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Araújo O, Hernández-Negrín H, Casaroli-Marano RP, Hernández-Rodríguez J, Adán A, Espinosa G, Pelegrín L, Cervera R. Factors associated with early hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06461-6. [PMID: 38578332 DOI: 10.1007/s00417-024-06461-6] [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: 11/11/2023] [Revised: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Hydroxychloroquine is currently recommended for the treatment of systemic lupus erythematosus (SLE), but it can cause irreversible retinal toxicity. This study aimed to identify factors associated with early hydroxychloroquine-induced retinal toxicity in patients with SLE from a single centre for 20 years. METHODS SLE patients diagnosed between 1998 and 2017 and followed up for at least 1 year were included. Demographic, clinical, laboratory and therapeutic data were collected from the electronic medical records and retrospectively analysed. Early hydroxychloroquine-induced retinal toxicity was defined as the development of macular toxicity within the first 5 years of hydroxychloroquine treatment. RESULTS A total of 345 patients followed for a median of 15 years were analysed; 337 (97.7%) patients received hydroxychloroquine, 38 (11.3%) of them presented with retinal toxicity, and 10 (3%) developed early retinal toxicity. These patients had a mean treatment duration of 3.3 years with a mean cumulative dose of 241 g. Patients were diagnosed by visual field (VF) and fundoscopy, and two were also assessed using spectral domain optical coherence tomography (SD-OCT). The median (IQR) age of patients with early toxicity was 56 (51-66) years, and 80% were female. Factors independently associated with early hydroxychloroquine-induced retinal toxicity were lupus anticoagulant positivity (OR 4.2; 95% CI 1.2-15.5) and hypercholesterolaemia (OR 5.6; 95% CI 1.5-21.5). CONCLUSION Our results suggest that lupus anticoagulant positivity and hypercholesterolaemia among SLE patients may be risk factors for early hydroxychloroquine-induced retinal toxicity, regardless of the dose or duration of treatment.
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Affiliation(s)
- Olga Araújo
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Halbert Hernández-Negrín
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Ricardo P Casaroli-Marano
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
| | - Laura Pelegrín
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
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Taieb D, Moyon Q, Lhote R, Annesi-Maesano I, Haroche J, Cervera R, Amoura Z, Cohen Aubart F. Phenotypes in antiphospholipid syndrome: A hierarchical cluster analysis based on two independent databases. J Autoimmun 2024; 144:103173. [PMID: 38330544 DOI: 10.1016/j.jaut.2024.103173] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/24/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is a rare autoimmune disease characterized by thromboses at various sites and obstetric events associated with the persistent presence of antiphospholipid antibodies. The identification of clinical phenotypes in APS patients is a clinical need. In this study, we aimed to determine the clinical phenotypes of APS patients through an unsupervised analysis of two well-characterized cohorts of APS patients. PATIENTS AND METHODS APS phenotypes were defined by an ascending hierarchical cluster analysis to identify preferential associations between 18 types of organ involvement and clinical characteristics. This analysis was performed on an initial multi-center cohort of 1000 patients, with validation in a replication cohort of 435 patients. RESULTS The hierarchical analysis identified three APS phenotypes in both the initial and replication cohorts: an obstetric phenotype (n = 259 and n = 74 patients, respectively), a venous thrombosis phenotype, accounting for the largest number of patients (n = 461 and n = 297 patients, respectively), and a skin-central nervous system-heart phenotype (n = 280 and n = 64 patients, respectively). The clinical characteristics of the patients differed significantly between the three phenotypes, but there was no difference in antiphospholipid antibody profile between the groups. CONCLUSIONS We identified three phenotypes of APS defined based on preferential associations of organ involvements and differences in presentation. These observations may help clinicians to detect organ involvement and to manage treatment.
