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Ruffatti A, Tonello M, Calligaro A, Del Ross T, Favaro M, Zen M, Hoxha A, Alaibac M. Prevalence and adverse consequences of delayed diagnosis and misdiagnosis in thrombotic antiphospholipid syndrome. An observational cohort study and a review of the literature. Clin Rheumatol 2023; 42:3007-3019. [PMID: 37453028 PMCID: PMC10587197 DOI: 10.1007/s10067-023-06699-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBIECTIVES This study aims to prospectively evaluate the frequency and adverse consequences of diagnostic delay and misdiagnosis in a cohort of patients with thrombotic antiphospholipid syndrome (TAPS). In addition, a systematic review of the literature concerning the diagnostic delay and misdiagnosis of TAPS was carried out. METHODS Patient enrollment occurred between 1999 and 2022. The study group was formed by TAPS patients whose diagnosis was delayed and those who were misdiagnosed. The control group was made up of patients who were timely and correctly diagnosed with TAPS. RESULTS The literature review showed 42 misdiagnosed patients, 27 of them were in one retrospective cohort study and 15 in 13 case reports. One hundred sixty-one out of 189 patients (85.2%) received a timely, correct diagnosis of TAPS; 28 (14.8%) did not. The number of patients with diagnostic issues was significantly higher for the first period (1999-2010), and the number of patients with a correct diagnosis was significantly higher for the second one (2011-2022). When the clinical and laboratory characteristics of the patients with delayed diagnosis were compared with those with misdiagnosis, there was a significantly higher number of severe adverse consequences characterized by permanent disability or death in the latter group. The two most common types of misdiagnoses were systemic lupus erythematosus (6 cases, 46.1%) and cardiovascular diseases (4 cases, 30.8%). CONCLUSIONS The study demonstrates that although knowledge about TAPS has improved over time, diagnostic delays and errors remains to be addressed as they are strongly associated to adverse consequences. Key Points •Although knowledge of thrombotic antiphospholipid syndrome has improved over time, it is still limited. •Diagnostic delay and misdiagnosis are still an important issue that remains to be addressed as they are strongly associated to adverse consequences. •The three more frequent misdiagnoses are multiple sclerosis, systemic lupus erythematosus and cardiovascular diseases.
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Affiliation(s)
- Amelia Ruffatti
- Department of Medicine-DIMED, University Hospital of Padua, Padua, Italy.
| | - Marta Tonello
- Department of Medicine-DIMED, Rheumatology Unit, University Hospital of Padua, Padua, Italy
| | - Antonia Calligaro
- Department of Medicine-DIMED, Rheumatology Unit, University Hospital of Padua, Padua, Italy
| | - Teresa Del Ross
- Department of Medicine-DIMED, Rheumatology Unit, University Hospital of Padua, Padua, Italy
| | - Maria Favaro
- Department of Medicine-DIMED, Rheumatology Unit, University Hospital of Padua, Padua, Italy
| | - Margherita Zen
- Department of Medicine-DIMED, Rheumatology Unit, University Hospital of Padua, Padua, Italy
| | - Ariela Hoxha
- Department of Medicine-DIMED, General Internal Medicine Unit, Thrombotic and Hemorrhagic Disease Unit, University Hospital of Padua, Padua, Italy
| | - Mauro Alaibac
- Department of Medicine-DIMED, Dermatology Unit, University Hospital of Padua, Padua, Italy
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Zen M, Tonello M, Favaro M, Del Ross T, Calligaro A, Giollo A, Vesentini F, Gennaio IA, Arru F, Ruffatti A, Doria A. Antiphospholipid antibody carriers and patients with quiescent antiphospholipid syndrome show persistent subclinical complement activation. Rheumatology (Oxford) 2023:kead517. [PMID: 37774001 DOI: 10.1093/rheumatology/kead517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES Complement activation has been advocated as one mechanism by which antiphospholipid antibodies (aPLs) can induce thrombosis. In patients with catastrophic aPL syndrome or re-thrombosis, enhanced complement activation was shown, even in quiescent phase of the disease. We aimed to assess complement activation and to investigate its association to clinical variables in aPL positive patients with a favorable disease course. METHODS Subjects with at least two consecutive positive aPL antibody results obtained ≥12 weeks apart were enrolled. They were subjects without history of thrombosis or pregnancy morbidity (aPL carriers), patients with pregnancy morbidity alone (OAPS), and/or with arterial, venous, or small-vessel thrombosis (TAPS); all patients should have been free of symptoms for ≥2 years. Patients affected with systemic autoimmune diseases were excluded. Healthy age and sex-matched subjects were included as controls. Plasma C5a and C5b-9 levels were assessed by commercially available ELISA assays. Non-parametric Mann-Whitney test and Spearman's correlation were applied. RESULTS Thirty-seven OAPS, 38 TAPS, 42 aPL carriers, and 30 healthy subjects were enrolled. Median C5a and C5b-9 levels were significantly higher in quiescent aPL positive patients (OAPS, TAPS, aPL carriers) compared with controls: C5a ng/ml 10.61 (IQR 6.87-15.46) vs 4.06 (2.66-7.35), p< 0.001; C5b-9 ng/ml 283.95 (175.8-439.40) vs 165.90 (124.23-236.8), p< 0.001. Similar C5a and C5b-9 levels were observed in OAPS and TAPS patients and aPL carriers. A positive correlation between C5b-9 median levels and the number of aPL positive tests was found (p= 0.002). CONCLUSIONS The persistence of aPL antibodies is associated to a persistent subclinical activation of the complement cascade.
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Affiliation(s)
- Margherita Zen
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Marta Tonello
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Maria Favaro
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Teresa Del Ross
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Antonia Calligaro
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Alessandro Giollo
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Filippo Vesentini
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Ilenia Anna Gennaio
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Federico Arru
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Amelia Ruffatti
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
| | - Andrea Doria
- University of Padua, Department of Medicine, Rheumatology Unit, Via Giustiniani 2, 35128 Padova Italy
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Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, Sáez-Comet L, Lefkou E, Mekinian A, Belizna C, Ruffatti A, Hoxha A, Tincani A, Nalli C, Marozio L, Maina A, Espinosa G, Ríos-Garcés R, Cervera R, De Carolis S, Monteleone G, Latino O, Udry S, LLurba E, Garrido-Gimenez C, Trespidi L, Gerosa M, Chighizola CB, Rovere-Querini P, Canti V, Mayer-Pickel K, Tabacco S, Arnau A, Trapé J, Ruiz-Hidalgo D, Sos L, Farran-Codina I. Corrigendum to: Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from EUROAPS registry. Rheumatology (Oxford) 2021; 60:5883. [PMID: 34672326 DOI: 10.1093/rheumatology/keab659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona.,Department of Medicine, Universitat Autònoma, Barcelona
| | - Enrique Esteve-Valverde
- Internal Medicine Department, Althaia Healthcare University Network of Manresa, Systemic Autoimmune Disease Unit, Manresa, Barcelona
| | | | - Luis Sáez-Comet
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elmina Lefkou
- Haematology Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Arsène Mekinian
- AP-HP, Hôpital Saint-Antoine, Service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ, Paris
| | - Cristina Belizna
- Vascular and Coagulation Department, University Hospital Angers and CNRS, 6015 INSERM 1083 Unit, Angers, France
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Luca Marozio
- Department of Obstetrics and Gynaecology, Università di Torino, Torino
| | - Aldo Maina
- Department of Internal Medicine, AO Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Roberto Ríos-Garcés
- Department of Autoimmune Diseases, Hospital Clinic, Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Sara De Carolis
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Istituto di Clinica Ostetrica e Ginecologica, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppina Monteleone
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Omar Latino
- Autoimmune, Thrombophilic Diseases and Pregnancy Division, Dr Carlos G. Durand Hospital, Buenos Aires, Argentina
| | - Sebastian Udry
- Autoimmune, Thrombophilic Diseases and Pregnancy Division, Dr Carlos G. Durand Hospital, Buenos Aires, Argentina
| | - Elisa LLurba
- Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carmen Garrido-Gimenez
- Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Trespidi
- Obstetrics and Gynaecology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan
| | - Maria Gerosa
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan
| | - Cecilia Beatrice Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan
| | - Patrizia Rovere-Querini
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan
| | - Valentina Canti
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan
| | | | - Sara Tabacco
- Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Anna Arnau
- Clinical Research Unit, Althaia Healthcare University Network of Manresa, University of Vic - Central University of Catalonia, Barcelona
| | - Jaume Trapé
- Department of Laboratory Medicine, Althaia Healthcare University Network of Manresa, University of Vic - Central University of Catalonia, Barcelona
| | - Domingo Ruiz-Hidalgo
- Internal Medicine Department, Althaia Healthcare Network of Manresa, Manresa, University of Vic - Central University of Catalonia, Barcelona
| | - Laia Sos
- Urology Department. Andrology and Male Reproductive Unit, Vilafranca del Penedès Hospital, Barcelona
| | - Inmaculada Farran-Codina
- Obstetrics and Gynaecology Department, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma, Barcelona, Spain
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Ruffatti A, Tonello M, Calligaro A, Del Ross T, Favaro M, Zen M, Carletto A, Lotti V, Bertoldo E, Tedesco F, Hoxha A, Biasi D. High plasma C5a and C5b-9 levels during quiescent phases are associated to severe antiphospholipid syndrome subsets. Clin Exp Rheumatol 2021; 40:2088-2096. [DOI: 10.55563/clinexprheumatol/7cinzu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Amelia Ruffatti
- Department of Medicine, University Hospital of Padova, Italy.
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Italy
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Italy
| | - Antonio Carletto
- Department of Medicine, Rheumatology Unit, L.U.R.M. University Hospital of Verona, Italy
| | - Virginia Lotti
- Department of Medicine, Rheumatology Unit, L.U.R.M. University Hospital of Verona, Italy
| | - Eugenia Bertoldo
- Department of Medicine, Rheumatology Unit, L.U.R.M. University Hospital of Verona, Italy
| | - Francesco Tedesco
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immuno-Rheumatology, Milan, Italy
| | - Ariela Hoxha
- Department of Medicine, Internal Medicine Unit, San Bortolo Hospital, Vicenza, Italy
| | - Domenico Biasi
- Department of Medicine, Rheumatology Unit, L.U.R.M. University Hospital of Verona, Italy
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Hoxha A, Marson P, Favaro M, Tonello M, Zen M, Del Ross T, Calligaro A, Ruffatti A. AB0295 TREATMENT OF HIGH RISK/REFRACTORY OBSTETRIC ANTIPHOSPHOLIPID SYNDROME. A SINGLE CENTRE EXPERIENCE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The most efficacious strategy to manage pregnant patients with antiphospholipid syndrome (APS) who are at high risk of adverse pregnancy outcomes ± refractory to conventional heparin/low-dose aspirin treatment is currently unknown (1, 2).Objectives:The purposes of this study were to investigate the efficacy and safety of a second-line treatment protocol administered in addition to twice daily low molecular weight heparin and low-dose aspirin to pregnant patients affected with high-risk ± refractory primary APS.Methods:Patients were included in the study if satisfying the following criteria were: 1) the presence of triple antiphospholipid antibody positivity (IgG/IgM anticardiolipin + IgG/IgM anti-β2 Glycoprotein I antibodies + lupus anticoagulant), 2) previous thrombosis and/or a history of one or more early and severe pregnancy complications. The second-line treatment protocol included weekly plasmapheresis or immunoadsorption and fortnightly 1g/kg intravenous immunoglobulins.Results:Twenty-four pregnancies occurring between 2002 and 2019 in 19 primary APS patients, (mean age 35.1 ± 3.5 SD) were monitored. Triple antiphospholipid positivity was detected in all 19 cases (100%). Seven of these women (36.8%) had a history of thrombosis, five (26.3%) one or more previous failed pregnancies associated to severe pregnancy complications and seven (36.8%) both clinical criteria. Twenty- three pregnancies (95.8%) produced live neonates (13 females and 10 males), all born between the 26th and 38th week of gestation (mean 33.6 ± 3.5 SD); birth weight percentile was 35.8 ± 24.1 SD and mean Apgar score at 5 min 8.7 ± 1.1 SD. Due to premature birth (24th week) complicated by fetal sepsis, one pregnancy (4.2%) had a negative outcome. During the treated pregnancy there were no episodes of thrombosis; there were five cases (20.8%) of severe maternal complications during pregnancy or puerperium and four of fetal complications (16.6%), all followed by complete recovery after delivery. No side-effects of the treatment were registered.Conclusion:Given the high live birth rate and the safety associated to it, the second-line treatment protocol described here could be taken into consideration when the treatment of a high-risk APS pregnancy ± refractory to conventional therapy is being evaluated.References:[1]Tektonidou MG, et al. Ann Rheum Dis 2019;0:1–9. doi:10.1136/annrheumdis-2019-215213[2]Giacomelli et al. Autoimmun Rev. 2020;102738. doi.org/10.1016/j.autrev.2020.102738Disclosure of Interests:None declared
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Fredi M, Rizzo G, Andreoli L, Bacco B, Bertero T, Bortoluzzi A, Ceccarelli F, Cimaz R, Conigliaro P, Corradi F, De Vita S, DI Poi E, Elefante E, Emmi G, Gerosa M, Govoni M, Hoxha A, Lojacono A, Marrani E, Marozio L, Mathieu A, Mosca M, Melissa P, Picchi C, Piga M, Priori R, Ramoni V, Ruffatti A, Simonini G, Tani C, Tonello M, Trespidi L, Urban ML, Vezzoli M, Zatti S, Calza S, Brucato A, Franceschini F, Tincani A. POS0751 COMORBIDITY AND LONG-TERM OUTCOME IN PATIENTS WITH CONGENITAL HEART BLOCK: PRELIMINARY DATA OF THE ITALIAN REGISTRY ON THE IMMUNE-MEDIATED CONGENITAL HEART BLOCK. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Congenital heart block (CHB) is due to placental transfer of maternal anti-Ro/SSA autoantibodies to the fetus. The prevalence of CHB has been estimated as 1-2% in anti-Ro/SSA women while the recurrence rate is 16-19% (1). This condition is associated with a high rate of fetal/neonatal mortality and most of the cases requires pacemaker (PM) pacing. Given the rarity of CHB, limited data are available regarding the long-term follow-up of the offspring other than the cardiovascular complications.Objectives:The results of the Italian Registry of the autoimmune congenital heart block were recently described (2). A peculiarity of this cohort was that most of the mothers had an established diagnosis of systemic autoimmune disease at CHB detection, in contrast with other registries where CHB was mostly incidentally detected in healthy women. Here we report an update, with the preliminary data regarding the long-term outcome of patients with CHB, their unaffected siblings and health controls born from mothers positive for Ro/SSA.Methods:Data regarding demography, treatment, maternal, neonatal outcome, and follow-up were collected through an online electronic datasheet. A dedicated questionnaire was created with the aim to investigate general health, cardiovascular follow-up, and frequency of autoimmune diseases.Results:One-hundred and five cases of CHB in 99 patients were included from 1969 to December 2020. CHB was mostly detected in utero (97 cases, 92.3%) with 8 neonatal cases. Third degree CHB occurred in 71 cases (67.6%). Child mortality was observed in 29 (27.6%) cases: 20 in utero, 7 during neonatal period and 2 during childhood. Overall, a PM was implanted in 54 out of the 85 live births (63.5%). Then, our cohort was divided into 2 subgroups: pregnancy that occurred before (N=61) and after 2010 (N=44) with the aim to evaluate possible differences among the subgroups. Whereas mortality, PM, CHB degree were similar, CHB more frequently occurred in the last 10 years among Ro/SSA asymptomatic carriers than in the group of pregnancies before 2010 (53.6% vs 32.8%, p=0.038). Questionnaires from 14 surviving CHB cases, 8 unaffected siblings 12 controls born from mothers Ro/SSA positive were collected. Among CHB cases, 6 were males and 8 females, median age 12 years (range 6-28). All presented a third degree CHB, 10 required a neonatal PM pacing and one had an implantable ECG recorder. PM was substituted at least once in 9 patients, the oldest patient had to change it four times. No dilated cardiomyopathy occurred and most of the patients maintain an annual follow-up. Two cases of autoimmune diseases were registered among CHB cases, one idiopathic juvenile arthritis and one Cogan’s vasculitis, both born from mothers with Sjogren Syndrome. Four cases of neurodevelopmental disorders occurred: three cases of learning disabilities (one in each group) and one case of speech disorder in the sibling group. In addition, a CHB case presented a stress disorder linked to frequent hospitalizations.Conclusion:This registry is an ongoing project aiming at collecting all Italian CHB. Moreover, here we reported the preliminary data concerning the evaluation of long-term follow-up of CHB patients. Our data, even if need to be confirmed in larger cohort, seems reassuring: no differences were reported comparing CHB patients with unaffected siblings or controls.References:[1]Brito-Zéron et al. Nat Rev Rheumatol 2015;11:301-312.[2]Fredi M et al. Front Cardiovasc Med. 2019 Feb 28;6:11.Disclosure of Interests:None declared
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Larosa M, Le Guern V, Morel N, Belhocine M, Ruffatti A, Silva NM, Paule R, Mouthon L, Dreyfus M, Piette JC, Souchaud-Debouverie O, Deneux-Tharaux C, Guettrot-Imbert G, Tsatsaris V, Pannier-Metzger E, Murarasu A, Doria A, Costedoat-Chalumeau N. Evaluation of the severe preeclampsia classification criterion for antiphospholipid syndrome in a study of 40 patients. Arthritis Res Ther 2021; 23:134. [PMID: 33947469 PMCID: PMC8094564 DOI: 10.1186/s13075-021-02518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background The criteria for antiphospholipid syndrome (APS) include severe preeclampsia and/or placental insufficiency leading to preterm delivery before 34 weeks of gestation, but this APS manifestation has been rarely studied. Thus, we report a series of severe preeclampsia occurred in patients with APS. Methods We retrospectively analysed data of women with APS (Sydney criteria) who experienced severe preeclampsia with delivery before 34 weeks’ gestation between 2000 and 2017 at five French internal medicine departments and one Italian rheumatology unit. Results The 40 women had a mean age of 30.5 ± 4.6 years at their first episode of preeclampsia; 21 were nulligravid (52.5%), 12 (30%) had already been diagnosed with APS, and 21 (52.5%) had a triple-positive antiphospholipid (aPL) antibody test. Preeclampsia occurred at a median gestational age of 25.5 weeks (IQR 23-29). It was associated with HELLP in 18 cases (45%), eclampsia in 6 (15%), placental abruption in 3 (7.5%), catastrophic APS in 3 (7.5%), and foetal and neonatal death in 11 and 15 cases. Overall, 14 (35%) children survived, born at a median gestational age of 31 weeks. Among other APS criteria, 16 women (40%) experienced at least one thrombosis, 17 (42.5%) an intrauterine foetal death, and 19 (47.5%) at least one episode of HELLP during follow-up (median 5 years, IQR = 2-8). None had three or more consecutive miscarriages. Notably, 12 women (30%) had systemic lupus erythematosus. Conclusions Severe preeclampsia led to high mortality in the offspring. Almost half of these women experienced other APS features, but not three consecutive miscarriages. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02518-7.
