Frequency of Antiphospholipid Antibody Syndrome and its classification according to the new EULAR 2023 criteria in patients with Systemic Lupus Erythematosus Erythematosus, who consulted at the Internal Medicine Department of the National Hospital
Abstract
Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disease, whose clinical expression is characterized by two main domains, thrombotic events, with venous and/or arterial thrombosis, and obstetric morbidity, whose main clinical manifestations are recurrent loss in the first trimester of pregnancy, fetal death, pre-eclampsia, premature birth and fetal growth restriction, associated with the presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin IgG/IgM antibodies, and/or anti-β 2-glycoprotein I IgG/ IgM antibodies).
Objective: To determine the frequency of APS and its classification according to the new ACR/EULAR 2023 criteria, in patients diagnosed with systemic lupus erythematosus (SLE).
Materials and Methods: Observational, descriptive, cross-sectional study of adult patients with SLE, who attended the National Hospital, in the period between January 2020 and August 2024. The sampling was non-probabilistic, for convenience. Patients with incomplete records were excluded. The variables analyzed were sociodemographic, clinical and laboratory.
Results: 70 patients diagnosed with SLE were studied, between 17 and 72 years of age (mean: 33.1 ± 12.3), 58 (82.80%) were women, 44 (62.8%) from the Central Department, 36 (59%) with secondary studies, 15 patients (26.3%) had nephritis. Of these, 13 patients (18.5%) presented antiphospholipid antibodies. According to the new criteria in the validation cohort, 5 patients (7.1%) were classified as APS. The clinical manifestations presented by the 5 patients with APS were deep vein thrombosis in the lower limbs 3/5 (60%), ischemic stroke 1/5 (20%), and Libman-Sacks endocarditis 1/5 (20%).
Conclusion: The frequency of antiphospholipid antibodies was 18.5% in patients with SLE. Of these, 5 patients were classified with APS. The clinical manifestations were deep vein thrombosis of the lower limbs, ischemic stroke, and Libman-Sacks endocarditis.
Downloads
References
(1) Meroni PL, Tsokos GC. Editorial: Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Front Immunol. 2019 Feb 25; 10:199.doi: https://doi.org/10.3389/fimmu.2019.00199.
(2) Paredes-Ruiz D, Martin-Iglesias D, Ruiz-Irastorza G. Thrombotic antiphospholipid syndrome: From guidelines to clinical management. Med Clin (Barc). 2024 Aug;163 Suppl 1:S22-S30. English, Spanish. doi: https://doi.org/10.1016/j.medcli.2024.02.010
(3) Soto-Peleteiro A, Gonzalez-Echavarri C, Ruiz-Irastorza G. Obstetric antiphospholipid syndrome. Med Clin (Barc). 2024 Aug;163 Suppl 1:S14-S21. English, Spanish. doi: https://doi.org/10.1016/j.medcli.2024.05.001
(4) Schreiber K, Lykke JA, Langhoff-Roos J, Nielsen HS, Jacobsen S. Antifosfolipidsyndrom og graviditet [Antiphospholipid syndrome and pregnancy]. Ugeskr Laeger. 2016 Jan 18;178(3):V09150730. Danish. PMID: 26815583.
(5) De Simone E, Sciascia S, Fenoglio R, Oddone V, Barreca A, Roccatello D. Antiphospholipid Syndrome and Kidney Involvement. Kidney Blood Press Res. 2023;48(1):666-677. doi: https://doi.org/10.1159/ 000529229. Epub 2023 Sep 21. PMID: 37734329.
(6) Schreiber K, Hunt BJ. Managing antiphospholipid syndrome in pregnancy. Thromb Res. 2019 Sep;181 Suppl 1:S41-S46. doi: https://doi.org/10.1016/S0049-3848(19)30366-4. PMID: 31477227.
(7) Fanouriakis A, Kostopoulou M, Andersen J, Aringer M, Arnaud L, Bae SC, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024 Jan 2;83(1):15-29. doi: https://doi.org/10.1136/ard-2023-224762. PMID: 37827694.
(8) Zuily S, Cervera R, Foret T, Bertocchi S, Tincani A. Thrombocytopenia in antiphospholipid syndrome: Is anticoagulation and/or anti- aggregation always required? Autoimmun Rev. 2024 Jan; 23(1):103417. doi: https://doi.org/10.1016/j.autrev.2023.103417. Epub 2023 Aug 22. PMID: 37619905.
(9) Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999; 42(7): 1309–11. doi: https://doi.org/10.1002/1529-0131(199907)42:7<1309::AID-ANR1>3.0.CO;2-F
(10) Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306. doi: https://doi.org/10.1111/j.1538-7836.2006.01753.x.
(11) Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, et al. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol. 2023 Oct;75(10):1687-1702. doi: https://doi.org/10.1002/art.42624
(12) Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey- Goldman R, et al. 2019 European League Against Rheumatism/ American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019 Sep; 71(9):1400-1412. doi: https://doi.org/10.1002/art.40930.
(13) Amigo MC, García-Torres R, Robles M, Bochicchio, Reyes Pensilvania. Afectación renal en el síndrome antifosfolípido primario. J Reumatol 1992;19(8): 1181–5.
(14) Sciascia S, Montaruli B, Infantino M. Antiphospholipid antibody testing. Med Clin (Barc). 2024 Aug;163 Suppl 1:S4-S9. English, Spanish. doi: https://doi.org/10.1016/j.medcli.2024.06.002. PMID: 39174152.
(15) Yang Y, Jiang H, Tang Z, Pan H, Liu H, Cheng X, et al. Assessment of the 2023 ACR/EULAR antiphospholipid syndrome classification criteria in a Chinese cohort: Impact on clinical practice. J Auto- immun. 2024 Jun;146:103237. doi: https://doi.org/10.1016/j.jaut.2024.103237
(16) Romero L. Pros y contras de los criterios EULAR SAF 2023. Hematología. 2024 (28). Número extraordinario. XVI Congreso Argentino de hemostasia y trombosis, 135-140.
(17) Martínez-Taboada VM, Gómez AM, Merino A, López-Hoyos M, Del Barrio-Longarela S, Comins-Boo A, et al. Are the new 2023 ACR/EULAR classification criteria suitable for advancing the knowledge of obstetric antiphospholipid syndrome? Autoimmun Rev. 2024 Jul-Aug;23(7-8):103592. doi: https://doi.org/10.1016/j.autrev.2024.103592.
Copyright (c) 2024 Dora Montiel, Margarita Samudio
This work is licensed under a Creative Commons Attribution 4.0 International License.