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Affiliation(s)
- Dov Taieb
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Raphael Lhote
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Isabella Annesi-Maesano
- Institut Debrest D'Epidémiologie et de Santé Publique, UMR UA11, Université de Montpellier et INSERM 34090-Montpellier, Service des Maladies Allergiques et Respiratoires, CHU, Montpellier, France
| | - Julien Haroche
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of ERN-ReCONNET/RITA, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Fleur Cohen Aubart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
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Yelnik CM, Erton ZB, Drumez E, Cheildze D, de Andrade D, Clarke A, Tektonidou MG, Sciascia S, Pardos-Gea J, Pengo V, Ruiz-Irastorza G, Belmont HM, Pedrera CL, Fortin PR, Wahl D, Gerosa M, Kello N, Signorelli F, Atsumi T, Ji L, Efthymiou M, Branch DW, Nalli C, Rodriguez-Almaraz E, Petri M, Cervera R, Shi H, Zuo Y, Artim-Esen B, Pons-Estel G, Willis R, Barber MRW, Skeith L, Bertolaccini ML, Cohen H, Roubey R, Erkan D. Thrombosis recurrence and major bleeding in non-anticoagulated thrombotic antiphospholipid syndrome patients: Prospective study from antiphospholipid syndrome alliance for clinical trials and international networking (APS ACTION) clinical database and repository ("Registry"). Semin Arthritis Rheum 2024; 65:152347. [PMID: 38185079 DOI: 10.1016/j.semarthrit.2023.152347] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Long-term anticoagulant therapy is generally recommended for thrombotic antiphospholipid syndrome (TAPS) patients, however it may be withdrawn or not introduced in routine practice. OBJECTIVES To prospectively evaluate the risk of thrombosis recurrence and major bleeding in non-anticoagulated TAPS patients, compared to anticoagulated TAPS, and secondly, to identify different features between those two groups. PATIENTS/METHODS Using an international registry, we identified non-anticoagulated TAPS patients at baseline, and matched them with anticoagulated TAPS patients based on gender, age, type of previous thrombosis, and associated autoimmune disease. Thrombosis recurrence and major bleeding were prospectively analyzed using Kaplan-Meier method and compared using a marginal Cox's regression model. RESULTS As of June 2022, 94 (14 %) of the 662 TAPS patients were not anticoagulated; and 93 of them were matched with 181 anticoagulated TAPS patients (median follow-up 5 years [interquartile range 3 to 8]). The 5-year thrombosis recurrence and major bleeding rates were 12 % versus 10 %, and 6 % versus 7 %, respectively (hazard ratio [HR] 1.38, 95 % confidence interval [CI] 0.53 to 3.56, p = 0.50 and HR 0.53; 95 % CI 0.15 to 1.86; p = 0.32, respectively). Non-anticoagulated patients were more likely to receive antiplatelet therapy (p < 0.001), and less likely to have more than one previous thrombosis (p < 0.001) and lupus anticoagulant positivity (p = 0.01). CONCLUSION Fourteen percent of the TAPS patients were not anticoagulated at recruitment. Their recurrent thrombosis risk did not differ compared to matched anticoagulated TAPS patients, supporting the pressing need for risk-stratified secondary thrombosis prevention trials in APS investigating strategies other than anticoagulation.
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Affiliation(s)
- Cecile M Yelnik
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, INSERM, UMR 1167, F-59000 Lille, France.
| | | | - Elodie Drumez
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, INSERM, UMR 1167, F-59000 Lille, France
| | - Dachi Cheildze
- Hospital for Special Surgery, New York, NY, USA; Yale New Haven Hospital, New Haven, CT, USA
| | | | - Ann Clarke
- University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | - Paul R Fortin
- Centre ARThrite - CHU de Québec- Université Laval, Quebec, QC, Canada
| | - Denis Wahl
- Université de Lorraine, Inserm DCAC, and CHRU-Nancy, Nancy, France
| | | | - Nina Kello
- Northwell Health, New Hyde Park, NY, USA
| | | | | | - Lanlan Ji
- Peking University First Hospital, Beijing, China
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zuo
- University of Michigan, Ann Arbor, MI, USA
| | | | - Guillermo Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas del Grupo Oroño (GO-CREAR), Rosario, Argentina
| | - Rohan Willis
- University of Texas Medical Branch, Galveston, TX, USA
| | | | | | | | - Hannah Cohen
- University College London, London, United Kingdom
| | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
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Gómez-Caverzaschi V, Yagüe J, Espinosa G, Mayordomo-Bofill I, Bedón-Galarza R, Araújo O, Pelegrín L, Arbelo E, Morales X, Balagué O, Figueras-Nart I, Mascaró JM, Fuertes I, Giavedoni P, Muxí A, Alobid I, Vilaseca I, Cervera R, Aróstegui JI, Mensa-Vilaró A, Hernández-Rodríguez J. Disease phenotypes in adult patients with suspected undifferentiated autoinflammatory diseases and PFAPA syndrome: Clinical and therapeutic implications. Autoimmun Rev 2024:103520. [PMID: 38561135 DOI: 10.1016/j.autrev.2024.103520] [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: 01/18/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Undifferentiated autoinflammatory diseases are characterized by recurrent or persistent fever, usually combined with other inflammatory manifestations, and negative or inconclusive genetic studies for monogenic autoinflammatory disorders. AIMS To define and characterize disease phenotypes in adult patients diagnosed in an adult reference center with undifferentiated autoinflammatory diseases, and to analyze the efficacy of the drugs used in order to provide practical diagnostic and therapeutic recommendations. METHODS Retrospective study (2015-2022) of patients with undifferentiated autoinflammatory diseases among all patients visited in our reference center. Demographic, clinical, laboratory features and detailed therapeutic information was collected. RESULTS Of the 334 patients with a suspected autoinflammatory disease, 134 (40%) patients (61% women) were initially diagnosed with undifferentiated autoinflammatory diseases. Mean age at disease onset and at diagnosis was 28.7 and 37.7 years, respectively. In 90 (67.2%) patients, symptoms started during adulthood. Forty-four (32.8%) patients met diagnostic/classification criteria for adult PFAPA syndrome. In the remaining patients, four additional phenotypes were differentiated according to the predominant manifestations: a) Predominantly fever phenotype (n = 18; 13.4%); b) Predominantly abdominal/pleuritic pain phenotype (n = 9; 6.7%); c) Predominantly pericarditis phenotype (n = 18; 13.4%), and d) Complex syndrome phenotype (n = 45; 33.6%). Prednisone (mainly on demand), colchicine and anakinra were the drugs commonly used. Overall, complete responses were achieved with prednisone in 41.3%, colchicine in 40.2%, and anakinra in 58.3% of patients in whom they were used. By phenotypes, prednisone on demand was more effective in adult PFAPA syndrome and colchicine in patients with the abdominal/pleuritic pain pattern and PFAPA syndrome. Patients with complex syndrome achieved complete responses with prednisone (21.9%), colchicine (25.7%) and anakinra (44.4%), and were the group more often requiring additional immunosuppressive drugs. CONCLUSIONS The analysis of the largest single-center series of adult patients with undifferentiated autoinflammatory diseases identified and characterized different disease phenotypes and their therapeutic approaches. This study is expected to contribute to increase the awareness of physicians for an early identification of these conditions, and to provide the best known therapeutic options.
