1
|
Gaspar P, Sciascia S, Tektonidou MG. Epidemiology of antiphospholipid syndrome: macro- and microvascular manifestations. Rheumatology (Oxford) 2024; 63:SI24-SI36. [PMID: 38320589 PMCID: PMC10846913 DOI: 10.1093/rheumatology/kead571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/08/2023] [Indexed: 02/08/2024] Open
Abstract
Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by thrombotic and non-thrombotic macro- and microvascular manifestations and pregnancy complications in the setting of persistent antiphospholipid antibodies (aPL), namely anticardiolipin antibodies, anti-β2 glycoprotein-I antibodies and lupus anticoagulant. Four decades after its first description, APS prevalence and incidence are still not completely understood due to the limited number of well-designed, population-based multi-ethnic studies. Furthermore, despite decades of efforts to standardise aPL immunoassays, considerable intraassay and interlaboratory variances in aPL measures still exist. Large multicentre APS cohorts have shown a 10-year survival of ∼91% and the presence of catastrophic APS occurs in about 1% of the entire population, associated with a 50% mortality rate. Clinically, any organ can be affected in the context of large, medium or small vessel (artery and/or vein) thrombosis. Macrovascular thrombosis is the hallmark of the disease and veins are more frequently affected than arteries. Deep vein thrombosis/pulmonary embolism thromboembolic disease is the most common APS manifestation, while stroke and transient ischaemic attack are the most frequent arterial thrombosis events. Myocardial infarction can also occur and contributes to increased mortality in APS. A minority of patients present with thrombosis affecting the intraabdominal organs, including the liver, spleen, small and large bowel, and the kidneys. Microvascular thrombosis, including APS nephropathy, chronic skin ulcers and livedoid vasculopathy represent a diagnostic challenge requiring histologic confirmation. In this narrative review we summarize the available evidence on APS epidemiology, focusing on the description of the prevalence of macro- and microvascular manifestations of the disease.
Collapse
Affiliation(s)
- Pedro Gaspar
- Internal Medicine Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-ReConnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), ASL Città Di Torino and University of Turin, Turin, Italy
| | - Maria G Tektonidou
- First Department of Propaedeutic and Internal Medicine, Joint Academic Rheumatology Program, EULAR Centre of Excellence, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| |
Collapse
|
2
|
Svenungsson E, Spaak J, Strandberg K, Wallén HN, Agewall S, Brolin EB, Collste O, Daniel M, Ekenbäck C, Frick M, Henareh L, Malmqvist K, Elvin K, Sörensson P, Y-Hassan S, Hofman-Bang C, Tornvall P. Antiphospholipid antibodies in patients with myocardial infarction with and without obstructive coronary arteries. J Intern Med 2022; 291:327-337. [PMID: 34820922 DOI: 10.1111/joim.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). OBJECTIVES To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C-protein C inhibitor (APC-PCI) complex. METHODS Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case-control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β2 glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC-PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay. RESULTS Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β2 glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC-PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients. CONCLUSIONS aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability-measured by increased levels of the APC-PCI complex-were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.
Collapse
Affiliation(s)
- Elisabet Svenungsson
- Department of Medicine, Solna, Division of Rheumatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Strandberg
- Department of Clinical Chemistry and Pharmacology, Division of Laboratory Medicine, Coagulation Laboratory Malmö, University and Regional Laboratories, Region Skåne, Sweden
| | - Håkan N Wallén
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital and Institute of Clinical Sciences, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Elin B Brolin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Radiology, Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maria Daniel
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Christina Ekenbäck
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Loghman Henareh
- Department of Medicine, Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karin Malmqvist
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Elvin
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Matthia E, Altshuler E, Naik DK, Keeley EC. Acute coronary syndrome as the first presentation of antiphospholipid antibody syndrome. BMJ Case Rep 2021; 14:14/7/e242872. [PMID: 34290014 DOI: 10.1136/bcr-2021-242872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of a 42-year-old man who presented with anginal chest pain. He had objective evidence of ongoing cardiac injury. After initial treatment for coronary arterial disease, cardiac catheterisation revealed diffuse coronary arterial thrombosis with embolisation. Follow-up testing implicated new-onset antiphospholipid antibody syndrome as the aetiology.
