American Journal of Clinical Medicine Research. 2013, 1(4), 61-64
DOI: 10.12691/AJCMR-1-4-4
Original Research

Prevalence of Antiphospholipid Antibodies in Sample of Iraqi Patients with Systemic Lupus Erythematosus: A Cross Sectional Study

Ahmed S. Noori1, Ali M. Jawad2, Nizar A.Jassim2 and Faiq I. Gorial2,

1Hematology Department, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq

2Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq

Pub. Date: October 06, 2013

Cite this paper

Ahmed S. Noori, Ali M. Jawad, Nizar A.Jassim and Faiq I. Gorial. Prevalence of Antiphospholipid Antibodies in Sample of Iraqi Patients with Systemic Lupus Erythematosus: A Cross Sectional Study. American Journal of Clinical Medicine Research. 2013; 1(4):61-64. doi: 10.12691/AJCMR-1-4-4

Abstract

Objective: Antiphospholipid antibodies (APLAs) have high risk of vascularthrombosis with significant clinical comorbidities. Anticardiolipin antibodies (ACLAs)and Lupus anticoagulant (LA) are important APLAs. The aim of this study was to evaluate the prevalence of APLAs(ACLAs and LA) and their clinical significance among sample of Iraqi patients with systemic lupus erythematosus patients (SLE). Patients and methods: A single center cross sectional study conducted on 50 SLE patients diagnosed according to the 1997 revised American College of Rheumatology (ACR) criteria for SLE from February 2010 to April 2011. Patients' age at SLE diagnosis, disease duration, SLE disease activity index (SLEDAI), renal involvement, cerebral involvement, cardiac involvement, pregnancy events, and thrombotic events were analyzed. Serum samples were extracted and screened for IgG and IgM using an anticardiolipin (ACL) enzyme-linked immunosorbent assay, Lupus anticoagulant (LA), prothrombin time (PT), partial thromboplastic time (PTT), kaolin clotting time (KCT), and KCT index were assessed in all patients. Results: Of 50 SLE patients, the prevalence of positive anticardiolipin antibodies (ACLA) was 10(20%) and positive LA 5 (10%). Abnormal KCT12 (24.5%), Abnormal KCT index 5(10), Abnormal PTT2 (4.1%), and Abnormal PT 2(4%). Thrombotic events, pregnancy events, and cerebral involvement were associated with positive serology (P = 0.000, 0.225, 0.083 respectively). Renal and cardiac involvement were associated with negative serology (P = 0.019, 0.094 respectively). No new thrombotic events were found. Conclusions: Prevalence of positive ACLAs was 20% and positive LA 10%. Thrombotic events, pregnancy events, and cerebral involvement were associated with positive serology while renal and cardiac involvement with negative serology. We suggest screening SLE patients for the presence of APLAsand larger sample with longer follow up for their clinical manifestations.

Keywords

antiphospholipid antibodies, systemic lupus erythematosus, anticardiolipin antibodies, autoantibodies and SLE

Copyright

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References

[1]  Gharavi AE, Pierangeli SS, Harris EN. New developments in viral peptides and APL induction. J Autoimmun 2000;15(2):227-30.
 
[2]  García-García C.. Antiphospholipid antibodies and antiphospholipid syndrome: diagnosis and management ActasActas Dermosifiliogr. 2007 Jan-Feb;98(1):16-23.
 
[3]  Petri M. Update on anti-phospholipid antibodies in SLE: the Hopkins’ Lupus Cohort. Lupus.2010;19:419-23.
 
[4]  Cervera R, Asherson RA. Clinical and epidemiological aspects in the antiphospholipid syndrome.Immunobiology.2003;207:5-11.
 
[5]  Leroy V, Arvieux J, Jacob MC, et al. Prevalence and significance of anticardiolipin,anti-beta2glycoproteinI and anti-prothrombin antibodies in chronic hepatitis C. BrJHematol.1998;101:468---74.
 
[6]  Triplett DA.Many facesoflupusanticoagulants.Lupus.1998;7: S18--22.
 
[7]  Wiener MH, Burke M, Fried M, Yust I. Thromboagglutination by anticardiolipin antibody complex in the antiphospholipid syndrome: a possible mechanism of immune-mediated thrombosis. Thromb Res 2001; 103(3):193-9.
 
