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Do all antiphospholipid antibodies confer the same risk for major organ involvement in systemic lupus erythematosus patients?


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28

 

  1. Rheumatology Department, Hospital Sierrallana, IDIVAL, Torrelavega, Spain.
  2. Rheumatology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Spain. vmartinezt64@gmail.com
  3. Rheumatology Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain.
  4. Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
  5. Rheumatology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.
  6. Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  7. Rheumatology Department, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain.
  8. Rheumatology Department, Hospital Regional Universitario de Málaga, Spain.
  9. Rheumatology Department, Hospital Universitario Araba, Álava, Spain.
  10. Rheumatology Department, Hospital de Jerez, Cádiz, Spain.
  11. Rheumatology Department, Hospital Universitario La Princesa, Madrid, Spain.
  12. Rheumatology Department, Hospital Universitario Donosti, San Sebastián, Spain.
  13. Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
  14. Rheumatology Department, Hospital General Universitario de Alicante, Spain.
  15. Rheumatology Department, Hospital Universitario Juan Canalejo, A Coruña, Spain.
  16. Rheumatology Department, Hospital Marina Baixa, Alicante, Spain.
  17. Rheumatology Department, Hospital Universitario Basurto, Bilbao, Spain.
  18. Rheumatology Department, Hospital Universitario Son Llàtzer, Palma, Spain.
  19. Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  20. Rheumatology Department, Hospital Universitario Parc Taulí, Barcelona, Spain.
  21. Rheumatology Department, Hospital Comarcal Monforte, Lugo, Spain.
  22. Rheumatology Department, Hospital Universitario Clínico San Cecilia, Granada, Spain.
  23. Rheumatology Department, Hospital Universitario de Bellvitge, Barcelona, Spain.
  24. Rheumatology Department, Hospital Universitario Canaries, Tenerife, Spain.
  25. Rheumatology Department, Hospital Insular Universitario de Gran Canaria, Las Palmas, Spain.
  26. Rheumatology Department, Complejo Hospitalario Universitario de Navarra, Spain.
  27. Rheumatology Department, Hospital Sierrallana, IDIVAL, Torrelavega, Spain.
  28. Complejo Hospitalario Universitario de Vigo IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain.

CER13367
2021 Vol.39, N°3
PI 0555, PF 0563
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PMID: 32828148 [PubMed]

Received: 26/03/2020
Accepted : 01/06/2020
In Press: 07/08/2020
Published: 21/05/2021

Abstract

OBJECTIVES:
We aimed to investigate the association between the different antiphospholipid antibodies (aPL) and both systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) manifestations.
METHODS:
Patients from the RELESSER registry, a Spanish retrospective, cross-sectional, forty-five hospital registry of adult SLE patients, were included.
RESULTS:
Out of a total of 3,658 SLE patients, 1372 were aPL positive (555 of them fulfilled criteria for APS). All aPL types showed a negative association with cutaneous SLE manifestations. Lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) were both associated with haematological, ophthalmological and neuropsychiatric manifestations. IgG isotypes were associated with a higher risk of lupus manifestations compared with IgM. We found that the risk of neuropsychiatric and ophthalmological manifestations significantly increased with a higher number of positive aPL whereas the risk of cutaneous symptoms showed a negative correlation. All types of aPL, and more strongly LA, were associated with non-criteria antiphospholipid syndrome (APS) manifestations such as thrombocytopenia and haemolytic anaemia. Moreover, LA and aCL (particularly IgG isotype) were also associated with Libman-Sacks endocarditis and cognitive impairment. This association was stronger with more than one positive aPL. All types of aPL were also associated with classic APS manifestations, although LA, IgG isotypes, and patients with more than one aPL displayed a higher risk.
CONCLUSIONS:
There is a hierarchy for aPL and the risk of APS and SLE manifestations. aCL, and especially LA, confer a higher risk for major organ involvement in SLE. IgG isotypes seem to have a more important role. The load of aPL confer a higher risk for APS and certain SLE manifestations.

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