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Affiliation(s)
- Maddalena Larosa
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France.,Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Mériem Belhocine
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France.,Sacré-Coeur Hospital, Internal Medicine Department, University of Montréal, Montréal, Canada
| | - Amelia Ruffatti
- Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Nicolas Martin Silva
- University Hospital Center of Caen, Department of Internal Medicine, Caen, France
| | - Romain Paule
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Luc Mouthon
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France.,Université de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Michel Dreyfus
- University Hospital Center of Caen, Gynecology and Obstetrics Department, Caen, France
| | - Jean-Charles Piette
- AP-HP, Pitié-Salpétrière University Hospital, Internal Medicine and Clinical Immunology Department, Centre de référence maladies auto-immunes et systémiques rares de l'Ile de France, Paris, France
| | | | - Catherine Deneux-Tharaux
- INSERM U 1153, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Université de Paris, Paris, France
| | - Gaelle Guettrot-Imbert
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Vassilis Tsatsaris
- AP-HP, Cochin Broca Hôtel-Dieu Hospital, Port-Royal maternity, DHU Risk in Pregnancy, INSERM Unité 1139, Paris, France
| | - Emmanuelle Pannier-Metzger
- AP-HP, Cochin Broca Hôtel-Dieu Hospital, Port-Royal maternity, DHU Risk in Pregnancy, INSERM Unité 1139, Paris, France
| | - Anne Murarasu
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France. .,Université de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France. .,INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France.
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Ruffatti A, Tonello M, Favaro M, Del Ross T, Calligaro A, Ruffatti AT, Gervasi MT, Hoxha A. The efficacy and safety of second-line treatments of refractory and/or high risk pregnant antiphospholipid syndrome patients. A systematic literature review analyzing 313 pregnancies. Semin Arthritis Rheum 2020; 51:28-35. [PMID: 33360227 DOI: 10.1016/j.semarthrit.2020.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/23/2020] [Accepted: 10/16/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The most efficacious strategy to manage pregnant patients with antiphospholipid syndrome (APS) refractory to conventional heparin/low-dose aspirin treatment or at high risk of adverse pregnancy outcomes has not been determined with any degree of certainty. The study set out to evaluate the efficacy and safety of the second-line treatments most frequently used in addition to conventional therapy, and the data were analyzed to identify which is/are associated to the best pregnancy outcomes. METHODS A systematic review of the literature on studies concerning second-line treatments for refractory and/or high risk pregnant APS women published between February 2006 and February 2020 was conducted. The records were retrieved by searching Medline via Pubmed, the Web of Science platform, the Cochrane library database and clinicaltrials.gov. RESULTS Fourteen studies met the eligibility criteria of the review: six retrospective cohort studies, one case-control, one case-series and six case reports. The results of single treatment protocols based upon hydroxychloroquine (HCQ), low-dose steroids (LDS), intravenous immunoglobulins (IVIG), plasma exchange (PE) or pravastatin and of combination protocols based upon HCQ+LDS, IVIG+LDS, PE+LDS and PE+IVIG used during 313 pregnancies in 303 APS women were analyzed and compared. The second-line treatments produced 261/313 (83.4%) live births; severe pregnancy complications were registered in 75/313 (24%) pregnancies. Drug side-effects were observed in 3/313 (0.9%) pregnancies. Statistical analysis identified a significantly higher live birth rate and/or a significantly lower number of severe complications in the pregnancies treated with IVIG, HCQ, pravastatin, PE+IVIG and PE+LDS. CONCLUSION Our results suggest using low-dose IVIG (< 2 g/Kg/month) or HCQ 400 mg/day starting before pregnancy in women with APS refractory to conventional therapy, while high-dose IVIG (2 g/Kg/month) associated with PE or alone in those with high risk±refractory APS.
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua Italy.
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua Italy
| | - Alessandra Teresa Ruffatti
- Gynaecology and Obstetrics Unit, Department of Woman and Child Health, University Hospital of Padua, Padua, Italy
| | - Maria Teresa Gervasi
- Gynaecology and Obstetrics Unit, Department of Woman and Child Health, University Hospital of Padua, Padua, Italy
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua Italy; Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, Italy
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Tonello M, Calligaro A, Favaro M, Del Ross T, Veronese P, Salvan E, Gervasi MT, Ruffatti A. The first thrombotic event in purely obstetric antiphospholipid syndrome patients and in antiphospholipid antibody carriers: comparison of incidence and characteristics. Arch Gynecol Obstet 2020; 303:455-461. [PMID: 32880711 DOI: 10.1007/s00404-020-05766-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The long-term risk of thrombosis after pregnancy in women with purely obstetric antiphospholipid syndrome (OAPS) is not well defined. The current study's primary outcome was to evaluate the incidence and characteristics of the first thrombotic event in OAPS, identifying the risk factors for thrombosis in OAPS was its secondary one. METHODS Patients with purely OAPS were consecutively enrolled between September 1999 and September 2019. Subjects without a history of pregnancy morbidity or thrombosis but with persistent positivity for one or more antiphospholipid antibodies (aPL carriers) made up the control group. The study groups included 94 OAPS patients and 124 aPL carriers who were matched for clinical and laboratory parameters. RESULTS An event rate of 0.49/100 patient years was registered in OAPS patients during a mean follow-up of 8.7 years ± 5.5 SD. Kaplan-Meier survival analysis revealed that the cumulative incidence of thromboembolic events was not significantly different in OAPS patients vs aPL carriers. Arterial thrombosis and cerebrovascular events were the more frequent types of vascular involvement in the two groups. As far as risk factors for thrombosis were concerned, the presence of lupus anticoagulant significantly prevailed in both thrombotic OAPS patients and thrombotic aPL carriers with respect to purely OAPS patients and aPL carriers who did not develop thrombosis (p = 0.01 and p = 0.00, respectively). CONCLUSION Just as for aPL carriers, closer monitoring and possibly, a pharmacological prophylaxis should be reserved for OAPS patients at highest risk of developing the first thrombotic event.
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Affiliation(s)
- Marta Tonello
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Paola Veronese
- Obstetrics and Gynecology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Elisa Salvan
- General Department, University of Padua, Padua, Italy
| | - Maria Teresa Gervasi
- Obstetrics and Gynecology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy.
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Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, Sáez-Comet L, Lefkou E, Mekinian A, Belizna C, Ruffatti A, Hoxha A, Tincani A, Nalli C, Marozio L, Maina A, Espinosa G, Ríos-Garcés R, Cervera R, Carolis SD, Monteleone G, Latino O, Udry S, LLurba E, Garrido-Gimenez C, Trespidi L, Gerosa M, Chighizola CB, Rovere-Querini P, Canti V, Mayer-Pickel K, Tabacco S, Arnau A, Trapé J, Ruiz-Hidalgo D, Sos L, Farran-Codina I. Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from the EUROAPS registry. Rheumatology (Oxford) 2020; 59:1306-1314. [PMID: 31580459 DOI: 10.1093/rheumatology/kez419] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare clinical features, laboratory data and fetal-maternal outcomes between 1000 women with obstetric APS (OAPS) and 640 with aPL-related obstetric complications not fulfilling Sydney criteria (non-criteria OAPS, NC-OAPS). METHODS This was a retrospective and prospective multicentre study from the European Registry on Obstetric Antiphospholipid Syndrome. RESULTS A total of 1650 women with 5251 episodes, 3601 of which were historical and 1650 latest episodes, were included. Altogether, 1000 cases (OAPS group) fulfilled the Sydney classification criteria and 650 (NC-OAPS group) did not. Ten NC-OAPS cases were excluded for presenting thrombosis during follow-up. All cases were classified as category I (triple positivity or double positivity for aPL) or category II (simple positivity). Overall, aPL laboratory categories showed significant differences: 29.20% in OAPS vs 17.96% in NC-OAPS (P < 0.0001) for category I, and 70.8% in OAPS vs 82% in NC-OAPS (P < 0.0001) for category II. Significant differences were observed when current obstetric complications were compared (P < 0.001). However, major differences between groups were not observed in treatment rates, livebirths and thrombotic complications. In the NC-OAPS group, 176/640 (27.5%) did not fulfil Sydney clinical criteria (subgroup A), 175/640 (27.34%) had a low titre and/or non-persistent aPL positivity but did meet the clinical criteria (subgroup B) and 289/640 (45.15%) had a high aPL titre but did not fulfil Sydney clinical criteria (subgroup C). CONCLUSION Significant clinical and laboratory differences were found between groups. Fetal-maternal outcomes were similar in both groups when treated. These results suggest that we could improve our clinical practice with better understanding of NC-OAPS patients.
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Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona.,Department of Medicine, Universitat Autònoma, Barcelona
| | - Enrique Esteve-Valverde
- Internal Medicine Department, Althaia Healthcare University Network of Manresa, Systemic Autoimmune Disease Unit, Manresa, Barcelona
| | | | - Luis Sáez-Comet
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elmina Lefkou
- Haematology Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Arsène Mekinian
- AP-HP, Hôpital Saint-Antoine, Service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ, Paris
| | - Cristina Belizna
- Vascular and Coagulation Department, University Hospital Angers and CNRS, 6015 INSERM 1083 Unit, Angers, France
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Luca Marozio
- Department of Obstetrics and Gynaecology, Università di Torino, Torino
| | - Aldo Maina
- Department of Internal Medicine, AO Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Roberto Ríos-Garcés
- Department of Autoimmune Diseases, Hospital Clinic, Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Sara De Carolis
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Istituto di Clinica Ostetrica e Ginecologica, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppina Monteleone
- UOC di Patologia Ostetrica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Omar Latino
- Autoimmune, Thrombophilic Diseases and Pregnancy Division, Dr Carlos G. Durand Hospital, Buenos Aires, Argentina
| | - Sebastian Udry
- Autoimmune, Thrombophilic Diseases and Pregnancy Division, Dr Carlos G. Durand Hospital, Buenos Aires, Argentina
| | - Elisa LLurba
- Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carmen Garrido-Gimenez
- Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Trespidi
- Obstetrics and Gynaecology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan
| | - Maria Gerosa
- Division of Rheumatology, Department of Clinical Sciences and Community Health, University of Milan, Milan
| | | | - Patrizia Rovere-Querini
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan
| | - Valentina Canti
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan
| | | | - Sara Tabacco
- Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Anna Arnau
- Clinical Research Unit, Althaia Healthcare University Network of Manresa, University of Vic - Central University of Catalonia, Barcelona
| | - Jaume Trapé
- Department of Laboratory Medicine, Althaia Healthcare University Network of Manresa, University of Vic - Central University of Catalonia, Barcelona
| | - Domingo Ruiz-Hidalgo
- Internal Medicine Department, Althaia Healthcare Network of Manresa, Manresa, University of Vic - Central University of Catalonia, Barcelona
| | - Laia Sos
- Urology Department. Andrology and Male Reproductive Unit, Vilafranca del Penedès Hospital, Barcelona
| | - Inmaculada Farran-Codina
- Obstetrics and Gynaecology Department, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma, Barcelona, Spain
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Hoxha A, Mattia E, Zanetti A, Carrara G, Morel N, Costedoat-Chalumeau N, Brucato AL, Ruffatti A. Fluorinated steroids are not superior to any treatment to ameliorate the outcome of autoimmune mediated congenital heart block: a systematic review of the literature and meta-analysis. Clin Exp Rheumatol 2020; 38:783-791. [PMID: 32573408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/28/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Fluorinated steroids are largely the therapeutic approach of autoimmune mediated congenital heart block (CHB). We performed a meta-analysis to assess the efficacy of fluorinated steroids for the treatment of CHB. METHODS Studies evaluating the efficacy of fluorinated steroids versus no treatment in CHB patients were identified in electronic databases. Random-effects model was used to pool odds ratio (OR) (with 95% CI) of live births as the primary outcome. ORs of CHB progression, pacemaker implantation and extranodal disease were the secondary outcome. Subgroup analysis according to CHB grade and study type was performed. RESULTS Data from nine studies involving 747 patients were analysed. The overall live birth rates were 86.8% and 86.7%, respectively, in the fluorinated steroids exposed foetuses and in the non-exposed ones. Fluorinated steroids did not ameliorate overall survival in CHB (OR 1.02; 95% CI: 0.65-1.61) with any significant statistical heterogeneity between studies (I2 0%, p=0.45). No significant differences for the progression of CHB, the pacing and the presence of extranodal disease were observed. Subgroup analysis revealed a significant protective role of fluorinated steroids for survival in 3rd degree CHB and for pacing in monocentric studies, OR 4.07; 95% CI: 1.10-15.08 and OR 0.15; 95% CI: 0.02-0.99, respectively. CONCLUSIONS This meta-analysis shows that fluorinated steroids are not superior to any treatment in patients with CHB in terms of live birth, prevention of progression of incomplete CHB, pacemaker implantation and extranodal disease. Thus, considering their side effects, their use in CHB patients should be discouraged.