Collapse
Affiliation(s)
- Eldon Matthia
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ellery Altshuler
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dhaval K Naik
- Division of Cardiology, University of Florida Department of Medicine, Gainesville, Florida, USA
| | - Ellen C Keeley
- Division of Cardiology, University of Florida Department of Medicine, Gainesville, Florida, USA
| |
Collapse
|
4
|
Kazzaz NM, Wilson AM, Kado R, Barnes GD, Knight JS. A 37-Year-Old Man With Primary Antiphospholipid Syndrome Presenting With Respiratory Distress and Worsening Toe Ischemia. Arthritis Care Res (Hoboken) 2019; 69:1253-1259. [PMID: 27992694 DOI: 10.1002/acr.23168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/30/2016] [Accepted: 12/06/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Ruba Kado
- University of Michigan Medical School, Ann Arbor
| | | | | |
Collapse
|
5
|
Alishiri G, Moshkani Farahani M, Sadr A, Salesi M, Rahemi M, Rezapoor B. The frequency of anti-phospholipid antibody syndrome in patients with premature coronary artery disease. J Cardiovasc Thorac Res 2019; 10:227-230. [PMID: 30680082 PMCID: PMC6335990 DOI: 10.15171/jcvtr.2018.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction: Coronary Artery Disease (CAD) is known as the major cause of morbidity and
mortality in the world with a growing trend, especially in some developing countries. CAD
commonly observed in elderly cases, however; recently it is usually found in young adults. In
this study, we aimed to evaluate the prevalence of anti-phospholipid antibody syndrome (APS) in
patients with premature CAD.
Methods: The cross-sectional study was conducted in Baqiyatallah hospital from April 2012 to
April 2016. Patients with premature CAD were included in the study. The data regarding the
laboratory tests, echocardiography, and angiography were obtained from all cases.
Results: Overall 133 eligible patients were included in the study. In the first set of the laboratory
test, 18 patients were recognized to have APS (13.53%). The second confirmatory APA test was
showing 3 of 18 patients were considered to have APS (2.25%).
Conclusion: The results showed there is an association between the risk of developing Premature
CAD and APS could potentially. The APS may have significant effects on the risk of coronary
heart disease, especially in young adults.
Collapse
Affiliation(s)
| | | | - Ali Sadr
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Rahemi
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bahador Rezapoor
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Pasupathy S, Rodgers S, Tavella R, McRae S, Beltrame JF. Risk of Thrombosis in Patients Presenting with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA). TH OPEN 2018; 2:e167-e172. [PMID: 31249940 PMCID: PMC6524870 DOI: 10.1055/s-0038-1645875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/19/2018] [Indexed: 11/09/2022] Open
Abstract
Patients presenting with myocardial infarction (MI) in the absence of obstructive coronary artery disease (CAD) is termed MI with nonobstructive coronary arteries (MINOCA). The underlying pathophysiology of MINOCA is multifactorial and in situ formation and subsequent spontaneous lysis of a coronary thrombus is often hypothesized as one of the mechanisms. The objective of this study is to determine whether MINOCA patients had a greater prothrombotic tendency in comparison to MI patients with obstructive CAD (MICAD). Prospectively, blood samples of 25 consecutive MINOCA patients (58 (interquartile range [IQR]: 48, 75) years, 48% women) and 25 age-/gender-matched MICAD patients (58 (IQR: 50, 66) years, 48% women) were obtained at 1 month after the initial presentation and overall thrombin generation potential and congenital/acquired thrombophilia states were assessed. As regard to results, overall thrombin generation parameters were similar (
p
> 0.05) between the MINOCA and MICAD groups, highlighting similar endogenous thrombin potential (1,590 nM/min; IQR: 1,380, 2,000 vs. 1,750 nM/min; IQR: 1,500, 2,040, respectively). There were no significant differences between MINOCA and MICAD, respectively, in respect to the numbers of patients with congenital thrombophilia states including factor V Leiden (0 vs. 4%) and prothrombin gene mutation (8 vs. 4%), decreased antithrombin (8 vs. 0%), protein C (0 vs. 0%), and protein S (4 vs. 0%). None of the patients demonstrated presence of lupus anticoagulant and anticardiolipin antibodies. Although MINOCA patients revealed thrombotic characteristics that are similar to those with MICAD, the results from this study are inconclusive and a larger study with healthy control subjects is required to assess the risk of thrombosis in MINOCA.
