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The role of clinically significant antiphospholipid antibodies in systemic lupus erythematosus

M. Taraborelli, M.G. Lazzaroni, N. Martinazzi, M. Fredi, I. Cavazzana, F. Franceschini, A. Tincani
  • M.G. Lazzaroni
    Rheumatology and Clinical Immunology, Spedali Civili of Brescia; Rheumatology and Clinical Immunology, University of Brescia, Italy
  • N. Martinazzi
    Rheumatology and Clinical Immunology, University of Brescia, Italy
  • M. Fredi
    Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
  • I. Cavazzana
    Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
  • F. Franceschini
    Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
  • A. Tincani
    Rheumatology and Clinical Immunology, Spedali Civili of Brescia; Rheumatology and Clinical Immunology, University of Brescia, Italy

Abstract

The objective is to investigate the role of clinically significant antiphospholipid antibodies (aPL) in a cohort of systemic lupus erythematosus (SLE) patients. All SLE patients followed for at least 5 years and with available aPL profile at the beginning of the follow-up in our center were studied. Clinically significant aPL were defined as: positive lupus anticoagulant test, anti-cardiolipin and/or anti- β2Glycoprotein I IgG/IgM >99th percentile on two or more occasions at least 12 weeks apart. Patients with and without clinically significant aPL were compared by univariate (Chi square or Fisher’s exact test for categorical variables and Student’s t or Mann-Whitney test for continuous variables) and multivariate analysis (logistic regression analysis). P values <0.05 were considered significant. Among 317 SLE patients studied, 117 (37%) had a clinically significant aPL profile at baseline. Such patients showed at univariate analysis an increased prevalence of deep venous thrombosis, pulmonary embolism, cardiac valvular disease, cognitive dysfunction and antiphospholipid syndrome (APS), but a reduced prevalence of acute cutaneous lupus and anti-extractable nuclear antigens (ENA) when compared with patients without clinically significant aPL. Multivariate analysis confirmed the association between clinically significant aPL and reduced risk of acute cutaneous lupus [p=0.003, odds ratio (OR) 0.43] and ENA positivity (p<0.001, OR 0.37), with increased risk of cardiac valvular disease (p=0.024, OR 3.1) and APS (p<0.0001, OR 51.12). Triple positivity was the most frequent profile and was significantly associated to APS (p<0.0001, OR 28.43). Our study showed that one third of SLE patients had clinically significant aPL, and that this is associated with an increased risk, especially for triple positive, of APS, and to a different clinical and serological pattern of disease even in the absence of APS.

Keywords

Systemic lupus erythematosus; antiphospholipid antibodies; antiphospholipid syndrome; thrombosis; valvulopathy.

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Submitted: 2016-05-04 09:50:53
Published: 2016-12-16 11:20:52
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Copyright (c) 2016 M. Taraborelli, M.G. Lazzaroni, N. Martinazzi, M. Fredi, I. Cavazzana, F. Franceschini, A. Tincani

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