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Affiliation(s)
- Ariela Hoxha
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, and Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
| | - Elena Mattia
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy
| | - Anna Zanetti
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, and Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Greta Carrara
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Nathalie Morel
- AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, and Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris; Université Paris Descartes-Sorbonne Paris Cité, and INSERM U 1153, Centre for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), France
| | - Antonio L Brucato
- Department of Biomedical and Clinical Sciences, University of Milan, Fatebenefratelli Hospital, Milan, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy
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Colpo A, Marson P, Tison T, Zambon A, La Rosa A, Zanetti E, Ruffatti A, De Silvestro G, Hoxha A. SAT0176 THERAPEUTIC APHERESIS DURING PREGNANCY IN RHEUMATIC DISEASES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Therapeutic apheresis (TA) represents a therapeutic option in pre-existing conditions or rheumatic diseases that occur during gestation. Although pregnancy is not a contraindication itself, due to the lack of evidence-based guidelines and the alleged risk of maternal and/or fetal adverse events, there is general resistance to its application during pregnancy.Objectives:In this observational study we aimed to evaluate the efficacy and safety of TA in high-risk pregnancies in patients with rheumatic diseases, followed over a decade in a tertiary Center.Methods:Between January 2005 and April 2019, 843 TA procedures were performed during 51 pregnancies in 43 patients: 745 plasma exchange sessions and 98 immunoabsorption sessions. TA was performed in 29 (57%) pregnancies of 21 (48.8%) patients with antiphospholipid antibody syndrome (APS), in 20 (39.2%) pregnancies of 20 (46.5%) patients with congenital heart block (CHB), in 1 (1.9%) pregnancy of 1 (2.3%) patient with systemic sclerosis (SSc) and 1 (1.9%) pregnancy of 1 (2.3%) patient affected by lupic nephritis (SLE).Results:During the period considered, apheresis sessions applied to pregnant women were 7.1% of the total (n = 13.251). The average age at the first treatment was 33 years (range 24-43). The mean management age at the first apheretic treatment was 21 weeks (range 4-32). Twelve (1.4%) apheresis sessions were complicated by adverse events, none required or prolonged hospitalization. There were 44 (86.3%) live births, 3 (5.9%) spontaneous abortions and 2 (3.9%) voluntary terminations of pregnancy, 2 (3.9%) lost to follow-up. The average gestational age at birth was 35 weeks (range 24-37) and cesarean section was performed in 41 (80.4%) cases. TA was added to conventional therapy in 24/29 (82.7%) patients with APS, to the detection of fetal cardiac activity, while in 5/26 (17.3%) it was introduced when the first signs of pregnancy complications such as mild preclampsia, HELLP and IUGR were detected. TA was started within 24 hours of atrioventricular block (AVB) detection; 10/20 (50%) mothers with CHB were diagnosed with 2nd degree AVB, 9/20 (45%) with 3rd degree AVB and one (5%) with sinus bradycardia and endocardial fibroelastosis. The patient with SSc was treated with TA twice a week from the 32nd SG until delivery, which occurred at the 36th SG, due to severe IUGR and oligohydramnios. The patient with SLE complicated by lupic nephritis was treated with TA twice a week, from the 26th SG until the birth, which took place at the 31st SG.Conclusion:Our data have shown that TA in pregnancy is well tolerated. Close collaboration between rheumatologist, obstetrician and specialist in TA is essential to ensure a successful outcome of high-risk pregnancies.Disclosure of Interests: :Anna Colpo: None declared, Piero Marson: None declared, Tiziana Tison: None declared, Alessandra Zambon: None declared, Annalisa La Rosa: None declared, Ermella Zanetti: None declared, Amelia Ruffatti: None declared, Giustina De Silvestro: None declared, Ariela Hoxha Speakers bureau: Celgene, UCB, Novartis, Sanofi, Werfen
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Hoxha A, Favaro M, Calligaro A, Del Ross T, Ruffatti AT, Infantolino C, Tonello M, Mattia E, Ruffatti A. AB0378 UPGRADING THERAPY STRATEGY IMPROVES PREGNANCY OUTCOME IN ANTIPHOSPHOLIPID SYNDROME: A COHORT MANAGEMENT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:While it is generally agreed that pregnant APS patients should receive personalized treatment, evidence-based guidelines for these patients continue to be lacking.Objectives:The current study was designed as a management cohort study aiming to evaluate the efficacy and safety of different treatment strategies for pregnant APS patients in the attempt to provide some practical suggestions for attending physicians.Methods:One-hundred-twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH)+low-dose aspirin (LDA, 100 mg) [Group I] and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH+LDA [Group II]. LMWH doses were increased throughout the pregnancies depending on the patients’ weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study’s primary outcome was live births.Results:There were no significant differences in live birth rate between Group I (95.4%) and Group II (87.5%). Even, fetal complication rate was similar in the two groups; the Group II nevertheless had a higher prevalence of maternal and neonatal complications (p=0.0005 and p=0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p=0.0001 and p=0.0005, respectively). Two patients in Group I switched to Group II therapy, six patients in Group II switched to a more intensive treatment strategy (weekly plasma exchange+ fortnightly intravenous immunoglobulins in addition to therapeutic LMWH+LDA). Comparison of the clinical and laboratory characteristics between patients who had shifted to a more intensive therapy and those who did not showed a significant prevalence of history of thrombosis ± pregnancy morbidity (p=0.02, OR 5.96, 95% CI 1.33-26.62) previous pregnancy complications (p=0.02, OR 8.32, 95% CI 1.67-41.3), triple aPL positivity (p <0.0001, OR 97.13, 95% CI 10.6-890) and pregnancy complications (p<0.0001, OR 197,7, 95% CI 10.57-3699) in upgrading group, instead single aPL positivity significantly prevailed (p=0.003, OR 0.06, 95% CI 0.008-0.58) in non-upgrading group. Logistic regression analysis demonstrated that triple aPL positivity was an independent factor for switching to a more effective therapy protocol (p <0.0001, OR 98, 95% CI 10.7-897.54). All eight switched patients achieved a live birth.Conclusion:Using adjusted LMWH doses and upgrading therapy at the first signs of pregnancy complications led to a high rate of live births in a relatively large group of APS patients. The study outlines the criteria for prescribing appropriate therapy for various subsets of these patients and for switching/upgrading the treatment protocol when it is no longer sufficient. Unfortunately, for the moment there are no evidence-based guidelines on the ideal additional treatment in refractory to conventional therapy APS patients. The present results will hopefully help point the direction of future clinical trials investigating the efficacy and safety of the different therapies on large numbers of APS pregnant patients in order to identify the benefits and limits of different treatment strategies administered from the beginning of pregnancy.Disclosure of Interests:Ariela Hoxha Speakers bureau: Celgene, UCB, Novartis, Sanofi, Werfen, Maria Favaro: None declared, Antonia Calligaro: None declared, Teresa Del Ross: None declared, Alessandra Teresa Ruffatti: None declared, Chiara Infantolino: None declared, Marta Tonello: None declared, Elena Mattia: None declared, Amelia Ruffatti: None declared
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Larosa M, Morel N, Belhocine M, Ruffatti A, Silva NM, Paul R, Mouthon L, Dreyfus M, Piette JC, Souchaud-Debouverie O, Deneux-Tharaux C, Tsatsaris V, Pannier E, Guettrot Imbert G, Le Guern V, Doria A, Costedoat-Chalumeau N. THU0275 SEVERE PREECLAMPSIA RELATED TO ANTIPHOSPHOLIPID SYNDROME: AN EUROPEAN STUDY OF 40 WOMEN. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:One of the 3 features of obstetrical antiphospholipid syndrome (APS) is severe preeclampsia (PE). Its time of occurrence, the associated risk of thromboses and systemic lupus erythematosus (SLE) have not been reported yet.Objectives:We analyzed severe PE in a series of women with APS.Methods:We retrospectively collected data of female patients from 5 French internal medicine and 1 Italian rheumatology units. Inclusion criteria were: a severe PE/eclampsia(1), that occurred before 34 weeks of gestation (WG) in patients who met the APS classification criteria(2).Results:40 patients were enrolled (Table 1). Because of known APS/positive aPL/previous obstetrical complications, 23(57.5%) patients were treated during the index PE: 4 with low dose aspirin (LDA), 4 with low molecular weight heparin (LMWH), and 15 with a combination of both. 7 patients were also treated with hydroxychloroquine, 8 with corticosteroids and 3 with immunosuppressants. 17(42.5%) patients received no treatment. 24(60%) live births were observed. During a follow-up period of 3 years, 26(65%) patients had at least 1 new pregnancy, with a total of 38 pregnancies which resulted in 33(86.8%) live births. 57.5% pregnancies who resulted in live births occurred without any maternal or fetal complications. All 26 patients who had at least 1 pregnancy after index PE were treated with LDA; LMWH was given at prophylactic and therapeutic dosage in 13(50%) patients, respectively. No patient experienced 3 consecutive miscarriages.Table 1.40 APS patients with severe PEOverall features (n, %)Patients40 (100)Age at PE, (median, IQR)30.5 (27-33)PE term, WG (median, IQR)25.5 (23-29) Live births24 (60) Birth term, WG (median, IQR)25.5 (23.7-30.3) Associated SLE12 (30)Maternal complications (n, %)25 (62.5) HELLP18 (45) E6 (15) CAPS3 (7.5) Placental abruptions3 (7.5)Fetal complications (n, %)31 (77.5) IUGR18 (45) IUFD11 (2.5) Preterm delivery22 (55)Obstetrical history (n, %) Primiparous21 (52.5) Index PE before APS12 (30)Thrombosis (n, %) Thrombosis before PE index14 (35.0) Thrombosis after PE index2 (5.0)Abs at APS diagnosis (n, %) aPL triple positivity21 (52.5) IgG/IgM anti-cardiolipin34 (85.0) IgG/IgM anti-β2GPI25 (62.5) LAC33 (82.5)Legend to Table 1:PE: preeclampsia; APS: antiphospholipid syndrome; IQR: interquartile range; WG: weeks of gestation; SLE: systemic lupus erythematosus; HELLP: Hemolysis, elevated liver enzymes, low platelet; E: eclampsia; CAPS: catastrophic APS; IUGR: intrauterine growth restriction; IUFD: intrauterine fetal death; CHB: congenital atrioventricular block; aPL: antiphospholipid antibodies; LAC: lupus anticoagulant.Conclusion:Among the APS criteria, “3 consecutive miscarriages criterion” was not found. The majority of patients also experienced thrombosis and SLE before the index PE.References:[1]Diagnosis and Management of preeclampsia and eclampsia. International Journal of Gynecology &Obestetrics 2002;77:67-75.[2]Miyakis S, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295e 306.Disclosure of Interests:Maddalena Larosa: None declared, Nathalie Morel: None declared, Meriem BELHOCINE: None declared, Amelia Ruffatti: None declared, Nicolas Martin Silva: None declared, Romain Paul: None declared, Luc Mouthon: None declared, Michel DREYFUS: None declared, Jean-Charles PIETTE: None declared, Odile Souchaud-Debouverie: None declared, Catherine Deneux-Tharaux: None declared, Vassilis Tsatsaris: None declared, Emmanuelle Pannier: None declared, Gaêlle Guettrot Imbert: None declared, Véronique LE GUERN Grant/research support from: UCB for GR2 study (to our institution), Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Nathalie Costedoat-Chalumeau Grant/research support from: UCB to my institution
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15
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Ruffatti A, Calligaro A, Lacognata CS, D'Odorico A, Colpo A, Cardin F, Calabrese F. Insights into the pathogenesis of catastrophic antiphospholipid syndrome. A case report of relapsing catastrophic antiphospholipid syndrome and review of the literature on ischemic colitis. Clin Rheumatol 2019; 39:1347-1355. [PMID: 31853731 DOI: 10.1007/s10067-019-04888-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022]
Abstract
We present the case of a woman with a severe clinical history of antiphospholipid syndrome and persistent positivity for lupus anticoagulant, IgG anticardiolipin and IgG anti-β2Glycoprotein I antibodies. An acute clinical onset characterized by severe abdominal pain immediately followed by circulatory shock and histological colonic small vessel thrombosis pattern pointed to a diagnosis of ischemic colitis. The subsequent rapid onset of pulmonary alveolitis and heart failure associated to subendocardial hypoperfusion led to a diagnosis of definite catastrophic antiphospholipid syndrome (CAPS). Conventional triple therapy together with a broad-spectrum preventive antibiotic therapy were quickly initiated, and the outcome was favorable. We evaluated the patients with ischemic colitis in CAPS described in the literature between 1992 and May 2019 and our CAPS case. In accordance with the "two-hit" hypothesis and on the basis of the patients' data, we would like to speculate that the colonic wall necrosis related to ischemic colitis damaged the intestinal barrier causing loss of resistance to bacteria and leading to endotoxemia and bacteremia with bacteria translocation through the circulatory stream to the lungs and heart. The bacteria acted as the priming factor which favored the binding of β2Glycoprotein I to the endothelium vessels in the colon, lungs, and heart following activation of anti-β2Glycoprotein I antibodies which attached to the domain I of β2Glycoprotein I. This was followed by complement activation which triggered the thrombotic and cytokine storm. If further clinical studies confirm this hypothesis, the treatment of CAPS could be more targeted and effective.
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Carmelo S Lacognata
- Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, University Hospital of Padua, Padua, Italy
| | - Anna D'Odorico
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Anna Colpo
- Apheresis Unit, Department of Transfusion Medicine, University Hospital of Padua, Padua, Italy
| | - Fabrizio Cardin
- Endoscopic Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
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16
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Hoxha A, Favaro M, Calligaro A, Del Ross T, Ruffatti AT, Infantolino C, Tonello M, Mattia E, Ruffatti A. Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study. Thromb Haemost 2019; 120:36-43. [PMID: 31634958 DOI: 10.1055/s-0039-1697665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study evaluates the efficacy and safety of different treatment strategies for pregnant patients with antiphospholipid syndrome. One hundred twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH) + low-dose aspirin (LDA, 100 mg) (group I) and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH + LDA (group II). LMWH doses were increased throughout the pregnancies depending on the patients' weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study's primary outcome was live births. There were no significant differences in live birth rate between group I (95.4%) and group II (87.5%). Even fetal complication rate was similar in the two groups; group II nevertheless had a higher prevalence of maternal and neonatal complications (p = 0.0005 and p = 0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p = 0.0001 and p = 0.0005, respectively). Two patients in group I switched to group II therapy, six patients in group II switched to a more intensive treatment strategy (weekly plasma exchange + fortnightly intravenous immunoglobulins in addition to therapeutic LMWH + LDA). The multivariate analysis uncovered that triple antiphospholipid antibodies positivity was an independent factor leading to a more intensive therapy. All eight switched patients achieved a live birth. Study results revealed that adjusted LMWH doses and switching therapy at first signs of severe pregnancy complications led to a high rate of live births in antiphospholipid syndrome patients.