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Affiliation(s)
- Verónica Gómez-Caverzaschi
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Jordi Yagüe
- Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain; Department of Immunology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gerard Espinosa
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Isabet Mayordomo-Bofill
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ricardo Bedón-Galarza
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Olga Araújo
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Section, Department of Cardiology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Xavier Morales
- Gastrointestinal Surgery Section, Department of General and Digestive Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Olga Balagué
- Department of Anatomic Pathology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Ignasi Figueras-Nart
- Department of Dermatology, Hospital Universitari de Bellvitge, University of Barcelona, Spain
| | - José M Mascaró
- Department of Dermatology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Fuertes
- Department of Dermatology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Priscila Giavedoni
- Department of Dermatology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Africa Muxí
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Isam Alobid
- Department of Otorhinolaryngology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Isabel Vilaseca
- Department of Otorhinolaryngology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ricard Cervera
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Juan I Aróstegui
- Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain; Department of Immunology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Mensa-Vilaró
- Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain; Department of Immunology, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Hernández-Rodríguez
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain.
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Araújo O, Casaroli-Marano RP, Hernández-Rodríguez J, Figueras-Roca M, Budi V, Morató M, Hernández-Negrín H, Ríos J, Adan A, Espinosa G, Pelegrín L, Cervera R. New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus. BMJ Open Ophthalmol 2024; 9:e001608. [PMID: 38499344 PMCID: PMC10953034 DOI: 10.1136/bmjophth-2023-001608] [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: 12/07/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity. METHODS A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations. RESULTS Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF. CONCLUSION Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.
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Affiliation(s)
- Olga Araújo
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Ricardo P Casaroli-Marano
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Marc Figueras-Roca
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Vanesa Budi
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Montse Morató
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Halbert Hernández-Negrín
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José Ríos
- Department of Medical Statistics Platform, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
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Greco R, Alexander T, Del Papa N, Müller F, Saccardi R, Sanchez-Guijo F, Schett G, Sharrack B, Snowden JA, Tarte K, Onida F, Sánchez-Ortega I, Burman J, Castilla Llorente C, Cervera R, Ciceri F, Doria A, Henes J, Lindsay J, Mackensen A, Muraro PA, Ricart E, Rovira M, Zuckerman T, Yakoub-Agha I, Farge D. Innovative cellular therapies for autoimmune diseases: expert-based position statement and clinical practice recommendations from the EBMT practice harmonization and guidelines committee. EClinicalMedicine 2024; 69:102476. [PMID: 38361991 PMCID: PMC10867419 DOI: 10.1016/j.eclinm.2024.102476] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Autoimmune diseases (ADs) are characterized by loss of immune tolerance, high chronicity, with substantial morbidity and mortality, despite conventional immunosuppression (IS) or targeted disease modifying therapies (DMTs), which usually require repeated administration. Recently, novel cellular therapies (CT), including mesenchymal stromal cells (MSC), Chimeric Antigen Receptors T cells (CART) and regulatory T cells (Tregs), have been successfully adopted in ADs. An international expert panel of the European Society for Blood and Marrow Transplantation and the International Society for the Cell and Gene Therapy, reviewed all available evidence, based on the current literature and expert practices, on use of MSC, CART and Tregs, in AD patients with rheumatological, neurological, and gastroenterological indications. Expert-based consensus and recommendations for best practice and quality of patient care were developed to support clinicians, scientists, and their multidisciplinary teams, as well as patients and care providers and will be regularly updated.
