthal E, Sangle SR, Khamashta MA, D'Cruz D, Hughes GRV. [Orthopedic manifestations of the antiphospholipid syndrome]. Rev Med Interne 2006; 28:103-7. [PMID: 16854503 DOI: 10.1016/j.revmed.2006.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 05/22/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE The antiphospholipid syndrome (APS) is characterized by arterial and/or venous thrombosis, and pregnancy morbidity in association with antiphospholipid antibodies. Since its classical description 22 years ago, the clinical spectrum of APS has embraced the realms of obstetrics, nephrology, cardiology, neurology, gastroenterology, angiology and now, possibly orthopaedics. This is not surprising given that this disease can affect virtually any organ system and blood vessel of any size and nature. Just as venous thrombosis may affect limbs and internal organs, arterial thrombosis has been shown to affect organs such as the brain, eye, heart, kidney, liver and may also involve the skeleton. CURRENT KNOWLEDGE AND KEY POINTS In this review, we describe the orthopedic aspects of APS recently reported, bone metatarsal fractures, osteonecrosis and more exceptional complications, ie algodystrophy and bone marrow necrosis. We briefly discuss postulated pathogenesis and possible implications of anticoagulation. FUTURE PROSPECTS AND PROJECTS This data need further confirmation. They may suggest complementary physiopathologic and therapeutic implications.
Collapse
Affiliation(s)
- E Rosenthal
- Service de médecine interne-cancérologie, hôpital de l'Archet 1, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
| | | | | | | | | |
Collapse
|
29
|
Affiliation(s)
- David P D'Cruz
- Louise Coote Lupus Unit, St Thomas' Hospital, London SE1 7EH. david.d'
| |
Collapse
|