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Affiliation(s)
- Ariela Hoxha
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy.,Department of Medicine, Internal Medicine Unit, San Bortolo Hospital, Vicenza, Italy
| | - Maria Favaro
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
| | - Antonia Calligaro
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
| | - Teresa Del Ross
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
| | | | - Chiara Infantolino
- Obstetrics and Gynaecology Unit, University Hospital Padua, Padua, Italy
| | - Marta Tonello
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
| | - Elena Mattia
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
| | - Amelia Ruffatti
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
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17
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Scambi C, Ugolini S, Tonello M, Bortolami O, De Franceschi L, Castagna A, Lotti V, Corbella M, Raffaelli R, Caramaschi P, Mattia E, Biasi D, Ruffatti A. Complement activation in the plasma and placentas of women with different subsets of antiphospholipid syndrome. Am J Reprod Immunol 2019; 82:e13185. [DOI: 10.1111/aji.13185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/13/2019] [Accepted: 08/21/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cinzia Scambi
- Department of Medicine Rheumatology Unit University Hospital of Verona Verona Italy
| | - Sara Ugolini
- Department of Medicine Section of Internal Medicine University Hospital of Verona Verona Italy
| | - Marta Tonello
- Department of Medicine Rheumatology Unit University Hospital of Padua Padua Italy
| | - Oscar Bortolami
- Department of Diagnostics and Public Health University Hospital of Verona Verona Italy
| | | | | | - Virginia Lotti
- Department of Medicine Rheumatology Unit University Hospital of Verona Verona Italy
| | - Michela Corbella
- Department of Medicine University Hospital of Verona Verona Italy
| | - Ricciarda Raffaelli
- Department of Surgical Sciences Dentistry, Gynecology and Pediatrics University Hospital of Verona Verona Italy
| | - Paola Caramaschi
- Department of Medicine University Hospital of Verona Verona Italy
| | - Elena Mattia
- Department of Medicine Rheumatology Unit University Hospital of Padua Padua Italy
| | - Domenico Biasi
- Department of Medicine Rheumatology Unit University Hospital of Verona Verona Italy
| | - Amelia Ruffatti
- Department of Medicine Rheumatology Unit University Hospital of Padua Padua Italy
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18
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Colpo A, Marson P, Pavanello F, Tison T, Gervasi MT, Zambon A, Ruffatti A, De Silvestro G, Hoxha A. Therapeutic apheresis during pregnancy: A single center experience. Transfus Apher Sci 2019; 58:652-658. [PMID: 31522920 DOI: 10.1016/j.transci.2019.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Therapeutic apheresis (TA) represents a treatment option for pre-existing conditions or diseases occurring during gestation. Although pregnancy is not a contraindication per se, due to the lack of evidence-based guidelines and presumed risk of maternal/fetal adverse events there is a general resistance to its application. MATERIAL AND METHODS Between January 2005 and August 2017, at the Apheresis Unit of the University Hospital of Padua 936 TA procedures were performed during 57 pregnancies in 48 patients: 813 Plasma Exchange sessions, 119 Immunoadsorptions, 4 Red Blood Cell exchanges. The treated disease were as follows: antiphospholipid syndrome (18 patients), autoimmune congenital heart block (18), myasthenia gravis (3), Rh alloimmunization (2), systemic sclerosis (1), suspected autoimmune encephalitis (1), severe hypertriglyceridaemia (1), post partum hemolytic-uremic syndrome (1), sickle cell disease (1), lupus nephritis (1) and thrombotic thrombocytopenic purpura (1). RESULTS In the time period considered the apheresis sessions applied to pregnant women were 7.1% of the total (n = 13.251). The median age at the first treatment was 33 years. The median week of gestation (WG) at the beginning of treatments was 21. Twenty (2.1%) sessions were complicated by adverse events, none requiring or prolonging hospitalization. There were 50 live births, 5 spontaneous abortions and 2 voluntary terminations of pregnancy. Median WG at delivery was 35 and caesarean section was performed in 46 cases. CONCLUSIONS Our data showed that TA in pregnancy is well tolerated. Close collaboration between clinician, obstetrician and TA specialist is crucial to ensure a good outcome of high-risk pregnancies.
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Affiliation(s)
- Anna Colpo
- Department of Transfusion Medicine, University Hospital of Padua, Italy.
| | - Piero Marson
- Department of Transfusion Medicine, University Hospital of Padua, Italy
| | | | - Tiziana Tison
- Department of Transfusion Medicine, University Hospital of Padua, Italy
| | | | - Alessandra Zambon
- Department of Women and Children's Health, University of Padua, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Italy
| | | | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Italy; Internal Medicine, San Bortolo Hospital, Vicenza, Italy
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19
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Lazzaroni MG, Fredi M, Andreoli L, Chighizola CB, Del Ross T, Gerosa M, Kuzenko A, Raimondo MG, Lojacono A, Ramazzotto F, Zatti S, Trespidi L, Meroni PL, Pengo V, Ruffatti A, Tincani A. Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies. Front Immunol 2019; 10:1948. [PMID: 31475009 PMCID: PMC6702797 DOI: 10.3389/fimmu.2019.01948] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/01/2019] [Indexed: 01/20/2023] Open
Abstract
Objective: Antiphospholipid antibodies (aPL) are risk factors for thrombosis and adverse pregnancy outcomes (APO). The management of the so called “aPL carriers” (subjects with aPL positivity without the clinical criteria manifestations of APS) is still undefined. This study aims at retrospectively evaluating the outcomes and the factors associated with APO and maternal complications in 62 pregnant aPL carriers. Methods: Medical records of pregnant women regularly attending the Pregnancy Clinic of 3 Rheumatology centers from January 1994 to December 2015 were retrospectively evaluated. Patients with concomitant autoimmune diseases or other causes of pregnancy complications were excluded. Results: An aPL-related event was recorded in 8 out of 62 patients (12.9%) during pregnancy: 2 thrombosis and 6 APO. At univariate analysis, factors associated with pregnancy complications were acquired risk factors (p:0.008), non-criteria aPL manifestations (p:0.024), lupus-like manifestations (p:0.013), and triple positive aPL profile (p:0.001). At multivariate analysis, only the association with a triple aPL profile was confirmed (p:0.01, OR 21.3, CI 95% 1.84–247). Patients with triple aPL positivity had a higher rate of pregnancy complications, despite they were more frequently receiving combined treatment of low dose aspirin (LDA) and low molecular weight heparin (LMWH) at prophylactic dose. Conclusion: This study highlights the importance of risk stratification in pregnant aPL carriers, in terms of both immunologic and non-immunologic features. Combination treatment with LDA and LMWH did not prevent APO in some cases, especially in carriers of triple aPL positivity. Triple positive aPL carriers may deserve additional therapeutic strategies during pregnancy.
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Affiliation(s)
- Maria-Grazia Lazzaroni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Micaela Fredi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Cecilia Beatrice Chighizola
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Rheumatology Unit, Istituto Auxologico Italiano, Milan, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Maria Gerosa
- Division of Clinical Rheumatology, ASST Pini-CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Kuzenko
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Maria-Gabriella Raimondo
- Division of Clinical Rheumatology, ASST Pini-CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Lojacono
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Obstetrics and Gynaecology Unit, ASST Spedali Civili, Brescia, Italy
| | | | - Sonia Zatti
- Obstetrics and Gynaecology Unit, ASST Spedali Civili, Brescia, Italy
| | - Laura Trespidi
- Obstetrics and Gynaecology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier-Luigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Vittorio Pengo
- Cardiology Clinic, Department of Cardiac Thoracic and Vascular Sciences, Thrombosis Centre, University of Padova, Padova, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Angela Tincani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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20
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Andreoli L, Lazzaroni MG, Carini C, Dall’Ara F, Nalli C, Reggia R, Rodrigues M, Benigno C, Baldissera E, Bartoloni-Bocci E, Basta F, Bellisai F, Bortoluzzi A, Campochiaro C, Cantatore FP, Caporali R, Ceribelli A, Chighizola CB, Conigliaro P, Corrado A, Cutolo M, D’Angelo S, De Stefani E, Doria A, Favaro M, Fischetti C, Foti R, Gabrielli A, Generali E, Gerli R, Gerosa M, Larosa M, Maier A, Malavolta N, Meroni M, Meroni PL, Montecucco C, Mosca M, Padovan M, Paolazzi G, Pazzola G, Peccatori S, Perricone R, Pettiti G, Picerno V, Prevete I, Ramoni V, Romeo N, Ruffatti A, Salvarani C, Sebastiani GD, Selmi C, Serale F, Sinigaglia L, Tani C, Trevisani M, Vadacca M, Valentini E, Valesini G, Visalli E, Vivaldelli E, Zuliani L, Tincani A. “Disease knowledge index” and perspectives on reproductive issues: A nationwide study on 398 women with autoimmune rheumatic diseases. Joint Bone Spine 2019; 86:475-481. [DOI: 10.1016/j.jbspin.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/21/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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21
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Tonello M, Mattia E, Favaro M, Del Ross T, Calligaro A, Salvan E, Hoxha A, Fedrigo M, Ruffatti A. IgG phosphatidylserine/prothrombin antibodies as a risk factor of thrombosis in antiphospholipid antibody carriers. Thromb Res 2019; 177:157-160. [DOI: 10.1016/j.thromres.2019.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
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22
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Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, Sáez-Comet L, Lefkou E, Mekinian A, Belizna C, Ruffatti A, Tincani A, Marozio L, Espinosa G, Cervera R, Ríos-Garcés R, De Carolis S, Latino O, LLurba E, Chighizola CB, Gerosa M, Pengo V, Lundelin K, Rovere-Querini P, Canti V, Mayer-Pickel K, Reshetnyak T, Hoxha A, Tabacco S, Stojanovich L, Gogou V, Varoudis A, Arnau A, Ruiz-Hidalgo D, Trapé J, Sos L, Stoppani C, Martí-Cañamares A, Farran-Codina I. The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases. Autoimmun Rev 2019; 18:406-414. [DOI: 10.1016/j.autrev.2018.12.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/08/2018] [Indexed: 11/17/2022]
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23
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Ruffatti A, Tarzia V, Fedrigo M, Calligaro A, Favaro M, Macor P, Tison T, Cucchini U, Cosmi E, Tedesco F, Angelini A, Gerosa G. Evidence of complement activation in the thrombotic small vessels of a patient with catastrophic antiphospholipid syndrome treated with eculizumab. Autoimmun Rev 2019; 18:561-563. [PMID: 30844561 DOI: 10.1016/j.autrev.2019.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
| | - Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Via Giustiniani, 2, 35, 128 Padua, Italy.
| | - Marny Fedrigo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Via A. Gabelli, 61, 35121 Padua, Italy.
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy
| | - Paolo Macor
- Department of Life Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
| | - Tiziana Tison
- Immunohematology and Transfusion Medicine Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
| | - Umberto Cucchini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy
| | - Erich Cosmi
- Obstetrics and Gynecology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Francesco Tedesco
- Clinical Immunology and Rheumatology Research Department Auxologico Institute Milan, IRCCS, Via G. Spagnoletto, 3, 20149 Milan, Italy.
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Via A. Gabelli, 61, 35121 Padua, Italy.
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Via Giustiniani, 2, 35, 128 Padua, Italy.
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Fredi M, Andreoli L, Bacco B, Bertero T, Bortoluzzi A, Breda S, Cappa V, Ceccarelli F, Cimaz R, De Vita S, Di Poi E, Elefante E, Franceschini F, Gerosa M, Govoni M, Hoxha A, Lojacono A, Marozio L, Mathieu A, Meroni PL, Minniti A, Mosca M, Muscarà M, Padovan M, Piga M, Priori R, Ramoni V, Ruffatti A, Tani C, Tonello M, Trespidi L, Zatti S, Calza S, Tincani A, Brucato A. First Report of the Italian Registry on Immune-Mediated Congenital Heart Block (Lu.Ne Registry). Front Cardiovasc Med 2019; 6:11. [PMID: 30873413 PMCID: PMC6404544 DOI: 10.3389/fcvm.2019.00011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: Neonatal Lupus (NL) is a rare syndrome caused by placental transfer of maternal anti-SSA/Ro and anti-La/SSB autoantibodies to the fetus. The rarity of this condition requires the establishment of multidisciplinary registries in order to improve our knowledge. Method: Inclusion criteria in this retrospective study were the maternal confirmed positivity for anti-SSA/Ro and/or anti-SSB/La antibodies, and the presence of II or III degree congenital heart block (CHB) in utero or neonatal period (up to 27 days after birth). Result: Eighty-nine cases of CHB were observed in 85 women with 88 pregnancies that occurred between 1969 and 2017. CHB was mostly detected in utero (84 cases, 94.2%), while five cases were observed in the neonatal period. A permanent pacemaker was implanted in 51 of 73 children born alive (69.8), whereas global mortality rate was 25.8% (23 cases): 16 in utero, five perinatal, and two during childhood. By univariate analysis, factors associated with fetal death were pleural effusion (p = 0.005, OR > 100; CI 95% 2.88->100 and hydrops (p = 0.003, OR = 14.09; CI 95% 2.01–122). Fluorinated steroids (FS) were administered in 71.4% pregnancies, and its use was not associated with better survival. Some centers treated all cases with fluorinated steroids and some centers did not treat any case. CHB was initially incomplete in 24 fetuses, and of them five cases of II degree block reverted to a lower degree block after treatments. Recurrence rate in subsequent pregnancies was 17.6% (3 out of 17). A prophylactic treatment was introduced in 10 of these 16 subsequent (58.8%) pregnancies, mostly with FS or high dose intravenous immunoglobulins. Conclusion: This is the first report from the Italian Registry of neonatal lupus/CHB. The live birth rate was nearly 80%, with nearly two thirds of the children requiring the implantation of a pacemaker. The management of fetuses diagnosed with CHB was heterogeneous across Italian Centers. The registry at present is mainly rheumatological, but involvement of pediatric cardiologists and gynecologists is planned.