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Affiliation(s)
- Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Co-Chair of the Practice Harmonization and Guidelines Committee of EBMT and Chair of the ADWP of the EBMT, Barcelona, Spain
| | - Tobias Alexander
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Nicoletta Del Papa
- Scleroderma Clinic, Rheumatology Department, ASST G. Pini-CTO, Università degli Studi di Milano, Milano, Italy
| | - Fabian Müller
- Department of Internal Medicine 5 - Hematology and Oncology, University Hospital of Erlangen, Erlangen, Germany
- Bayrisches Zentrum für Krebsforschung (BZKF) Erlangen, Germany
| | - Riccardo Saccardi
- Cellular Therapies and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Fermin Sanchez-Guijo
- Department of Hematology, IBSAL-University Hospital of Salamanca and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen- Nürnberg, Erlangen, Germany
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England, United Kingdom
| | - John A. Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Karin Tarte
- SITI Lab, CHU Rennes, EFS Bretagne, University Rennes, Rennes, France
| | - Francesco Onida
- Hematology & ASCT Unit, ASST Fatebenefratelli-Sacco, University of Milan, Italy
- Co-Chair of the Practice Harmonization and Guidelines Committee of EBMT, Spain
| | - Isabel Sánchez-Ortega
- Secretary of the Practice Harmonization and Guidelines Committee of EBMT, Barcelona, Spain
- EBMT Medical Officer, Executive Office, Barcelona, Spain
| | - Joachim Burman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC, CSUR) of the Catalan and Spanish Health Systems/Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DiMED), University of Padua, Padua, Italy
| | - Jörg Henes
- Center for Interdisciplinary Rheumatology, Immunology and Autoimmune diseases and Department of Internal Medicine II (Haematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Germany
| | - James Lindsay
- Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Andreas Mackensen
- Department of Internal Medicine 5 - Hematology and Oncology, University Hospital of Erlangen, Erlangen, Germany
- Bayrisches Zentrum für Krebsforschung (BZKF) Erlangen, Germany
| | - Paolo A. Muraro
- Department of Brain Sciences, Imperial College London, London, UK
| | - Elena Ricart
- Gastroenterology Department. Hospital Clínic Barcelona. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Montserrat Rovira
- BMT Unit, Haematology Department, Institute of Haematology and Oncology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Josep Carreras Leukaemia Research Foundation, Spain
| | - Tsila Zuckerman
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ibrahim Yakoub-Agha
- CHU de Lille, University Lille, INSERM U1286, Infinite, 59000, Lille, France
- Chair of the Practice Harmonization and Guidelines Committee of EBMT, Spain
| | - Dominique Farge
- Internal Medicine Unit (04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d’Ile-de-France, AP-HP, St-Louis Hospital Paris-Cite University, France
- Department of Medicine, McGill University, Montreal, QC, Canada
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Balbi GGM, Ahmadzadeh Y, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Lopez-Pedrera C, Fortin PR, Wahl D, Gerosa M, de Jesús GR, Ji L, Atsumi T, Efthymiou M, Branch DW, Nalli C, Rodriguez Almaraz E, Petri M, Cervera R, Knight JS, Artim-Esen B, Willis R, Bertolaccini ML, Cohen H, Roubey R, Erkan D, de Andrade DCO. Damage measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in antiphospholipid antibody-positive patients included in the APS ACTION registry. Rheumatology (Oxford) 2024; 63:772-779. [PMID: 37307082 DOI: 10.1093/rheumatology/kead292] [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: 03/04/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES Our primary objective was to quantify damage burden measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in aPL-positive patients with or without a history of thrombosis in an international cohort (the APS ACTION cohort). Secondly, we aimed to identify clinical and laboratory characteristics associated with damage in aPL-positive patients. METHODS In this cross-sectional study, we analysed the baseline damage in aPL-positive patients with or without APS classification. We excluded patients with other autoimmune diseases. We analysed the demographic, clinical and laboratory characteristics based on two subgroups: (i) thrombotic APS patients with high vs low damage; and (ii) non-thrombotic aPL-positive patients with vs without damage. RESULTS Of the 826 aPL-positive patients included in the registry as of April 2020, 586 with no other systemic autoimmune diseases were included in the analysis (412 thrombotic and 174 non-thrombotic). In the thrombotic group, hyperlipidaemia (odds ratio [OR] 1.82; 95% CI 1.05, 3.15; adjusted P = 0.032), obesity (OR 2.14; 95% CI 1.23, 3.71; adjusted P = 0.007), aβ2GPI high titres (OR 2.33; 95% CI 1.36, 4.02; adjusted P = 0.002) and corticosteroid use (ever) (OR 3.73; 95% CI 1.80, 7.75; adjusted P < 0.001) were independently associated with high damage at baseline. In the non-thrombotic group, hypertension (OR 4.55; 95% CI 1.82, 11.35; adjusted P = 0.001) and hyperlipidaemia (OR 4.32; 95% CI 1.37, 13.65; adjusted P = 0.013) were independent predictors of damage at baseline; conversely, single aPL positivity was inversely correlated with damage (OR 0.24; 95% CI 0.075, 0.77; adjusted P = 0.016). CONCLUSIONS DIAPS indicates substantial damage in aPL-positive patients in the APS ACTION cohort. Selected traditional cardiovascular risk factors, steroids use and specific aPL profiles may help to identify patients more prone to present with a higher damage burden.