Collapse
Affiliation(s)
- Sivabaskari Pasupathy
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Susan Rodgers
- Division of Hematology, SA Pathology, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Rosanna Tavella
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Simon McRae
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Division of Hematology, SA Pathology, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - John F Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| |
Collapse
|
7
|
Cutting-edge issues in coronary disease and the primary antiphospholipid syndrome. Clin Rev Allergy Immunol 2013; 44:51-6. [PMID: 21403998 DOI: 10.1007/s12016-011-8268-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Antiphospholipid syndrome (APS) is the most frequent cause of venous and arterial thrombotic events in young patients. The brain arterial tree is primarily affected, but coronary ischemic manifestations are also relatively frequent. Coronary involvement was suggested to be closely related to the accelerated atherosclerosis linked to the underlying disease in APS associated to systemic autoimmune diseases, in particular, systemic lupus erythematosus. However, arterial ischemic events can occur in primary APS--with no other systemic disorders--even in the absence of traditional cardiovascular risk factors and overt atherosclerosis. From a biological point of view, this finding speaks in favor for a pro-coagulant activity of anti-phospholipid antibodies rather than for their role in atherosclerotic plaque formation. On the other hand, the clinical challenge is to avoid the risk to misdiagnose young patients with potentially life-threatening symptoms, such as myocardial infarction (MI). In fact, the occurrence of nonspecific symptoms related to coronary ischemic events is frequently misdiagnosed because of its rarity in young patients. This issue is well illuminated by two cases of MI in young patients reported in the manuscript together with a systematic review of the associations and implications of coronary ischemic events in APS.
Collapse
|
8
|
Javaid MM, Grigoriou A, Katsianos D, Kon SP. Nephrotic and anti-phospholipid syndromes: multisystem conditions associated with acute myocardial infarction in young patients. J Ren Care 2011; 38:9-14. [PMID: 21917124 DOI: 10.1111/j.1755-6686.2011.00249.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute myocardial infarction is relatively uncommon in patients under the age of 40 years. Unlike the older patients where rupture of coronary artery atherosclerotic plaque is the main underlying pathology, the pathogenesis in younger patients can be varied and may require different diagnostic and therapeutic approaches. Hypercoagulable state associated with nephrotic syndrome and antiphospholipid syndrome can lead to the development of occlusive coronary artery thrombus in absence of atherosclerotic coronary artery disease. Acute myocardial infarction in such a setting can sometimes be the first manifestation of an underlying disease. We describe a case of myocardial infarction in a young man with both nephrotic and antiphospho-lipid syndromes and present a brief literature review.
Collapse
Affiliation(s)
- Muhammad M Javaid
- Department of Nephrology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | | | | | | |
Collapse
|
9
|
Intracardiac Thrombosis and Acute Myocardial Infarction as Initial Presentation of Antiphospholipid Syndrome. Am J Med Sci 2011; 342:254-6. [DOI: 10.1097/maj.0b013e3182267a7b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
YEE DZY, TENG GG, LIM AYN, LOW AF, VASOO S. The autoimmunity conundrum: clotting or inflammation. Int J Rheum Dis 2010; 13:e62-6. [DOI: 10.1111/j.1756-185x.2010.01534.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Becker AC, Sliwa K, Stewart S, Libhaber E, Essop AR, Zambakides CA, Essop MR. Acute coronary syndromes in treatment-naïve black South africans with human immunodeficiency virus infection. J Interv Cardiol 2009; 23:70-7. [PMID: 20015160 DOI: 10.1111/j.1540-8183.2009.00520.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND HIV patients on protease inhibitors have greater risk of acute coronary syndromes (ACS) but little is known about treatment-naïve patients. METHODS AND RESULTS Authors conducted a prospective single-center study from Soweto, South Africa, comparing the clinical and angiographic features of treatment-naïve HIV positive and negative patients with ACS. Between March 2004 and February 2008, 30 consecutive treatment-naïve HIV patients with ACS were compared to the next HIV-negative patient as a 1:1 control. HIV patients were younger (43 +/- 7 vs. 54 +/- 13, P = 0.004) and, besides smoking (73% vs. 33%, P = 0.002), had fewer risk factors than the control group with less hypertension (23% vs. 77%, P = 0.0001), diabetes (3% vs. 23%, P = 0.05), LDL hyperlipidemia (2.2 +/- 0.9 vs. 3.0 +/- 1.2, P = 0.006), and other coronary risk factors (7% vs. 53%, P = 0.0001). HDL was lower in the HIV group (0.8 +/- 0.3 vs. 1.1 +/- 0.4, P = 0.001). Atherosclerotic burden was lower in the HIV group with more normal infarct-related arteries (47% vs. 13%, P = 0.005) but a higher degree of large thrombus burden (43% vs. 17%, P = 0.02). Stents were used to a similar degree in HIV and control patients (30% vs. 37%, P = 0.78) with more target lesion revascularization in the HIV group (56% vs. 0%, P = 0.008). CONCLUSION Treatment-naïve HIV patients with ACS are younger and have fewer traditional risk factors than HIV-negative patients. HIV patients have less atherosclerotic but higher thrombotic burden which may imply a prothrombotic state in the pathogenesis of ACS in these patients.