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Affiliation(s)
- Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Science, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Science, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Beatrice Bacco
- S.S.d.D.U. Immunologia, Allergologia, A.O. Ordine Maurziano di Torino, Torino, Italy
| | - Tiziana Bertero
- S.S.d.D.U. Immunologia, Allergologia, A.O. Ordine Maurziano di Torino, Torino, Italy
| | - Alessandra Bortoluzzi
- UO e Sezione di Reumatologia, Dipartimento di Scienze Mediche, Universita' degli Studi di Ferrara, Cona, Italy
| | - Silvia Breda
- Struttura Complessa Medicina Interna, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Veronica Cappa
- Unit of Biostatistics, Biomathematics, and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Fulvia Ceccarelli
- UO Complessa Reumatologia, Policlinico Umberto I- University La Sapienza, Rome, Italy
| | - Rolando Cimaz
- Anna Meyer Children's Hospital, University of Firenze, Firenze, Italy
| | - Salvatore De Vita
- Clinica di Reumatologia, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Emma Di Poi
- Clinica di Reumatologia, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elena Elefante
- UO Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Universita' di Pisa, Pisa, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Science, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Maria Gerosa
- Istituto Ortopedico Gaetano Pini, University of Milan, Milan, Italy
| | - Marcello Govoni
- UO e Sezione di Reumatologia, Dipartimento di Scienze Mediche, Universita' degli Studi di Ferrara, Cona, Italy
| | - Ariela Hoxha
- Unità di Reumatologia, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Andrea Lojacono
- Department of Obstetrics and Gynecology, ASST Spedali Civili and University, Brescia, Italy
| | - Luca Marozio
- Ginecologia e Ostetricia 1, Dipartimento di Scienze Chirurgiche, Università di Torino, Turin, Italy
| | - Alessandro Mathieu
- Cattedra e Struttura Complessa di Reumatologia, Universita' degli Studi e AOU di Cagliari, Cagliari, Italy
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Antonina Minniti
- UO Complessa Reumatologia, Policlinico Umberto I- University La Sapienza, Rome, Italy
| | - Marta Mosca
- UO Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Universita' di Pisa, Pisa, Italy
| | | | - Melissa Padovan
- UO e Sezione di Reumatologia, Dipartimento di Scienze Mediche, Universita' degli Studi di Ferrara, Cona, Italy
| | - Matteo Piga
- Cattedra e Struttura Complessa di Reumatologia, Universita' degli Studi e AOU di Cagliari, Cagliari, Italy
| | - Roberta Priori
- UO Complessa Reumatologia, Policlinico Umberto I- University La Sapienza, Rome, Italy
| | - Véronique Ramoni
- Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Padova, Italy
| | - Amelia Ruffatti
- Unità di Reumatologia, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Chiara Tani
- UO Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Universita' di Pisa, Pisa, Italy
| | - Marta Tonello
- Unità di Reumatologia, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Laura Trespidi
- Dipartimento per la Salute della Donna, Bambino e Neonato, Fondazione Ospedale Maggiore, Milan, Italy
| | - Sonia Zatti
- Department of Obstetrics and Gynecology, ASST Spedali Civili and University, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics, Biomathematics, and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Science, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Antonio Brucato
- Struttura Complessa Medicina Interna, ASST Papa Giovanni XXIII, Bergamo, Italy.,Dipartimento di Scienze Biomediche e Cliniche "Sacco", Università degli Studi di Milano, Milan, Italy
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25
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Reggia R, Andreoli L, Sebbar H, Canti V, Ceccarelli F, Favaro M, Hoxha A, Inversetti A, Larosa M, Ramoni V, Caporali R, Conti F, Doria A, Montecucco C, Rovere-Querini P, Ruffatti A, Valesini G, Zatti S, Fallo L, Lojacono A, Tincani A. An observational multicentre study on the efficacy and safety of assisted reproductive technologies in women with rheumatic diseases. Rheumatol Adv Pract 2019; 3:rkz005. [PMID: 31431993 PMCID: PMC6649948 DOI: 10.1093/rap/rkz005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/04/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives The aim was to determine whether assisted reproductive technologies (ARTs) confer additional risk in rheumatic patients (in terms of disease flare and fetal–maternal complications) and whether, if performed, their efficacy is affected by maternal disease. Methods Sixty infertile rheumatic women undergoing 111 ART cycles were included. Clinical pregnancy rate, live birth rate, maternal disease flares and maternal–fetal complications were recorded. Results One hundred and eleven ART cycles in 60 women were analysed. We reported 46 pregnancies (41.4%), 3 (3.1%) cases of ovarian hyperstimulation syndrome and no cases of thrombosis during stimulation, pregnancy and puerperium. One or more maternal complication was reported in 13 (30.2%) pregnancies, and fetal complications occurred in 11 fetuses (21.1%). The live birth rate was 98%, but we reported three (6%) perinatal deaths in the first days of life. During puerperium, we recorded one (2.5%) post-partum haemorrhage and one (2.5%) articular flare. Conclusion The safety and efficacy of the ARTs, demonstrated in the general population, seems to be confirmed also in rheumatic patients. No evidence was found to advise against their application, and the choice of therapy should be made depending on the patient’s risk profile, irrespective of whether the pregnancy is natural or artificial induced.
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Affiliation(s)
- Rossella Reggia
- Rheumathology and Clinical Immunology, ASST Spedali Civili and University of Brescia, Brescia
| | - Laura Andreoli
- Rheumathology and Clinical Immunology, ASST Spedali Civili and University of Brescia, Brescia
| | - Houssni Sebbar
- Rheumathology and Clinical Immunology, ASST Spedali Civili and University of Brescia, Brescia
| | - Valentina Canti
- Rheumatology Unit, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan
| | - Fulvia Ceccarelli
- Rheumatologic Unit, Department of Internal Medicine and Medical Specialties, 'La Sapienza' University of Rome, Rome
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua
| | - Annalisa Inversetti
- Obstetrics and Gynaecology Unit, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan
| | | | - Veronique Ramoni
- Rheumatology Unit, IRCCS Policlinico San Matteo and University of Pavia, Pavia
| | - Roberto Caporali
- Rheumatology Unit, IRCCS Policlinico San Matteo and University of Pavia, Pavia
| | - Fabrizio Conti
- Rheumatologic Unit, Department of Internal Medicine and Medical Specialties, 'La Sapienza' University of Rome, Rome
| | | | | | - Patrizia Rovere-Querini
- Rheumatology Unit, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua
| | - Guido Valesini
- Rheumatologic Unit, Department of Internal Medicine and Medical Specialties, 'La Sapienza' University of Rome, Rome
| | | | - Luca Fallo
- Unit of Assisted Reproductive Technologies, Department of Obstetrics and Gynaecology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Angela Tincani
- Rheumathology and Clinical Immunology, ASST Spedali Civili and University of Brescia, Brescia
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26
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Alessandra Zambon
- Obstetrics and Gynecology Unit, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
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27
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Pengo V, Del Ross T, Ruffatti A, Bison E, Cattini MG, Pontara E, Testa S, Legnani C, Pozzi N, Peterle D, Acquasaliente L, De Filippis V, Denas G. Lupus anticoagulant identifies two distinct groups of patients with different antibody patterns. Thromb Res 2018; 172:172-178. [PMID: 30466070 DOI: 10.1016/j.thromres.2018.11.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Whether antibodies directed to β2-Glycoprotein I (aβ2GPI) are responsible for LA activity is not well defined. However, in the absence of such antibodies the molecule responsible for LA phenomenon is unknown. OBJECTIVE The aim of this study was the biochemical identification of the target antigen epitope of aPL responsible of LA activity in the absence of aβ2GPI antibodies together with the biological and clinical characteristics of these patients in comparison with classical triple positive patients. PATIENTS/METHODS A comparison of patients with LA without (LA+/aβ2GPI-) and those with (LA+/aβ2GPI+) associated aβ2GPI antibodies was performed. Size exclusion chromatography and analytical chromatography were used to identify the molecule with LA activity in patients LA+/aβ2GPI-. RESULTS AND CONCLUSIONS Analytical size-exclusion chromatography revealed a peak of 996Kd with LA activity perfectly overlapping that of IgM anti phosphatidylserine/prothrombin (aPS/PT) antibodies. Similarly, all the 25 LA+/aβ2GPI- patients were positive for aPS/PT antibodies. LA+/aβ2GPI- compared to 33 LA+/aβ2GPI+ patients turned out to be significantly older, with a lower rate of previous thromboembolic events and a weaker LA activity. Search for aPS/PT and aβ2GPI antibodies in patients with LA is useful to identify two subgroups of LA at different risk of thromboembolic events.
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Affiliation(s)
- V Pengo
- Cardiology Clinic, Thrombosis Centre, Department of Cardiac Thoracic and Vascular Sciences, Italy.
| | - T Del Ross
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - A Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - E Bison
- Cardiology Clinic, Thrombosis Centre, Department of Cardiac Thoracic and Vascular Sciences, Italy
| | - M G Cattini
- Cardiology Clinic, Thrombosis Centre, Department of Cardiac Thoracic and Vascular Sciences, Italy
| | - E Pontara
- Cardiology Clinic, Thrombosis Centre, Department of Cardiac Thoracic and Vascular Sciences, Italy
| | - S Testa
- Hemostasis and Thrombosis Center, District Hospital, Cremona, Italy
| | - C Legnani
- Angiology and Blood Coagulation, University Hospital of Bologna, Italy
| | - N Pozzi
- Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, USA
| | - D Peterle
- Laboratory of Protein Chemistry, Department of Pharmaceutical & Pharmacological Sciences, University of Padua, Italy
| | - L Acquasaliente
- Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, USA; Laboratory of Protein Chemistry, Department of Pharmaceutical & Pharmacological Sciences, University of Padua, Italy
| | - V De Filippis
- Laboratory of Protein Chemistry, Department of Pharmaceutical & Pharmacological Sciences, University of Padua, Italy
| | - G Denas
- Cardiology Clinic, Thrombosis Centre, Department of Cardiac Thoracic and Vascular Sciences, Italy
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28
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Belizna C, Pregnolato F, Abad S, Alijotas-Reig J, Amital H, Amoura Z, Andreoli L, Andres E, Aouba A, Apras Bilgen S, Arnaud L, Bienvenu B, Bitsadze V, Blanco P, Blank M, Borghi MO, Caligaro A, Candrea E, Canti V, Chiche L, Chretien JM, Cohen Tervaert JW, Damian L, Delross T, Dernis E, Devreese K, Djokovic A, Esteve-Valverde E, Favaro M, Fassot C, Ferrer-Oliveras R, Godon A, Hamidou M, Hasan M, Henrion D, Imbert B, Jeandel PY, Jeannin P, Jego P, Jourde-Chiche N, Khizroeva J, Lambotte O, Landron C, Latino JO, Lazaro E, de Leeuw K, Le Gallou T, Kiliç L, Limper M, Loufrani L, Lubin R, Magy-Bertrand N, Mahe G, Makatsariya A, Martin T, Muchardt C, Nagy G, Omarjee L, Van Paasen P, Pernod G, Perrinet F, Pïres Rosa G, Pistorius MA, Ruffatti A, Said F, Saulnier P, Sene D, Sentilhes L, Shovman O, Sibilia J, Sinescu C, Stanisavljevic N, Stojanovich L, Tam LS, Tincani A, Tollis F, Udry S, Ungeheuer MN, Versini M, Cervera R, Meroni PL. HIBISCUS: Hydroxychloroquine for the secondary prevention of thrombotic and obstetrical events in primary antiphospholipid syndrome. Autoimmun Rev 2018; 17:1153-1168. [PMID: 30316994 DOI: 10.1016/j.autrev.2018.05.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 05/25/2018] [Indexed: 02/09/2023]
Abstract
The relapse rate in antiphospholipid syndrome (APS) remains high, i.e. around 20%-21% at 5 years in thrombotic APS and 20-28% in obstetrical APS [2, 3]. Hydroxychloroquine (HCQ) appears as an additional therapy, as it possesses immunomodulatory and anti-thrombotic various effects [4-16]. Our group recently obtained the orphan designation of HCQ in antiphospholipid syndrome by the European Medicine Agency. Furthermore, the leaders of the project made the proposal of an international project, HIBISCUS, about the use of Hydroxychloroquine in secondary prevention of obstetrical and thrombotic events in primary APS. This study has been launched in several countries and at now, 53 centers from 16 countries participate to this international trial. This trial consists in two parts: a retrospective and a prospective study. The French part of the trial in thrombosis has been granted by the French Minister of Health in December 2015 (the academic trial independent of the pharmaceutical industry PHRC N PAPIRUS) and is coordinated by one of the members of the leading consortium of HIBISCUS.
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Affiliation(s)
- Cristina Belizna
- Vascular and Coagulation Department, University Hospital Angers, Angers, France; MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France.
| | - Francesca Pregnolato
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immunorheumatology, Milan, Italy
| | - Sebastien Abad
- Department of Internal Medicine, Hospital Avicenne, Publique - Hôpitaux de Paris, University Paris 13, Bobigny, France
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medicine, Universitat Autonòma, Barcelona, Spain
| | - Howard Amital
- The Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Zahir Amoura
- Internal Medicine Department 2, Pitié-Salpêtrière Hospital, French National Centre for Rare Systemic Diseases, AP-HP, Paris, France; Paris VI University, UPMC, Sorbonne Universities, Paris, France
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, University of Brescia, Brescia, Italy
| | - Emmanuel Andres
- Internal Medicine Department, University Hospital Strasbourg, Strasbourg, France
| | - Achile Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Normandy, Caen, France
| | | | - Laurent Arnaud
- Rheumatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Boris Bienvenu
- Department of Internal Medicine, Saint Joseph Hospital, Marseille, France
| | - Viktoria Bitsadze
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Patrick Blanco
- ImmunoConcEpT, CNRS-UMR 5164, University Bordeaux, Bordeaux, France; FHU ACRONIM, Bordeaux University Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Miri Blank
- The Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Maria Orietta Borghi
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immunorheumatology, Milan, Italy
| | - Antonia Caligaro
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Elisabeta Candrea
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valentina Canti
- Immunology, Rheumatology, Allergology and Rare Disease-IRCCS San Raffaele Hospital, Laboratory of Autoimmunity and vascular inflammation San Raffaele, Milan, Italy
| | - Laurent Chiche
- Department of Internal Medicine and Infectious Disease, Hôpital européen Marseille, Marseille, France
| | | | - Jan Willem Cohen Tervaert
- Nephrology Department, Maastricht University, Maastricht, the Netherlands; Rheumatology Department, Kaye Edmonton Clinic University of Alberta, Edmonton, Canada
| | - Laura Damian
- Department of Rheumatology, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Teresa Delross
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Katrien Devreese
- Coagulation Laboratory, Department of Clinical Biology, Immunology and Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Aleksandra Djokovic
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Belgrade, Serbia
| | | | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Céline Fassot
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Raquel Ferrer-Oliveras
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alban Godon
- Departement of hematology et immunology, University Hospital Angers, Angers, France
| | - Mohamed Hamidou
- Department of Internal Medicine, University Hospital Nantes, Nantes, France
| | - Milena Hasan
- Cytometry and Biomarkers Unit of Technology and Service, Center for Translational Science, Institut Pasteur, 28, Rue Doct Roux, 75015 Paris, France
| | - Daniel Henrion
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Bernard Imbert
- Vascular Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Pierre Yves Jeandel
- Department of Internal Medicine, Archet-1 Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint Antoine de Ginestière, 06202 Nice, France
| | - Pascale Jeannin
- Departement of hematology et immunology, University Hospital Angers, Angers, France
| | - Patrick Jego
- Department of Internal Medicine, University Hospital Rennes, Rennes, France
| | - Noemie Jourde-Chiche
- INSERM, UMR-S 1076, VRCM, Aix-Marseille University, Marseille, France; Centre de Néphrologie et Transplantation Rénale, AP-HM, Marseille, France
| | - Jamilya Khizroeva
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Olivier Lambotte
- Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie clinique, F-94275 Le Kremlin-Bicêtre, France; UMR 1184, Université Paris Sud, F-94276 Le Kremlin-Bicêtre, France; INSERM, U1184, Immunology of Viral Infections and Autoimmune Diseases, F-94276 Le Kremlin-Bicêtre, France; CEA, DSV/iMETI, IDMIT, F-92265 Fontenay-aux-Roses, France
| | - Cédric Landron
- Department of Internal Medicine, University Hospital Poitiers, Poitiers, France
| | - Jose Omar Latino
- Autoimmune and thrombophilic disorders Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Estibaliz Lazaro
- Department of Internal Medicine, Haut-Lévêque Hospital, 33604 Pessac, France
| | - Karina de Leeuw
- Department of Internal Medicine, Division of Clinical Immunology, University Hospital Groningen, Groningen, the Netherlands
| | - Thomas Le Gallou
- Department of Internal Medicine, University Hospital Rennes, Rennes, France
| | - Levent Kiliç
- Internal Medicine Department, Hacettepe University, Ankara, Turkey
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laurent Loufrani
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Romain Lubin
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Guillaume Mahe
- Vascular Medicine Department, University Hospital Rennes, Rennes, France; CHU Rennes, INSERM, CIC 1414, University Rennes, F-35000 Rennes, France
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Thierry Martin
- Clinical Immunology Department, University Hospital Strasbourg, Strasbourg, France
| | - Christian Muchardt
- CM Unit of Epigenetic Regulation, Department of Developmental and Stem Cell Biology UMR3738 CNRS, Pasteur Institute, Paris, France
| | - Gyorgy Nagy
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary; Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Loukman Omarjee
- Vascular Medicine Department, University Hospital Rennes, Rennes, France; CHU Rennes, INSERM, CIC 1414, University Rennes, F-35000 Rennes, France
| | - Pieter Van Paasen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gilles Pernod
- InnoVTE: French Investigation Network on Venous Thromboembolique Disease, Grenoble-Alps University, France; Informatique, Mathématiques et Applications (IMAG) Unité Mixte de Recherche (UMR), 5525/Themas, Centre National de Recherche Scientifique (CNRS)/Techniques de l'Ingénieurie Médicale et de la Complexité (TIMC), Grenoble, France
| | | | - Gilberto Pïres Rosa
- Internal Medicine Sao Joao Hospital, Alameda Prof Hernani Monteiro Vila Nova de Gaia, 4200-319 Porto, Portugal
| | | | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Fatma Said
- Internal Medicine Department, University Hospital La Rabta, Tunis, Tunisia
| | - Patrick Saulnier
- Research Department Unit, University Hospital Angers, Angers, France
| | - Damien Sene
- Department of Internal Medicine, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - Loic Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Ova Shovman
- The Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jean Sibilia
- Rheumatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Crina Sinescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Natasa Stanisavljevic
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Belgrade, Serbia
| | - Ljudmila Stojanovich
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Belgrade, Serbia
| | - Lai Shan Tam
- Department of Medicine and Therapeutics, and Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, University of Brescia, Brescia, Italy
| | | | - Sebastian Udry
- Autoimmune and thrombophilic disorders Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Marie Noelle Ungeheuer
- Clinical Investigation and Acces to Bioresources Department, Institut Pasteur, 28, Rue Doct Roux, 75015 Paris, France
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Pier Luigi Meroni
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immunorheumatology, Milan, Italy
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Ruffatti A, De Silvestro G, Marson P, Tonello M, Calligaro A, Favaro M, Del Ross T, Hoxha A, Mattia E, Pengo V. Catastrophic antiphospholipid syndrome: Lessons from 14 cases successfully treated in a single center. A narrative report. J Autoimmun 2018; 93:124-130. [DOI: 10.1016/j.jaut.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/30/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
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Canti V, Del Rosso S, Tonello M, Lucianò R, Hoxha A, Coletto LA, Vaglio Tessitore I, Rosa S, Manfredi AA, Castiglioni MT, Ruffatti A, Rovere-Querini P. Antiphosphatidylserine/prothrombin Antibodies in Antiphospholipid Syndrome with Intrauterine Growth Restriction and Preeclampsia. J Rheumatol 2018; 45:1263-1272. [PMID: 30008452 DOI: 10.3899/jrheum.170751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Antibodies that recognize the phosphatidylserine/prothrombin complex (antiphosphatidylserine/prothrombin antibodies; aPS/PT) might reveal enhanced thrombotic risk in patients with systemic lupus erythematosus. Little is known about their association with pregnancy complications in the antiphospholipid syndrome (APS). METHODS We enrolled 55 patients with APS who were seeking pregnancy in 2 Italian hospitals. Antiphospholipid antibodies (aPL), including anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, lupus-like anticoagulant, and aPS/PT antibodies were assessed, and the patients were prospectively followed for 24 months. RESULTS There were 65% (36/55) of the APS patients who had aPS/PT antibodies. Forty-seven pregnancies were followed, including 33 of aPS/PT+ patients. Forty-one of the 47 patients (87%) who initiated a pregnancy eventually gave birth to a child. The pregnancy duration and the mean newborn weight at delivery were significantly lower in aPS/PT+ than in aPS/PT- patients (33.1 ± 4.7 vs 36.2 ± 3.4 wks of gestation, respectively, and 2058 ± 964 g vs 2784 ± 746 g, respectively, p < 0.05). Late pregnancy complications, including intrauterine fetal death, preterm delivery, preeclampsia, and intrauterine growth restriction (IUGR), were more frequent in aPS/PT+ patients, independent of the therapy. Titers of aPS/PT IgG were significantly inversely correlated with the neonatal weight at delivery. Vascular injury, as reflected by thrombosis, fibrinoid necrosis, ischemic and hemorrhagic areas, and presence of chorangiomas characterized the IUGR placentas in the presence of aPS/PT. CONCLUSION The aPS/PT antibodies might represent markers of aPL-related pregnancy complications, IUGR/preeclampsia in particular, and could help identify beforehand patients who may require additional treatment.