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Affiliation(s)
- Gustavo G M Balbi
- Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Yasaman Ahmadzadeh
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Hospital Universitario Cruces, País Vasco, Barakaldo, Spain
| | | | - Chary Lopez-Pedrera
- Rheumatology Service, IMIBIC/Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Paul R Fortin
- CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Denis Wahl
- Université de Lorraine, INSERM, DCAC, Nancy, France
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU-Nancy, Nancy, France
| | - Maria Gerosa
- Clinical Immunology & Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Lanlan Ji
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | | | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Cecilia Nalli
- Rheumatology and Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
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Parodis I, Lindblom J, Barturen G, Ortega-Castro R, Cervera R, Pers JO, Genre F, Hiepe F, Gerosa M, Kovács L, De Langhe E, Piantoni S, Stummvoll G, Vasconcelos C, Vigone B, Witte T, Alarcón-Riquelme ME, Beretta L. Molecular characterisation of lupus low disease activity state (LLDAS) and DORIS remission by whole-blood transcriptome-based pathways in a pan-European systemic lupus erythematosus cohort. Ann Rheum Dis 2024:ard-2023-224795. [PMID: 38373843 DOI: 10.1136/ard-2023-224795] [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: 07/30/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES To unveil biological milieus underlying low disease activity (LDA) and remission versus active systemic lupus erythematosus (SLE). METHODS We determined differentially expressed pathways (DEPs) in SLE patients from the PRECISESADS project (NTC02890121) stratified into patients fulfilling and not fulfilling the criteria of (1) Lupus LDA State (LLDAS), (2) Definitions of Remission in SLE remission, and (3) LLDAS exclusive of remission. RESULTS We analysed data from 321 patients; 40.8% were in LLDAS, and 17.4% in DORIS remission. After exclusion of patients in remission, 28.3% were in LLDAS. Overall, 604 pathways differed significantly in LLDAS versus non-LLDAS patients with an false-discovery rate-corrected p (q)<0.05 and a robust effect size (dr)≥0.36. Accordingly, 288 pathways differed significantly between DORIS remitters and non-remitters (q<0.05 and dr≥0.36). DEPs yielded distinct molecular clusters characterised by differential serological, musculoskeletal, and renal activity. Analysis of partially overlapping samples showed no DEPs between LLDAS and DORIS remission. Drug repurposing potentiality for treating SLE was unveiled, as were important pathways underlying active SLE whose modulation could aid attainment of LLDAS/remission, including toll-like receptor (TLR) cascades, Bruton tyrosine kinase (BTK) activity, the cytotoxic T lymphocyte antigen 4 (CTLA-4)-related inhibitory signalling, and the nucleotide-binding oligomerization domain leucine-rich repeat-containing protein 3 (NLRP3) inflammasome pathway. CONCLUSIONS We demonstrated for the first time molecular signalling pathways distinguishing LLDAS/remission from active SLE. LLDAS/remission was associated with reversal of biological processes related to SLE pathogenesis and specific clinical manifestations. DEP clustering by remission better grouped patients compared with LLDAS, substantiating remission as the ultimate treatment goal in SLE; however, the lack of substantial pathway differentiation between the two states justifies LLDAS as an acceptable goal from a biological perspective.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Julius Lindblom
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Guillermo Barturen
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada / Andalusian Regional Government, Granada, Spain, Medical Genomics, Granada, Spain
- Department of Genetics, Faculty of Sciences, University of Granada, Granada, Spain
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Jacques-Olivier Pers
- Centre Hospitalier Universitaire de Brest, Hopital de la Cavale Blanche, Brest, France
| | - Fernanda Genre
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain
| | - Falk Hiepe
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ellen De Langhe
- Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | | | | | - Barbara Vigone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Marta E Alarcón-Riquelme
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada / Andalusian Regional Government, Granada, Spain, Medical Genomics, Granada, Spain
- Department of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lorenzo Beretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Rodriguez-Pintó I, Espinosa G, Cervera R. What we know and what we don't know about catastrophic antiphospholipid syndrome. Rheumatology (Oxford) 2024; 63:SI46-SI53. [PMID: 38320593 DOI: 10.1093/rheumatology/kead556] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/16/2023] [Indexed: 02/08/2024] Open
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a severe condition with high mortality. Since its description in 1992, an important effort has been made to improve and disseminate knowledge on CAPS. Most of our current knowledge comes from the studies performed using the CAPS Registry, a database created in 2000 to gather as many cases as possible in order to better define this disease. It has demonstrated that this condition has multiple faces and is often triggered by a precipitating factor that leads to a thrombotic microangiopathy and cytokine storm involving almost any organ of the body. Analysis of the CAPS Registry has also shown that patients receiving anticoagulation, glucocorticoids and plasma exchange and/or IVIG have a better prognosis. However, there are still many unresolved questions. In this review we summarize what is known and what is still a matter of research in this condition.
