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Abstract

Fluctuations in the titers of anticardiolipin antibodies (aCL) have been reported in systemic lupus erythematosus (SLE) patients, but their relation with thrombosis is not completely understood. Prospective inception cohort of 237 patients with SLE (American College of Rheumatology criteria). Positivity for antiphospholipid antibodies (aPL) was defined according to Sapporo criteria. aCL was defined as persistently positive when more than two-thirds of the determinations were positive during follow-up. Patients were classified into four groups: A [positive lupus anticoagulant (LA)], B (negative LA and persistently positive aCL), C (negative LA and transiently positive aCL) and D (negative LA and aCL). Of these 237 patients, 211 (89%) patients were women. Median age at diagnosis and follow-up were 32 (2—78) and 10 (1—31) years, respectively; 33 (13.9%), 23 (9.7%), 42 (17.7%) and 139 (58.6%) patients were classified in groups A, B, C and D, respectively. Thirty (12.6%) and 23 (9.7%) patients suffered arterial and venous thrombotic events, respectively. Adjusted risk for arterial thrombosis was increased in groups A [odds ratio (OR) 15.69, 95% confidential interval (CI) 4.79—51.42, P < 0.001] and B (OR 7.63, 95% CI 2.00—29.08, P = 0.003), but not in group C when compared with group D. Adjusted risk of venous thrombosis was increased in group A (OR 4.24, 95% CI 1.36—13.20, P = 0.013), but not in groups B or C when compared with group D. Risk of thrombosis is not increased in SLE patients with negative LA and transiently positive aCL, even fulfilling Sapporo laboratory criteria, when compared with aPL-negative SLE patients. Lupus (2007) 16, 810—816.

Keywords

antiphospholipid antibodies lupus anticoagulant anticardiolipin antibodies systemic lupus erythematosus thrombosis

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References

Wilson WA , Gharavi AE , Koike T. et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Arthritis Rheum 1999; 42: 1309—1311.

Harris E. , Baguley E. , Asherson R. et al. Clinical and serogical features of the antiphospholipid syndrome (APS). Br J Rheumatol 1987; 26:19.

Cervera R. , Khamashta MA , Font J. et al. Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 1999; 78: 167—175.

Ward M. , Pyun E. , Studenski S. Causes of death in systemic lupus erythematosus. Arthritis Rheum 1995; 38: 1492—1499.

Asanuma Y. , Oeser A. , Shintani AK et al. Premature coronary-artery atherosclerosis in systemic lupus erithematosus. N Engl J Med 2003; 349: 2407—2415.

Bruce IN , Gladman DD , Urowitz MB Premature atherosclerosis in systemic lupus erythematosus. Rheum Dis Clin N Am 2000; 26: 257—278.

Roman MJ , Shanker BA , Davis A. et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003; 349: 2399—2406.

Hahn BH Systemic lupus erythematosus and accelerated atherosclerosis. N Engl J Med 2003; 349: 2379—2380.

Ruiz-Irastorza G. , Egurbide MV , Ugalde J. , Aguisse C. High impact of antiphospholipid syndrome on irreversible organ damage and survival of patients with systemic lupus erythematosus . Arch Intern Med 2004; 164: 77—82.

10.

Ishii Y. , Nagasawa K. , Mayumi T. , Niho Y. Clinical importance of persistence of anticardiolipin antibodies in systemic lupus erythematosus. Ann Rheum Dis 1990; 49: 387—390.

11.

Hochberg MC Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus (letter) . Arthritis Rheum 1997; 40: 1725.

12.

Harris EN , Gharavi AE , Patel SP , Hughes Grv. Evaluation of the anticardiolipin antibody test: report of a standardization workshop, held April 4th 1986. Clin Exp Immunol 1987; 68: 215—222.

13.

Levine JS , Branch DW , Rauch J. The antiphospholipid syndrome. N Engl J Med 2002; 346: 752—763.

14.

Silver RM , Porter TF , Van Leeuween I , Jeng G. , Scott JR , Branch DW Anticardiolipin antibodies: clinical consequences of low titers. Obstet Gynecol 1996; 87: 494—500.

15.

Brandt JT , Triplett DA , Alving B. , Scharrer I. Criteria for the diagnosis of lupus anticoagulants: an update. Throm Haemost 1995; 74: 1185—1190.

16.

Schattner A. , Ling MH The cardiovascular burden of lupus. A complex challenge. Arch Intern Med 2003; 163: 1507—1510.

17.

Ruiz-Irastorza G. , Egurbide MV , Pijoan JI et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus 2006; 15: 577—583.

18.

Erkan D. , Yazici Y. , Peteron MG , Sammaritano L. , Lockshin MD A cross-section study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology 2002; 41: 924—929.

19.

Out HJ , van Vliet M. , de Groot PG et al. Prospective study of fluctuations of lupus anticoagulant activity and anticardiolipin antibody titer in patients with systemic lupus erythematosus . Ann Rheum Dis 1992; 51: 353—357.

20.

Inanc M. , Donohoe S. , Ravirajan CT et al. Anti-beta2-glycoprotein I, anti-prothrombin and anticardiolipin antibodies in a longitudinal study of patients with systemic lupus erythematosus and the antiphospholipid syndrome. Br J Rheumatol 1998; 37: 1089—1094.

21.

de Bandt M. , Benali K. , Guillevin L. et al. Longitudinal determination of antiphospholipid antibodies in lupus patients without previous manifestations of antiphospholipid syndrome. A prospective study. J Rheumatol 1999; 26: 91—96.

22.

Miyakis S. , Lockshin MD , Atsumi T. et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295—306.

23.

Male C. , Foulon D. , Hoogendoorn H. et al. Predictive value of persistent versus trastient antiphospholipid antibody subtypes for the risk of thrombotic events in pediatric patients with systemic lupus erythematosus. Blood 2005 ; 106: 4152—4158.

24.

Sairam S. , Baethge BA , McNearney T. Analysis of risk factors and comorbid diseases in the development of thrombosis in patients with anticardiolipin antibodies. Clin Rheumatol 2003; 22: 24—29.

25.

Neville C. , Rauch J. , Kassis J. et al. The persistence of anticardiolipin antibodies is associated with an increased risk of the presence of lupus anticoagulant and anti-β2-glycoprotein I antibodies. Rheumatology (Oxford) 2006; 45: 1116—1120.

26.

Galli M. , Luciani D. , Bertolini G. , Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature . Blood 2003; 101: 1827—1832.

27.

Ruiz-Irastorza G. , Khamashta MA Stroke and antiphospholipid syndrome: the treatment debate. Rheumatology (Oxford ) 2005; 44: 971—974.

28.

Martínez-Berriotxoa A. , Ruiz-Irastorza G. , Egurbide M. , Rueda M. , Aguirre C. Homocysteine, antiphospholipid antibodies and risk of thrombosis in patients with systemic lupus erythematosus. Lupus 2004; 13: 927—933.

29.

The Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 2006; 354: 1567—1577.

30.

Bonaa KH , Njolstad I. , Ueland PM et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med 2006; 354: 1578—1588.

31.

Arbuckle MR , McClain MT , Rubertone MV et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 2003; 349: 1526—1533.

Transiently positive anticardiolipin antibodies and risk of thrombosis in patients with systemic lupus erythematosus

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