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Affiliation(s)
- Valentina Canti
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Stefania Del Rosso
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Marta Tonello
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Roberta Lucianò
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Ariela Hoxha
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Lavinia A Coletto
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Isadora Vaglio Tessitore
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Susanna Rosa
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Angelo A Manfredi
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Maria Teresa Castiglioni
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Amelia Ruffatti
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Patrizia Rovere-Querini
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy. .,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University.
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Pengo V, Biasiolo A, Brocco T, Tonetto S, Ruffatti A. Autoantibodies to Phospholipid-binding Plasma Proteins in Patients with Thrombosis and Phospholipid-reactive Antibodies. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650355] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryAnti-phospholipid (aPL) antibodies are defined as antibodies detected in systems employing phospholipids (PL). This general definition is misleading as it comprises a large group of autoimmune phospholipid-reactive antibodies that are directed against specific phospholipid-binding plasma proteins, such as β2-glycoprotein I (β2GPI) and prothrombin. Definition of phospholipid-reacting antibodies according to the plasma protein against which they are directed appears more appropriate and could be useful in understanding clinical events and pathogenic mechanisms. Using ELISA systems we have studied the presence of antibodies directed against specific phospholipid-binding proteins in a series of 22 patients with thrombosis and phospholipid-reactive antibodies of the IgG isotype. High levels of anti-β2GPI IgG were detected in all 22 patients. Normal values were calculated on the basis of OD values at 405 nm (OD405) obtained for 22 age- and sex-matched healthy subjects (cut off value = 0.401). Levels of anti-β2GPI antibodies were linearly correlated with those of cardiolipin-reactive (aCL) antibodies. Eleven out of 22 patients (50%) had values of anti-prothrombin antibodies exceeding the cut-off value of 0.250. No relationship was found between the levels of anti-β2GPI and anti-prothrombin antibodies. Tests for antibodies against two natural inhibitors of blood coagulation, protein C and protein S, revealed elevated levels of anti-protein C IgG and anti-protein S IgG in 4 and 12 patients, respectively. A highly significant correlation between anti-protein C IgG and anti-protein S IgG values as well as between antibody titers against the two studied natural coagulation inhibitors and anti-prothrombin IgG was found. When comparing patients positive for aCL and presence or absence of a previous thrombotic episode (aCL+/T+ vs aCL+/T-), the positivity of anti-P2GPI IgG was found to be statistically associated with thrombosis. Conversely, among patients with previous thromboembolism with or without aCL (aCL+/T+ vs aCL-/T+) the positivity of anti-β2GPI IgG was strictly associated with the positivity of aCL, thus identifying the aPL antibody syndrome. These data demonstrate that anti-β2GPI antibodies are a marker of “autoimmune” thrombosis. Anti-prothrombin antibodies are not a marker of thrombosis and are closely associated with antibodies to protein C and protein S.
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Affiliation(s)
- V Pengo
- Division of Rheumatology, University of Padova, School of Medicine, Padova, Italy
| | - A Biasiolo
- Division of Rheumatology, University of Padova, School of Medicine, Padova, Italy
| | - T Brocco
- Division of Rheumatology, University of Padova, School of Medicine, Padova, Italy
| | - S Tonetto
- The Department of Cardiology, Thrombosis Center, School of Medicine, Padova, Italy
| | - A Ruffatti
- The Department of Cardiology, Thrombosis Center, School of Medicine, Padova, Italy
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Tonello M, Mattia E, Del Ross T, Favaro M, Calligaro A, Hoxha A, Bison E, Pengo V, Ruffatti A. Clinical value of anti-domain I-β2Glycoprotein 1 antibodies in antiphospholipid antibody carriers. A single centre, prospective observational follow-up study. Clin Chim Acta 2018; 485:74-78. [PMID: 29953850 DOI: 10.1016/j.cca.2018.06.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/19/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There seems to be a clear correlation between antibodies against domain I (anti-DI) of β2Glycoprotein I and severe clinical profiles in antiphospholipid syndrome (APS) patients. We investigated the clinical significance of anti-DI antibodies in a cohort of aPL carriers. METHODS One hundred and five carriers persistently positive for IgG anti-β2Glycoprotein 1 antibodies (a-β2GPI) and/or IgG anticardiolipin (aCL) and/or lupus anticoagulants (LAC) were tested for the presence of anti-DI antibodies using the QUANTA Flash® Beta2GPI-Domain I chemiluminescence immunoassay. RESULTS Anti-DI antibodies were detected in 44 aPL carriers (41.9%) and they were significantly associated to triple aPL positivity (LAC plus IgG a-β2GPI plus IgG aCL antibodies). Isolated LAC and a-β2GPI antibodies were significantly associated to anti-DI negative aPL carriers. During a 82.2 month mean follow-up, ten aPL carriers (9.5%) developed a first thrombotic event so becoming APS patients. Anti-DI antibodies, triple aPL positivity, thromboembolic risk factors and autoimmune disorders significantly prevailed in carriers becoming APS. Logistic regression analysis showed that anti-DI positivity was an independent risk factor for thrombosis. CONCLUSIONS Anti-DI antibody positivity can be considered a new risk factor predictive of the first thrombotic event in aPL carriers, instead, negative anti-DI may be useful to identify low-risk aPL carriers.
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Affiliation(s)
- M Tonello
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy.
| | - E Mattia
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - T Del Ross
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Favaro
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - A Calligaro
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - A Hoxha
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - E Bison
- Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - V Pengo
- Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - A Ruffatti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
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Ruffatti A, Hoxha A, Favaro M, Tonello M, Colpo A, Cucchini U, Banzato A, Pengo V. Additional Treatments for High-Risk Obstetric Antiphospholipid Syndrome: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 53:28-39. [PMID: 27342460 DOI: 10.1007/s12016-016-8571-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Most investigators currently advocate prophylactic-dose heparin plus low-dose aspirin as the preferred treatment of otherwise healthy women with obstetric antiphospholipid syndrome, whilst women with a history of vascular thrombosis alone or associated with pregnancy morbidity are usually treated with therapeutic heparin doses in association with low-dose aspirin in an attempt to prevent both thrombosis and pregnancy morbidity. However, the protocols outlined above fail in about 20 % of pregnant women with antiphospholipid syndrome. Identifying risk factors associated with pregnancy failure when conventional therapies are utilized is an important step in establishing guidelines to manage these high-risk patients. Some clinical and laboratory risk factors have been found to be related to maternal-foetal complications in pregnant women on conventional therapy. However, the most efficacious treatments to administer to high-risk antiphospholipid syndrome women in addition to conventional therapy in order to avoid pregnancy complications are as yet unestablished. This is a comprehensive review on this topic and an invitation to participate in a multicentre study in order to identify the best additional treatments to be used in this subset of antiphospholipid syndrome patients.
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy.
- Reumatologia, Policlinico Universitario, Via Giustiniani, 2-35128, Padova, Italy.
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Anna Colpo
- Blood Transfusion Unit, University-Hospital of Padua, Padua, Italy
| | - Umberto Cucchini
- Cardiology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandra Banzato
- Cardiology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Vittorio Pengo
- Cardiology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Mattia E, Tonello M, Del Ross T, Zerbinati P, Campello E, Simioni P, Ruffatti A. Clinical and laboratory characteristics of isolated lupus anticoagulants. Thromb Res 2018; 165:51-53. [PMID: 29567587 DOI: 10.1016/j.thromres.2018.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/16/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- E Mattia
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Tonello
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - T Del Ross
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - P Zerbinati
- Hemorrhagic and Thrombotic Diseases Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - E Campello
- Hemorrhagic and Thrombotic Diseases Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - P Simioni
- Hemorrhagic and Thrombotic Diseases Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - A Ruffatti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy.
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Pontara E, Banzato A, Bison E, Cattini MG, Baroni G, Denas G, Calligaro A, Marson P, Tison T, Ruffatti A, Pengo V. Thrombocytopenia in high-risk patients with antiphospholipid syndrome. J Thromb Haemost 2018; 16:529-532. [PMID: 29316193 DOI: 10.1111/jth.13947] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Indexed: 01/08/2023]
Abstract
Essentials The prevalence of thrombocytopenia in patients with antiphospholipid syndrome is not well defined. We studied triple positive patients with antiphospholipid syndrome and its catastrophic variant. Prevalence of thrombocytopenia was 6% and 100% in patients who developed the catastrophic form. In triple positive patients thrombocytopenia is low and platelets drop during the catastrophic form. SUMMARY Background Thrombocytopenia is the most common non-criteria hematological feature in patients with antiphospholipid syndrome (APS). This condition is more common in patients with catastrophic APS (CAPS). Objectives To evaluate the prevalence of thrombocytopenia in a large series of high-risk patients with APS, and to assess the behavior of the platelet count during CAPS. Methods/Patients This was a cross-sectional study in which we analyzed the platelet counts of a homogeneous group of high-risk APS patients (triple-positive). Six of these patients developed a catastrophic phase of the disease, and the platelet count was recorded before the acute phase, during the acute phase, and at recovery. Results The mean platelet count in 119 high-risk triple-positive patients was 210 × 109 L-1 . With a cut-off value for thrombocytopenia of 100 × 109 L-1 , the prevalence of thrombocytopenia was 6% (seven patients). No difference between primary APS and secondary APS was found. In patients who suffered from CAPS, a significant decrease from the basal count (212 ± 51 × 109 L-1 ) to that at the time of diagnosis (60 ± 33 × 109 L-1 ) was observed. The platelet count became normal again at the time of complete remission (220 ± 57 × 109 L-1 ). A decrease in platelet count always preceded the full clinical picture. Conclusions This study shows that, in high-risk APS patients, the prevalence of thrombocytopenia is low. A decrease in platelet count was observed in all of the patients who developed the catastrophic form of the disease. A decrease in platelet count in high-risk APS patients should be considered a warning signal for disease progression to CAPS.
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Affiliation(s)
- E Pontara
- Department of Cardiac Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padova, Padova, Italy
| | - A Banzato
- Department of Cardiac Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padova, Padova, Italy
| | - E Bison
- Department of Cardiac Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padova, Padova, Italy
| | - M G Cattini
- Department of Cardiac Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padova, Padova, Italy
| | - G Baroni
- Department of Cardiac Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padova, Padova, Italy
| | - G Denas
- Department of Cardiac Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padova, Padova, Italy
| | - A Calligaro
- Department of Medicine, Clinical Rheumatology, University of Padova, Padova, Italy
| | - P Marson
- Apheresis Unit, Blood Transfusion Service, University of Padova, Padova, Italy
| | - T Tison
- Apheresis Unit, Blood Transfusion Service, University of Padova, Padova, Italy
| | - A Ruffatti
- Department of Medicine, Clinical Rheumatology, University of Padova, Padova, Italy
| | - V Pengo
- Department of Cardiac Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padova, Padova, Italy
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Ruffatti A, Tonello M, Hoxha A, Sciascia S, Cuadrado MJ, Latino JO, Udry S, Reshetnyak T, Costedoat-Chalumeau N, Morel N, Marozio L, Tincani A, Andreoli L, Haladyj E, Meroni PL, Gerosa M, Alijotas-Reig J, Tenti S, Mayer-Pickel K, Simchen MJ, Bertero MT, De Carolis S, Ramoni V, Mekinian A, Grandone E, Maina A, Serrano F, Pengo V, Khamashta MA. Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study. Thromb Haemost 2018; 118:639-646. [PMID: 29490410 DOI: 10.1055/s-0038-1632388] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-β2 glycoprotein I antibodies; (2) a history of severe maternal-foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal-foetal complications (Group II). Two different additional treatments were considered: oral-low-dose steroids (10-20 mg prednisone daily) and/or 200 to 400 mg daily doses of hydroxychloroquine and parenteral-intravenous immunoglobulins at 2 g/kg per month and/or plasma exchange. The study's primary outcomes were live birth rates and pregnancy complications. A total of 194 pregnant PAPS patients attending 20 tertiary centres were retrospectively enrolled. Hydroxychloroquine was found to be linked to a significantly higher live birth rate with respect to the other oral treatments in the Group II patients. The high (400 mg) versus low (200 mg) doses of hydroxychloroquine (p = 0.036) and its administration before versus during pregnancy (p = 0.021) were associated with a significantly higher live birth rate. Hydroxychloroquine therapy appeared particularly efficacious in the PAPS patients without previous thrombosis. Parenteral treatments were associated with a significantly higher live birth rate with respect to the oral ones (p = 0.037), particularly in the Group I patients. In conclusion, some additional treatments were found to be safe and efficacious in high-risk PAPS pregnant women.