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Affiliation(s)
- Ignasi Rodriguez-Pintó
- Autoimmune Diseases Unit, Hospital Universitari Mútua de Terrassa, Terrassa, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC, CSUR) of the Catalan and Spanish Health Systems/Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC, CSUR) of the Catalan and Spanish Health Systems/Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
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Salman-Monte TC, Mateo PF, Izquierdo MG, Cervera R, López N, Pallares L, Torres MJÁ, Ortega SP. Correction to: An online survey of the Spanish Lupus Patient Association (FELUPUS): patient perceptions and experiences. Clin Rheumatol 2024; 43:847. [PMID: 38047981 DOI: 10.1007/s10067-023-06841-z] [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] [Indexed: 12/05/2023]
Affiliation(s)
| | | | | | - Ricard Cervera
- Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Norberto López
- Dermatology Service, Hospital Virgen de La Victoria, Málaga, Spain
| | - Lucio Pallares
- Internal Medicine Service, Hospital Universitario Son Espases, Palma, Spain
| | | | - Silvia Pérez Ortega
- FELUPUS (Spanish Lupus Federation), FELUPUS, Madrid, On Behalf of FELUPUS, Spain
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Espinosa G, Cervera R. Combination of old and new drugs to improve renal outcome in SLE patients. Rheumatology (Oxford) 2024; 63:271-272. [PMID: 37656924 DOI: 10.1093/rheumatology/kead458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023] Open
Affiliation(s)
- Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for the Catalan and Spanish Health Systems, Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for the Catalan and Spanish Health Systems, Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
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12
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Rojo R, Calvo Alén J, Prada Á, Valor S, Roy G, López-Hoyos M, Cervera R, Mateos PS, Roger AJ. Corrigendum to "Recommendations for the use of anti-dsDNA autoantibodies in the diagnosis and follow-up of systemic lupus erythematosus - A proposal from an expert panel" [Autoimmunity Reviews, Volume 22, Issue 12, December 2023, 103479]. Autoimmun Rev 2024; 23:103517. [PMID: 38237216 DOI: 10.1016/j.autrev.2024.103517] [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] [Indexed: 04/30/2024]
Affiliation(s)
- Ricardo Rojo
- Immunology Department of the University Hospital of A Coruña, Spain
| | - Jaime Calvo Alén
- Rheumatology Department at the Araba University Hospital, Vitoria, Spain
| | - Álvaro Prada
- Immunology Laboratory of the University Hospital of Donostia, Spain
| | | | - Garbiñe Roy
- Immunology Department of the Ramón y Cajal University Hospital, Madrid, Spain
| | - Marcos López-Hoyos
- Immunology Department at the Marqués de Valdecilla-IDIVAL University Hospital, Santander, Molecular Biology Department at the University of Cantabria, Santander, Spain.
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Paloma Sánchez Mateos
- Complutense University, Immunology Department of the Gregorio Marañón General University Hospital, Madrid, Spain
| | - Aurora Jurado Roger
- Immunology and Allergology Department of the Reina Sofía University Hospital, Córdoba, Spain
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13
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Fanouriakis A, Kostopoulou M, Andersen J, Aringer M, Arnaud L, Bae SC, Boletis J, Bruce IN, Cervera R, Doria A, Dörner T, Furie RA, Gladman DD, Houssiau FA, Inês LS, Jayne D, Kouloumas M, Kovács L, Mok CC, Morand EF, Moroni G, Mosca M, Mucke J, Mukhtyar CB, Nagy G, Navarra S, Parodis I, Pego-Reigosa JM, Petri M, Pons-Estel BA, Schneider M, Smolen JS, Svenungsson E, Tanaka Y, Tektonidou MG, Teng YO, Tincani A, Vital EM, van Vollenhoven RF, Wincup C, Bertsias G, Boumpas DT. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis 2024; 83:15-29. [PMID: 37827694 DOI: 10.1136/ard-2023-224762] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [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: 07/22/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To update the EULAR recommendations for the management of systemic lupus erythematosus (SLE) based on emerging new evidence. METHODS An international Task Force formed the questions for the systematic literature reviews (January 2018-December 2022), followed by formulation and finalisation of the statements after a series of meetings. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned, and participants finally provided their level of agreement with each item. RESULTS The Task Force agreed on 5 overarching principles and 13 recommendations, concerning the use of hydroxychloroquine (HCQ), glucocorticoids (GC), immunosuppressive drugs (ISDs) (including methotrexate, mycophenolate, azathioprine, cyclophosphamide (CYC)), calcineurin inhibitors (CNIs, cyclosporine, tacrolimus, voclosporin) and biologics (belimumab, anifrolumab, rituximab). Advice is also provided on treatment strategies and targets of therapy, assessment of response, combination and sequential therapies, and tapering of therapy. HCQ is recommended for all patients with lupus at a target dose 5 mg/kg real body weight/day, considering the individual's risk for flares and retinal toxicity. GC are used as 'bridging therapy' during periods of disease activity; for maintenance treatment, they should be minimised to equal or less than 5 mg/day (prednisone equivalent) and, when possible, withdrawn. Prompt initiation of ISDs (methotrexate, azathioprine, mycophenolate) and/or biological agents (anifrolumab, belimumab) should be considered to control the disease and facilitate GC tapering/discontinuation. CYC and rituximab should be considered in organ-threatening and refractory disease, respectively. For active lupus nephritis, GC, mycophenolate or low-dose intravenous CYC are recommended as anchor drugs, and add-on therapy with belimumab or CNIs (voclosporin or tacrolimus) should be considered. Updated specific recommendations are also provided for cutaneous, neuropsychiatric and haematological disease, SLE-associated antiphospholipid syndrome, kidney protection, as well as preventative measures for infections, osteoporosis, cardiovascular disease. CONCLUSION The updated recommendations provide consensus guidance on the management of SLE, combining evidence and expert opinion.