[8]  Galli M, Ruggeri L, Barbui T. Differential effects of anti-β2GPI and antiprothrombin antibodies on the anticoagulant activity of activated protein C. Blood 1998;91(6):1999-2004.
 
[9]  Pierangeli SS, Colden-Stanfield M, Liu X, et al. Antiphospholipid antibodies from antiphospholipid syndrome patients activate endothelial cells in vitro and in vivo. Circulation 1999; 99(15):1997-2002.
 
[10]  McMahon MA, Keogan M, O’Connell P, Kearns G. The prevalence of antiphospholipid antibody syndrome among systemic lupus erythematosus patients. Ir Med J 2006; 99: 296-8.
 
[11]  Tarr T, Lakos G, Bhattoa HP, et al. Clinical thrombotic manifestations in SLE patients with and without antiphospholipid antibodies: a5-year follow-up. Clin Rev Allergy Immunol.2007;32: 131-7.
 
[12]  Danowski A, de Azevedo MN, de Souza Papi JA, Petri M. Determinants of risk for venous and arterial thrombosis in primary antiphospholipid syndrome and in antiphospholipid syndrome with systemic lupus erythematosus. Rheumatol Int. 2012; 32(12):3881-6.
 
[13]  Hahn BH. Systemic Lupus Erythematosus. Harrisons Principles of Internal Medicine. 17th edition. New York: MC Graw-Hill; 2008; p.2075-83.
 
[14]  Hochberg MC. for the Diagnostic and Therapeutic Criteria Committee of the American College of Rheumatology. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis Rheum 1997;40:1725.
 
[15]  Gladman DD, Ibanez D, Urowitz MB. SLE disease activity index 2000. J Rheumatol 2002; 29: 288-91.
 
[16]  Willis R, Harris EN, Pierangeli SS. Pathogenesis of the antiphospholipid syndrome.SeminThrombHemost2012;38:305–21
 
[17]  Basiri Z, Gholyaf M, Faridnia M, et al. The prevalence of anticardiolipin antibody in patients with systemic lupus erythematosus and its association with clinical manifestations.Acta Med Iran. 2013; 51(1):35-40.
 
[18]  Petri M. Epidemiology of the antiphospholipid antibody syndrome. J Autoimmun. 2000 Sep;15(2):145-51.
 
[19]  Petri M. Update on anti-phospholipid antibodies in SLE: the Hopkins’ Lupus Cohort. Lupus.2010; 19:419-23.
 
[20]  Woo KS, Kim KE, Kim JM, et al. Prevalence and clinical associations of lupus anticoagulant, anticardiolipin antibodies, and anti-beta 2-glycoprotein 1 antibodies in patients with systemic lupus erythematosus. Korean J Lab Med. 2010 Feb; 30(1):38-44.
 
[21]  Jouhikainen T, Stephansson E, Leirisalo-Repo M. Lupus anticoagulant as a prognostic marker in systemic lupus erythematosus. Br J Rheumatol 1993; 32(7):568-73.
 
[22]  Levine JS, Ware Branch D., and RauchJ. The antiphospholipid syndrome. N Engl J Med 2002; 346 ( 10): 752-761.
 
[23]  Cordeiro A, Lermann R, Ambrósio P, et al. Pregnancy and antiphospholipid antibodies in systemic lupus erythematosus patients : an outcome evaluation. ActaRheumatol Port 2009; 34 (3):486-91.
 
[24]  Bhandari S, Harnden P, Brown John AM, and Turney JH. Association of anticardiolipin antibodies with intragolmerular thrombi and renal dysfunction in lupus nephritis. Q J Med 1998; 91: 401-9.
 
[25]  GomezP, Joshi J, Nihoyannopoulos P, and Oakley CM. Association between cardiac abnormalities and raised anticardiolipin antibodies in systemic lupus erythematosus. Posgraduate Medical Journal 1988; 64: 723.
 
[26]  Lagana B. Cardiac abnormalities in systemic lupus erythematosus and their association with antiphospholipid antibodies. RecentiProg Med 1993; 84 (10): 662-72.