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Savino Sciascia
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Maria J Cuadrado
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - José O Latino
- Autoimmune,Thrombophilic Diseases and Pregnancy Division, Dr. Carlos G Durand Hospital, Buenos Aires, Argentina
| | - Sebastian Udry
- Autoimmune,Thrombophilic Diseases and Pregnancy Division, Dr. Carlos G Durand Hospital, Buenos Aires, Argentina
| | - Tatiana Reshetnyak
- Department of Systemic Rheumatic Disease, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM U 1153, Centre for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Luca Marozio
- Department of Obstetrics and Gynaecology, Università di Torino, Torino, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Ewa Haladyj
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Pier L Meroni
- Division of Rheumatology, G. Pini Institute, Milan.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Istituto Auxologico IRCCS, Milan, Italy
| | - Maria Gerosa
- Division of Rheumatology, G. Pini Institute, Milan.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Istituto Auxologico IRCCS, Milan, Italy
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit, Department of Medicine, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, Universitat Autònoma, Barcelona, Spain
| | - Sara Tenti
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, University of Siena, Siena, Italy
| | | | - Michal J Simchen
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sheba Medical Centre, Tel Hashomer, Israel
| | | | - Sara De Carolis
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Véronique Ramoni
- Division of Rheumatology, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Arsène Mekinian
- Service de Médecine Interne et l'inflammation-(DHU i2B), Hôpital Saint-Antoine, Université Paris 06, Paris, France
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - Aldo Maina
- Servizio di Medicina Interna, Ospedale Sant'Anna, Torino, Italy
| | - Fátima Serrano
- Department of Obstetrics and Gynecology, Centro Hospitalar de Lisboa Central, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Vittorio Pengo
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy.,Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Munther A Khamashta
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom.,Lupus Research Unit, The Rayne Institute, Division of Women's Health, St Thomas Hospital, London, United Kingdom.,Department of Rheumatology, Dubai Hospital, Dubai, United Arab Emirates
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Nuri E, Taraborelli M, Andreoli L, Tonello M, Gerosa M, Calligaro A, Argolini LM, Kumar R, Pengo V, Meroni PL, Ruffatti A, Tincani A. Long-term use of hydroxychloroquine reduces antiphospholipid antibodies levels in patients with primary antiphospholipid syndrome. Immunol Res 2018; 65:17-24. [PMID: 27406736 DOI: 10.1007/s12026-016-8812-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hydroxychloroquine (HCQ) was suggested to play a role in lowering antiphospholipid antibody titers and preventing thrombotic recurrences in patients with systemic lupus erythematosus, but few data are available in patients with primary antiphospholipid syndrome (PAPS). In this retrospective, propensity score-matched cohort study, we evaluated the impact of HCQ on aPL titers and the incidence of thrombotic events in 57 exposed patients compared to 57 not exposed patients. These were matched for sex/type of disease onset/follow-up duration, age at the beginning of the follow-up ±10 years and initial date of the follow-up ±5 years. At baseline, no significant differences in demographical, clinical and serological features were observed between the two groups except for positive anti-extractable nuclear antigen antibodies (21 % in HCQ exposed vs 0 % in HCQ not exposed, P = 0.001). Both the levels of IgG anti-cardiolipin and IgG/IgM anti-β2-glycoprotein I (anti-β2GPI) were significantly reduced at end of follow-up compared to the baseline in HCQ-exposed patients, while there were no differences in the other group. Moreover, anti-β2GPI IgG titers were significantly decreased when the end of follow-up was compared between the two groups (P < 0.002). Among patients with a history of thrombosis, the annual incidence of recurrence was 1.16 % in HCQ exposed and 1.71 % in not exposed patients, with a significant reduction in the incidence of arterial events (0 vs 1.14 %). This study shows a strong reduction in aPL titers together with an apparent decrease in the incidence of arterial thrombosis recurrence in PAPS patients treated with HCQ.
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Affiliation(s)
- Entela Nuri
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Mara Taraborelli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Maria Gerosa
- Division of Rheumatology, ASST Gaetano Pini, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Lorenza Maria Argolini
- Division of Rheumatology, ASST Gaetano Pini, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rajesh Kumar
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Pier Luigi Meroni
- Division of Rheumatology, ASST Gaetano Pini, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- IRCSS Istituto Auxologico Italiano, Milan, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
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Kyriakidis NC, Kockum I, Julkunen H, Hoxha A, Salomonsson S, Meneghel L, Ebbing C, Dilthey A, Eronen M, Carolis SD, Kiserud T, Ruffatti A, Kere J, Meisgen S, Wahren-Herlenius M. European families reveal MHC class I and II associations with autoimmune-mediated congenital heart block. Ann Rheum Dis 2018; 77:1381-1382. [DOI: 10.1136/annrheumdis-2018-212953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 11/03/2022]
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39
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Chighizola CB, Pregnolato F, Andreoli L, Bodio C, Cesana L, Comerio C, Gerosa M, Grossi C, Kumar R, Lazzaroni MG, Mahler M, Mattia E, Nalli C, Norman GL, Raimondo MG, Ruffatti A, Tonello M, Trespidi L, Tincani A, Borghi MO, Meroni PL. Beyond thrombosis: Anti-β2GPI domain 1 antibodies identify late pregnancy morbidity in anti-phospholipid syndrome. J Autoimmun 2018; 90:76-83. [PMID: 29454510 DOI: 10.1016/j.jaut.2018.02.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/22/2022]
Abstract
Antibodies against β2 glycoprotein I (anti-β2GPI) have been identified as the main pathogenic autoantibody subset in anti-phospholipid syndrome (APS); the most relevant epitope is a cryptic and conformation-dependent structure on β2GPI domain (D) 1. Anti-β2GPI domain profiling has been investigated in thrombotic APS, leading to the identification of antibodies targeting D1 as the main subpopulation. In contrast, scarce attention has been paid to obstetric APS, hence this study aimed at characterizing the domain reactivity with regards to pregnancy morbidity (PM). To this end, 135 women with persistently positive, medium/high titre anti-β2GPI IgG, without any associated systemic autoimmune diseases and at least one previous pregnancy were included: 27 asymptomatic carriers; 53 women with obstetric APS; 20 women with thrombotic APS; and 35 women with both thrombotic and obstetric complications. Anti-D1 and anti-D4/5 antibodies were tested using a chemiluminescent immunoassay and a research ELISA assay, respectively (QUANTA Flash® β2GPI Domain 1 IgG and QUANTA Lite® β2GPI D4/5 IgG, Inova Diagnostics). Positivity for anti-D1 antibodies, but not anti-D4/5 antibodies, was differently distributed across the 4 subgroups of patients (p < 0.0001) and significantly correlated with thrombosis (χ2 = 17.28, p < 0.0001) and PM (χ2 = 4.28, p = 0.039). Patients with triple positivity for anti-phospholipid antibodies displayed higher anti-D1 titres and lower anti-D4/5 titres compared to women with one or two positive tests (p < 0.0001 and p = 0.005, respectively). Reactivity against D1 was identified as a predictor for PM (OR 2.4, 95% confidence interval [CI] 1.2-5.0, p = 0.017); in particular, anti-D1 antibodies were predictive of late PM, conveying an odds ratio of 7.3 (95% CI 2.1-25.5, p = 0.022). Positivity for anti-D1 antibodies was not associated with early pregnancy loss. Anti-D4/5 antibodies were not associated with clinical APS manifestations. As a whole, our data suggest that anti-D1 antibodies are significantly associated not only with thrombosis, but also with late PM, while positive anti-D4/5 antibodies are not predictive of thrombosis or PM.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
| | - Francesca Pregnolato
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Caterina Bodio
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
| | - Laura Cesana
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
| | - Chiara Comerio
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, Piazza Cardinal Ferrari, 1 20122 Milan, Italy
| | - Claudia Grossi
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
| | - Rajesh Kumar
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Michael Mahler
- INOVA Diagnostics, 9900 Old Grove Road, San Diego, CA 92131-1638, USA
| | - Elena Mattia
- Rheumatology Unit, Department of Medicine, University of Padua, via Giustiniani 2, 35128 Padua, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Gary L Norman
- INOVA Diagnostics, 9900 Old Grove Road, San Diego, CA 92131-1638, USA
| | - Maria Gabriella Raimondo
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, Piazza Cardinal Ferrari, 1 20122 Milan, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, via Giustiniani 2, 35128 Padua, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padua, via Giustiniani 2, 35128 Padua, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Maria Orietta Borghi
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
| | - Pier Luigi Meroni
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy; Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, Piazza Cardinal Ferrari, 1 20122 Milan, Italy.
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40
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Chighizola CB, Andreoli L, Gerosa M, Tincani A, Ruffatti A, Meroni PL. The treatment of anti-phospholipid syndrome: A comprehensive clinical approach. J Autoimmun 2018; 90:1-27. [PMID: 29449131 DOI: 10.1016/j.jaut.2018.02.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/06/2018] [Indexed: 01/02/2023]
Abstract
Anti-phospholipid syndrome (APS) is an acquired pro-thrombotic autoimmune disease that predisposes to thrombotic events and/or obstetric complications, in the persistent presence of anti-phospholipid antibodies (aPL). Life long moderate-intensity anticoagulation is the option of choice for aPL-positive patients with a previous thrombosis; critical issues concern the management of those with a history of arterial event due to the high rate of recurrence. Alternatives comprise anti-platelet agents and high-intensity anticoagulation. Low dose aspirin (LDASA) and low molecular weight heparin provide the mainstay of the treatment of obstetric APS, allowing a birth rate in 70% of cases. The management of refractory APS, thrombotic as well as obstetric, is highly debated, but an increasing burden of evidence points towards the beneficial effects of multiple treatments. Similarly, a management envisaging multiple drugs (anticoagulation, steroids, plasma exchange and/or intravenous immunoglobulins) is the most effective approach in catastrophic APS. Asymptomatic aPL carriers are at higher risk of thrombotic and obstetric complications compared to the general population, thus potentially benefitting of a pharmacological intervention. LDASA and hydroxychloroquine can be considered as options, in particular in case of high risk aPL profile, concomitant cardiovascular risk factors or associated autoimmune disease. APS is apparently a simple condition, but its multifaceted nature requires a complex and tailored treatment.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy; Allergology, Clinical Immunology and Rheumatology, Piazzale Brescia 20, 20149, Milan, Italy.
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy; Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, Piazza Cardinal Ferrari, 1 20122, Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
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Campello E, Radu CM, Tonello M, Kuzenko A, Bulato C, Hoxha A, Mattia E, Spiezia L, Ruffatti A, Simioni P. Circulating microparticles in pregnant patients with primary anti-phospholipid syndrome: an exploratory study. Scand J Rheumatol 2018; 47:501-504. [PMID: 29308695 DOI: 10.1080/03009742.2017.1372518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- E Campello
- a Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine , University of Padua , Padua , Italy
| | - C M Radu
- a Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine , University of Padua , Padua , Italy
| | - M Tonello
- b Rheumatology Unit, Department of Medicine , University of Padua , Padua , Italy
| | - A Kuzenko
- b Rheumatology Unit, Department of Medicine , University of Padua , Padua , Italy
| | - C Bulato
- a Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine , University of Padua , Padua , Italy
| | - A Hoxha
- b Rheumatology Unit, Department of Medicine , University of Padua , Padua , Italy
| | - E Mattia
- b Rheumatology Unit, Department of Medicine , University of Padua , Padua , Italy
| | - L Spiezia
- a Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine , University of Padua , Padua , Italy
| | - A Ruffatti
- b Rheumatology Unit, Department of Medicine , University of Padua , Padua , Italy
| | - P Simioni
- a Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine , University of Padua , Padua , Italy
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Mattia E, Hoxha A, Tonello M, Favaro M, Del Ross T, Calligaro A, Ghirardello A, Ruffatti A. Detection of autoantibodies to the p200-epitope of SSA/Ro52 antigen. A comparison of two laboratory assays. ACTA ACUST UNITED AC 2018; 56:927-932. [DOI: 10.1515/cclm-2017-0704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/22/2017] [Indexed: 12/11/2022]
Abstract
Abstract
Background:
Anti-p200 antibodies have been receiving growing interest in view of findings associating their presence to risk of fetal autoimmune congenital heart block (CHB). The study compares and evaluates the performance of two assays currently being used for their detection.
Methods:
One hundred and sixteen pregnant women positive for anti-SSA/Ro52 antibodies were considered as the study population. Fifty women negative for anti-SSA/Ro52 antibodies were considered as the control population. Anti-p200 antibodies were analyzed using two home-made ELISA assays: one with biotinylated antigen and the other with free antigen.
Results:
The specificity of the p200-free assay was significantly higher with respect to that of the p200-biotin assay (p=0.023). Both methods showed a high area under curve (AUC), thus, a good accuracy. There was a significant prevalence of anti-p200 antibodies when the p200-free assay was used to analyze the sera of the pregnant women with CHB fetuses (p=0.007). Cohen’s κ and Spearman’s ρ coefficients showed a good concordance (0.71) and a high correlation (0.93), respectively.
Conclusions:
The p200-free assay with respect to the biotin-based method was more specific in detecting p200 antibodies in women positive for anti-SSA/Ro52 antibodies. In addition, only the p200-free method significantly found p200 antibodies in patients with fetal CHB.
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Affiliation(s)
- Elena Mattia
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
| | - Ariela Hoxha
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
| | - Marta Tonello
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
| | - Maria Favaro
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
| | - Teresa Del Ross
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
| | - Antonia Calligaro
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
| | - Anna Ghirardello
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
| | - Amelia Ruffatti
- Rheumatology Unit , Department of Medicine-DIMED , University of Padua , Padua , Italy
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Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, LLurba E, Ruffatti A, Tincani A, Lefkou E, Bertero MT, Espinosa G, de Carolis S, Rovere-Querini P, Lundelin K, Picardo E, Mekinian A. Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies. Med Clin (Barc) 2017; 151:215-222. [PMID: 29274674 DOI: 10.1016/j.medcli.2017.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To compare clinical, laboratory, treatment and live birth rate data between women with aPL-related obstetric complications (OMAPS) not fulfilling the Sydney criteria and women fulfilling them (OAPS). MATERIALS AND METHODS Retrospective and prospective multicentre study. Data comparison between groups from The European Registry on Antiphospholipid Syndrome included within the framework of the European Forum on Antiphospholipid Antibody projects. RESULTS 338 women were analysed: 247 fulfilled the Sydney criteria (OAPS group) and 91 did not (OMAPS group). In the OMAPS group, 24/91 (26.37%) fulfilled laboratory Sydney criteria (subgroup A) and 67/91 (74.63%) had a low titre and/or non-persistent aPL-positivity (subgroup B). Overall, aPL laboratory categories in OAPS vs. OMAPS showed significant differences: 34% vs. 11% (p<0.0001) for category I, 66% vs. 89% (p<0.0001) for category II. No differences were observed when current obstetric complications were compared (p=0.481). 86.20% of OAPS women were treated vs. 75.82% of OMAPS (p=0.0224), particularly regarding the LDA+LMWH schedule (p=0.006). No differences between groups were observed in live births, gestational, puerperal arterial and/or venous thrombosis. CONCLUSIONS Significant differences were found among aPL categories between groups. Treatment rates were higher in OAPS. Both OAPS and OMAPS groups had similarly good foetal-maternal outcomes when treated. The proposal to modify OAPS classification criteria, mostly laboratory requirements, is reinforced by these results.