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Affiliation(s)
- Antonis Fanouriakis
- Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Kostopoulou
- Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center & Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg, INSERM UMR-S 1109, Centre National de Référence des Maladies Auto-immunes Systémiques Rares (RESO), Strasbourg, France
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research and Hanyang Institute of Bioscience and Biotechnology, Seoul, South Korea
| | - John Boletis
- Department of Nephrology and Renal Transplantation Unit, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK; National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charite Universitätsmedizin Berlin; Deutsches Rheumaforschungszentrum, Berlin, Germany
| | - Richard A Furie
- Division of Rheumatology, Northwell Health, Great Neck, New York City, New York, USA
| | - Dafna D Gladman
- Lupus Program, Centre for Prognosis Studies in the Rheumatic Disease, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Frederic A Houssiau
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Luís Sousa Inês
- Department of Rheumatology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal; School of Health Sciences, Universidade da Beira Interior, Covilha, Portugal
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - László Kovács
- Department of Rheumatology and Immunology, Faculty of Medicine, University of Szeged, Hungary
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gabriella Moroni
- Department of Biomedical Sciences Humanitas University, Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Johanna Mucke
- Department of Rheumatology & Hiller Research Unit Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - György Nagy
- Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sandra Navarra
- Section of Rheumatology, Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - José M Pego-Reigosa
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) - VIGO Group, Galicia Sur Health Research Institute, Vigo, Spain
| | - Michelle Petri
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernardo A Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Matthias Schneider
- Department of Rheumatology & Hiller Research Unit Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Elisabet Svenungsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Joint Academic Rheumatology Program, Athens, Greece
| | - Yk Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-mediated Systemic autoimmune diseases, Department of Internal Medicine - section Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chris Wincup
- Department of Rheumatology, King's College Hospital, London, UK
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece, University Hospital of Heraklion, Heraklion, Greece
| | - Dimitrios T Boumpas
- Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece, Medical School, University of Cyprus, Nicosia, Cyprus
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14
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Zuily S, Cervera R, Foret T, Bertocchi S, Tincani A. Thrombocytopenia in antiphospholipid syndrome: Is anticoagulation and/or antiaggregation always required? Autoimmun Rev 2024; 23:103417. [PMID: 37619905 DOI: 10.1016/j.autrev.2023.103417] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
The antiphospholipid syndrome (APS) is an autoimmune and prothrombotic condition defined by the association of thrombotic events and/or obstetrical complications and the persistence of antiphospholipid antibodies (aPL) over time. Among the new criteria recently included in the 2023 ACR/EULAR classification criteria for APS, thrombocytopenia is one of the most frequent. The occurrence of thrombocytopenia in aPL/APS patients is important to consider because it could predict APS-related clinical events with a 3-fold increased risk for thrombotic events or obstetrical morbidity or all-cause deaths. A debate on the need or not of anticoagulation and/or antiaggregation in APS patients and aPL carriers with thrombocytopenia took place on the 7th edition of the International Congress on Controversies in Rheumatology and Autoimmunity (CORA), that was organized in Turin, Italy, on March 18th, 2023, and this review summarizes the main arguments that were discussed in this session.
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Affiliation(s)
- Stephane Zuily
- CHRU-Nancy, Vascular Medicine Division, French Referral Center for Rare Systemic and Autoimmune Diseases, F-54000 Nancy, France; Université de Lorraine, INSERM, DCAC, F-54000 Nancy, France
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems-Member of ERN-ReCONNET, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
| | - Thomas Foret
- CHRU-Besancon, Vascular Medicine Unit, Vascular and Endovascular Surgery Department, F-25000 Besancon, France
| | - Stefania Bertocchi
- Rheumatology and Clinical Immunology Unit, Dpt. of Clinical and Experimental Science, ASST-Spedali Civili and University of Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Dpt. of Clinical and Experimental Science, ASST-Spedali Civili and University of Brescia, Italy
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15
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Casares-Marfil D, Martínez-Bueno M, Borghi MO, Pons-Estel G, Reales G, Zuo Y, Espinosa G, Radstake T, van den Hoogen LL, Wallace C, Guthridge J, James JA, Cervera R, Meroni PL, Martin J, Knight JS, Alarcón-Riquelme ME, Sawalha AH. A genome-wide association study suggests new susceptibility loci for primary antiphospholipid syndrome. medRxiv 2023:2023.12.05.23299396. [PMID: 38405993 PMCID: PMC10889036 DOI: 10.1101/2023.12.05.23299396] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objectives Primary antiphospholipid syndrome (PAPS) is a rare autoimmune disease characterized by the presence of antiphospholipid antibodies and the occurrence of thrombotic events and pregnancy complications. Our study aimed to identify novel genetic susceptibility loci associated with PAPS. Methods We performed a genome-wide association study comprising 5,485 individuals (482 affected individuals) of European ancestry. Significant and suggestive independent variants from a meta-analysis of approximately 7 million variants were evaluated for functional and biological process enrichment. The genetic risk variability for PAPS in different populations was also assessed. Hierarchical clustering, Mahalanobis distance, and Dirichlet Process Mixtures with uncertainty clustering methods were used to assess genetic similarities between PAPS and other immune-mediated diseases. Results We revealed genetic associations with PAPS in a regulatory locus within the HLA class II region near HLA-DRA and in STAT4 with a genome-wide level of significance. 34 additional suggestive genetic susceptibility loci for PAPS were also identified. The disease risk allele in the HLA class II locus is associated with overexpression of HLA-DRB6 , HLA-DRB9 , HLA-DPB2 , HLA-DQA2 and HLA-DQB2 , and is independent of the association between PAPS and HLA-DRB1*1302 . Functional analyses highlighted immune and nervous system related pathways in PAPS-associated loci. The comparison with other immune-mediated diseases revealed a close genetic relatedness to neuromyelitis optica, systemic sclerosis, and Sjögren's syndrome, suggesting colocalized causal variations close to STAT4 , TNPO3 , and BLK . Conclusions This study represents a comprehensive large-scale genetic analysis for PAPS and provides new insights into the genetic basis and pathophysiology of this rare disease.