Collapse
Affiliation(s)
- A C Becker
- Division of Cardiology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
| | | | | | | | | | | | | |
Collapse
|
12
|
Prashanth P, Mukhaini M, Riyami A. A rare presentation of primary antiphospholipid syndrome. Oman Med J 2009; 24:300-2. [PMID: 22216385 DOI: 10.5001/omj.2009.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 07/27/2009] [Indexed: 12/12/2022] Open
Abstract
This case presents a young patient with myocardial infarction, in-situ thrombosis of left anterior descending coronary artery and right common-iliac artery due to primary antiphospholipid syndrome. This report discusses the relationship between antiphospholipid antibodies and coronary artery disease along with management of this rare condition.
Collapse
|
13
|
Morchi GS, Wolfe RR, Kay JD. Antiphospholipid syndrome leading to myocardial infarction in a Fontan patient 17 years after Norwood palliation. CONGENIT HEART DIS 2009; 4:54-8. [PMID: 19207406 DOI: 10.1111/j.1747-0803.2008.00217.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Appropriate regimens for anticoagulation in the single ventricle population remain controversial and are usually based on individual practitioners' preferences. We present the case of a patient with a history of hypoplastic left heart syndrome and Norwood palliation who presented at 17 years of age with an acute myocardial infarction and a new diagnosis of antiphospholipid syndrome.
Collapse
Affiliation(s)
- Gira S Morchi
- The Children's Hospital Heart Institute-Pediatric Cardiology, Aurora, Colorado, USA
| | | | | |
Collapse
|
14
|
Mialdea M, Sangle SR, D'Cruz DP. Antiphospholipid (Hughes) syndrome: beyond pregnancy morbidity and thrombosis. JOURNAL OF AUTOIMMUNE DISEASES 2009; 6:3. [PMID: 19454015 PMCID: PMC2689867 DOI: 10.1186/1740-2557-6-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 05/19/2009] [Indexed: 11/10/2022]
Abstract
The antiphospholipid syndrome is an autoimmune disease characterised by recurrent arterial or venous thrombosis, pregnancy morbidity and the persistence of positive antiphospholipid antibodies. Many other clinical manifestations may occur including heart valve disease, livedo reticularis, thrombocytopenia and neurological manifestations such as migraine and seizures. We review a number of other manifestations including stenotic lesions, coronary artery disease and accelerated atherosclerosis, skeletal disorders and the concept of seronegative antiphospholipid syndrome.
Collapse
Affiliation(s)
- Maria Mialdea
- The Lupus Research Unit, The Rayne Institute, 4thFloor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Shirish R Sangle
- The Lupus Research Unit, The Rayne Institute, 4thFloor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - David P D'Cruz
- The Lupus Research Unit, The Rayne Institute, 4thFloor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| |
Collapse
|
15
|
Sangle SR, D'Cruz DP. Syndrome X (angina pectoris with normal coronary arteries) and myocardial infarction in patients with anti-phospholipid (Hughes) syndrome. Lupus 2008; 17:83-5. [DOI: 10.1177/0961203307086036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- SR Sangle
- The Lupus Research Unit, The Rayne Institute, Lambeth Wing, St Thomas' Hospital, London, UK
| | - DP D'Cruz
- The Lupus Research Unit, The Rayne Institute, Lambeth Wing, St Thomas' Hospital, London, UK, david.d'
| |
Collapse
|