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Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autonoma, Barcelona, Spain.
| | - Enrique Esteve-Valverde
- Internal Medicine Department, Althaia Healthcare Network of Manresa, Rheumatology Unit, Barcelona, Spain
| | - Raquel Ferrer-Oliveras
- Obstetrics and Gynaecology Department, High Risk Unit, Vall d'Hebron University Hospital, Universitat Autonoma, Barcelona, Spain.
| | - Elisa LLurba
- Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Clinical and Experimental Medicine Azienda Ospedaliera, University of Padua, Padua, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Ospedale Civile, Brescia, Italy
| | - Elmina Lefkou
- Haematology Unit, Hippokration Hospital of Thessaloniki, Greece
| | - Mª Tiziana Bertero
- Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy
| | - Gerard Espinosa
- Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Sara de Carolis
- Department of Gynaecology, Gemmeli Hospital, Catholic University, Roma, Italy
| | - Patrizia Rovere-Querini
- Scuola di Specializzazione in Allergologia e Immunolofia Clinica, U.O. Medicina ad indrizzo Immunlogico Clinico-Ospedale San Raffaele, Milano, Lab, Autoimminità e inflammazione vascolare - San Raffaele DIBIT, Milano, Italy
| | - Krista Lundelin
- Internal Medicine Department, Hospital Universitario La Paz, Universidad Autònoma, Madrid, Spain
| | - Elisa Picardo
- Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy
| | - Arsene Mekinian
- AP-HP, Hôpital Saint-Antoine, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, F-75012, Paris, France
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Rampazzo P, Biasiolo A, Garin J, Rosato A, Betterle C, Ruffatti A, Pengo V. Some Patients with Antiphospholipid Syndrome Express hitherto Undescribed Antibodies to Cardiolipin-binding Proteins. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612904] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryContrary to infective anticardiolipin (aCL) antibodies, autoimmune aCL antibodies react with phospholipids (PL) mainly via binding to the plasma glycoprotein cofactor β2-Glycoprotein I (β2GPI). While there is a well-documented link between the risk of thrombosis and the presence of β2GPI-dependent anticardiolipin antibodies, the pathological impact of other antiphospholipid antibodies is less clear. By means of cardiolipin affinity-chromatography, we isolated and identified 3 CL-binding proteins, complement component C4, complement factor H and a kallikrein-sensitive glycoprotein, and tested for the presence of autoantibodies against these proteins in patients with antiphospholipid syndrome (APS), systemic lupus erythematosus (SLE) and other autoimmune diseases. High titers of autoantibodies to C4 as compared to age- and sex-matched healthy controls were present in 3 of 26 patients with APS, and weak titers were found in 2 of 26 patients with SLE and in none of 26 patients with other autoimmune diseases. Autoantibodies to complement factor H were found in 4 APS, 3 SLE and none of the other autoimmune patients. Autoantibodies to kallikrein-sensitive glycoprotein were detected in 6 APS patients, 1 SLE patient, and 1 patient with another autoimmune disease. A close relationship between these antibodies was found, suggesting their origin from a common macromolecular complex. However, no relationship with anti-β2GPI antibodies was found, with the three patients with higher levels of autoantibodies having a low titer of anti-β2GPI antibodies. In conclusion, some patients with APS harbor circulating antibodies to other CL-binding proteins which might be useful to further characterize these patients.
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Ruffatti A, Tonello M, Del Ross T, Cavazzana A, Grava C, Noventa F, Tona F, Iliceto S, Pengo V. Antibody profile and clinical course in primary antiphospholipid syndrome with pregnancy morbidity. Thromb Haemost 2017; 96:337-41. [PMID: 16953276 DOI: 10.1160/th06-05-0287] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryIn women diagnosed as having category I primary obstetric antiphospholipid syndrome, clinical characteristics and the risk of subsequent thromboembolic events and further unsuccessful pregnancy has not been clearly documented. Women with unexplained obstetric complications and no definite autoimmune systemic diseases were tested for lupus anticoagulant (LA), IgG/ IgM anticardiolipin (aCL) and IgG/IgM anti-human β2-Glycoprotein I (aβ2GPI) antibodies and diagnosed as having primary antiphospholipid syndrome (APS) in classification category I on the basis of more than one laboratory criteria present in any combination. Characteristics at the time of diagnosis and risk factors for subsequent clinical events during a mean follow-up of 6.3 years were evaluated. Fifty-three of 600 women studied were found to fulfil obstetric criteria and had more than one positive laboratory test at the time of diagnosis. All the women were a CL and aβ2GPI positive, and 16 were also LA positive. This latter group (triple positivity) had distinct features and had more frequently experienced previous thromboembolism (OR= 122.5, 95% CI 16–957, p<0.001).They also had an increased rate of late pregnancy loss (OR=16.2, 95%CI 0.9–292, p=0.01), and a higher IgG aβ2GPI titer at diagnosis (median, 25th and 75th percentile were 118, 37–962, vs. 23, 18–32, respectively, p<0.0001). During follow-up, the rate of thromboembolic events was significantly higher in the group of women with triple positivity and/ or previous thromboembolism (OR=57.5, 95% CI 2.7–1160, p=0.0004) which were the only independent predictors of TE in the multivariate model. Recurrent pregnancy loss took place in seven out of 47 women who had a new pregnancy. Triple positivity and/or previous thromboembolism were again the only independent markers (OR=34.4, 95% CI 3.5–335.1, p=0.003) of an unsuccessful new pregnancy. In conclusion, in primary APS with pregnancy morbidity in classification category I, quite different groups of patients may be identified on the basis of laboratory tests. Triple positivity and/or a history of thromboembolism predict new TE events and new unsuccessful pregnancies.
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Affiliation(s)
- Amelia Ruffatti
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Padua, Italy
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46
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Pengo V, Tonello M, Noventa F, Grossi C, Borghi MO, Moerloose PD, Reber G, Ruffatti A, Cavazzana A. Anti-β2-glycoprotein I ELISA assay: The influence of different antigen preparations. Thromb Haemost 2017. [DOI: 10.1160/th08-02-0082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ainsworth HC, Marion MC, Bertero T, Brucato A, Cimaz R, Costedoat-Chalumeau N, Fredi M, Gaffney P, Kelly J, Levesque K, Maltret A, Morel N, Ramoni V, Ruffatti A, Langefeld CD, Buyon JP, Clancy RM. Association of Natural Killer Cell Ligand Polymorphism HLA-C Asn80Lys With the Development of Anti-SSA/Ro-Associated Congenital Heart Block. Arthritis Rheumatol 2017; 69:2170-2174. [PMID: 29045069 DOI: 10.1002/art.40228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/08/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Fetal exposure to maternal anti-SSA/Ro antibodies is necessary but not sufficient for the development of autoimmune congenital heart block (CHB), suggesting that other factors, such as fetal genetic predisposition, are important. Given the previously described association between major histocompatibility complex alleles and CHB risk, we undertook the present study to test the hypothesis that a variant form of HLA-C Asn80Lys, which binds with high affinity to an inhibitory killer cell immunoglobulin-like receptor (KIR) and thus renders natural killer (NK) cells incapable of restricting inflammation, contributes to the development of CHB. METHODS Members of 192 pedigrees in the US and Europe (194 cases of CHB, 91 unaffected siblings, 152 fathers, 167 mothers) and 1,073 out-of-study controls were genotyped on the Immunochip single-nucleotide polymorphism microarray. Imputation was used to identify associations at HLA-C Asn80Lys (Asn, C1; Lys, C2) and KIR. Tests for association were performed using logistic regression. McNemar's test and the pedigree disequilibrium test (PDT) were used for matched analyses between affected and unaffected children. RESULTS Compared with out-of-study controls of the same sex, the C2 allele was less frequent in the mothers (odds ratio [OR] 0.63, P = 0.0014) and more frequent in the fathers (OR 1.40, P = 0.0123), yielding a significant sex-by-C2 interaction (P = 0.0002). The C2 allele was more frequent in affected siblings than in unaffected siblings (OR 3.67, P = 0.0025), which was consistent with the PDT results (P = 0.016); these results were observed in both sexes and across the US and European cohorts. There was no difference in the frequency of the inhibitory KIR genotype (KIR AA) between affected and unaffected children (P = 0.55). CONCLUSION These data establish C2 as a novel genetic risk factor associated with CHB. This observation supports a model in which fetuses with C2 ligand expression and maternal anti-SSA/Ro positivity may have impaired NK cell surveillance, resulting in unchecked cardiac inflammation and scarring.
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Affiliation(s)
| | | | | | | | - Rolando Cimaz
- Meyer Children's Hospital and University of Florence, Florence, Italy
| | | | - Micaela Fredi
- Reumatologia e Immunologia, Spedali Civili e Università di Brescia, Brescia, Italy
| | - Patrick Gaffney
- Oklahoma Medical Research Foundation, University of Oklahoma, Oklahoma City
| | - Jennifer Kelly
- Oklahoma Medical Research Foundation, University of Oklahoma, Oklahoma City
| | - Kateri Levesque
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Alice Maltret
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Nathalie Morel
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | | | | | | | - Jill P Buyon
- New York University Langone Medical Center, New York, New York
| | - Robert M Clancy
- New York University Langone Medical Center, New York, New York
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Giacomelli R, Afeltra A, Alunno A, Baldini C, Bartoloni-Bocci E, Berardicurti O, Carubbi F, Cauli A, Cervera R, Ciccia F, Cipriani P, Conti F, De Vita S, Di Benedetto P, Doria A, Drosos AA, Favalli EG, Gandolfo S, Gatto M, Grembiale RD, Liakouli V, Lories R, Lubrano E, Lunardi C, Margiotta DPE, Massaro L, Meroni P, Minniti A, Navarini L, Pendolino M, Perosa F, Pers JO, Prete M, Priori R, Puppo F, Quartuccio L, Ruffatti A, Ruscitti P, Russo B, Sarzi-Puttini P, Shoenfeld Y, Somarakis GA, Spinelli FR, Tinazzi E, Triolo G, Ursini F, Valentini G, Valesini G, Vettori S, Vitali C, Tzioufas AG. International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)? Autoimmun Rev 2017; 16:911-924. [DOI: 10.1016/j.autrev.2017.07.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 02/06/2023]
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Taraborelli M, Reggia R, Dall'Ara F, Fredi M, Andreoli L, Gerosa M, Hoxha A, Massaro L, Tonello M, Costedoat-Chalumeau N, Cacoub P, Franceschini F, Meroni PL, Piette JC, Ruffatti A, Valesini G, Harris EN, Tincani A. Longterm Outcome of Patients with Primary Antiphospholipid Syndrome: A Retrospective Multicenter Study. J Rheumatol 2017; 44:1165-1172. [PMID: 28572466 DOI: 10.3899/jrheum.161364] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the longterm frequency of thrombotic recurrences, obstetrical complications, organ damage, severe comorbidities, and evolution toward connective tissue disease (CTD) in primary antiphospholipid syndrome (PAPS). METHODS Medical records of patients with PAPS followed in 6 centers for ≥ 15 years were retrospectively reviewed. RESULTS One hundred fifteen patients were studied: 88% women, followed between 1983 and 2014 with a mean (± SD) age at diagnosis of 33 (± 10) years. During a median followup of 18 years (range 15-30), 50 patients (44%) had at least a thrombotic event for a total of 75 events and an annual incidence of 3.5%. Thromboses were more frequent in patients with previous thrombotic history (p = 0.002). A catastrophic antiphospholipid syndrome occurred in 6 patients (5%). The use of oral anticoagulants in patients with thrombotic onset did not appear to be protective against recurrences (p = 0.26). Fifty-two women had 87 pregnancies, successful in 78%. Twenty-nine percent of patients accrued functional damage. Damage was significantly associated with a thrombotic history (p = 0.004) and with arterial events (p < 0.001), especially stroke, but not with demographics, serology, or treatment. Twenty-four major bleeding episodes were recorded in 18 patients, all receiving anticoagulants. Severe infections affected 6 patients (5%), with 1 fatality. A solid cancer was diagnosed in 8 patients (7%). Altogether, 16 patients (14%) developed an autoimmune disease and 13 (11%) a full-blown picture of CTD. CONCLUSION Despite therapy, a high proportion of patients experienced new thrombotic events and organ damage, while evolution toward CTD was infrequent.
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Affiliation(s)
- Mara Taraborelli
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Rossella Reggia
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Francesca Dall'Ara
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Micaela Fredi
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Laura Andreoli
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Maria Gerosa
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Ariela Hoxha
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Laura Massaro
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Marta Tonello
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Nathalie Costedoat-Chalumeau
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Patrice Cacoub
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Franco Franceschini
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Pier Luigi Meroni
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Jean Charles Piette
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Amelia Ruffatti
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Guido Valesini
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Eon Nigel Harris
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Angela Tincani
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica. .,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper.
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Hoxha A, Mattia E, Tonello M, Grava C, Pengo V, Ruffatti A. Antiphosphatidylserine/prothrombin antibodies as biomarkers to identify severe primary antiphospholipid syndrome. ACTA ACUST UNITED AC 2017; 55:890-898. [DOI: 10.1515/cclm-2016-0638] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/23/2016] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Anti-phosphatidylserine/prothrombin (aPS/PT) antibodies have begun to be considered potentional biomarkers for antiphospholipid syndrome (APS). This cohort study investigate the role of aPS/PT antibodies as a risk factor for severe APS by evaluating the association between those antibodies and clinical/laboratory profiles of APS.
Methods:
Plasma/serum samples from 197 APS patients, 100 healthy subjects and 106 patients with autoimmune diseases were collected. IgG/IgM aPS/PT antibodies were assayed using commercial ELISA kit.
Results:
Prevalences of IgG and IgM aPS/PT (p<0.0001 and p=0.0009, respectively) and their titres (p<0.0001 and p=0.0002, respectively) were significantly higher in thrombosis/pregnancy group with respect to pregnancy morbidity alone. Prevalences of IgG and IgM aPS/PT (p<0.0001 and p=0.0004, respectively) and their mean levels (p=0.0001 for both) were significantly higher in the prematurity linked to life-threatening obstetric complications group with respect to miscarriage group. There was a significant relationship between IgG and IgM aPS/PT (p=0.001 and p=0.0002) and their mean levels were higher (p=0.0004 and p=0.0002, respectively) in the thrombotic microangiopathy group, considered a milestone manifestation of catastrophic APS. The relationship between IgG and IgM aPS/PT was significant and mean levels were higher in triple positive antiphospholipid antibody patients than in double and single positivity ones (p<0.0001 for all).
Conclusions:
APS/PT antibodies were associated to severe thrombosis, severe pregnancy complications inducing prematurity, and vascular microangiopathy, all generally associated to high risk APS forms requiring strong therapy.
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