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Ponce A, Rodríguez-Pintó I, Espinosa G, Quintas H, Erkan D, Shoenfeld Y, Cervera R. Pulmonary involvement in catastrophic antiphospholipid syndrome: A descriptive analysis from the "CAPS Registry". Semin Arthritis Rheum 2023; 63:152265. [PMID: 37857048 DOI: 10.1016/j.semarthrit.2023.152265] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/10/2023] [Accepted: 08/27/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To describe the pulmonary involvement in patients with catastrophic antiphospholipid syndrome (CAPS), focusing on its relationship with extrapulmonary involvement, laboratory, radiological, and pathological findings. METHODS This retrospective cross-sectional study includes all patients grouped in the "CAPS Registry". All cases were reviewed, and those with pulmonary thromboembolism (PE) and/or diffuse alveolar hemorrhage (DAH) were selected. Data on pulmonary and extrapulmonary clinical presentation, radiologic patterns, laboratory findings, associated autoimmune diseases, treatments, and outcomes were analyzed. Frequency distribution and measures of central tendency were used to describe the cohort. Comparison between groups regarding qualitative variables was undertaken by chi-square or Fisher exact test, while T-test for independent variables was used to compare groups regarding continuous variables. IBM-SPSS v.22 was used for data analysis. RESULTS PE was reported in 129 (48.6 %) episodes, DAH in 75 (28.3 %) episodes, and overlap (DAH plus PE) in 7 (2.6 %) episodes. Bronchoalveolar lavage (BAL) was performed in 35 (4.9 %) CAPS episodes, and lung pathology samples were obtained in 84 (10.5 %) episodes (including autopsies). A significant relationship was observed between DAH and laboratory features of thrombotic microangiopathy (TMA). A meaningful relationship was also found between triple antiphospholipid antibody positivity and pathological TMA (26.5 %) as well as hypocomplementemia and DAH (24 %). CONCLUSIONS Pulmonary involvement may include both TMA and non-thrombotic inflammation, which can be differentiated into three patterns: PE, DAH with systemic TMA with hypocomplementemia or DAH without systemic TMA with/without hypocomplementemia.
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Affiliation(s)
- Ana Ponce
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital de Viladecans, Viladecans, Catalonia, Spain
| | - Ignasi Rodríguez-Pintó
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua de Terrassa, Terrassa, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems-Member of ERN-ReCONNET, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Helena Quintas
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital de Viladecans, Viladecans, Catalonia, Spain
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems-Member of ERN-ReCONNET, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
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Rojo R, Calvo Alén J, Prada Á, Valor S, Roy G, López-Hoyos M, Cervera R, Sánchez Mateos P, Jurado Roger A. Recommendations for the use of anti-dsDNA autoantibodies in the diagnosis and follow-up of systemic lupus erythematosus - A proposal from an expert panel. Autoimmun Rev 2023; 22:103479. [PMID: 37967782 DOI: 10.1016/j.autrev.2023.103479] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
Anti-dsDNA autoantibodies are listed as one of the classification criteria for systemic lupus erythematosus (SLE) and are relatively effective indicators for monitoring disease activity and treatment response. Therefore, clinicians rely on them to diagnose and adjust medication and treatment strategies for SLE patients. However, the use of anti-dsDNA antibodies is not free from controversy. Part of this controversy stems from the fact that anti-dsDNA antibodies are found in several disorders, besides SLE. In addition to this, anti-dsDNA antibodies are a heterogeneous group of antibodies, and their determination still lacks proper standardization. Moreover, anti-dsDNA testing specificity and diagnostic performance change depending on the population under study. These and other issues result in inconsistency and encumber the clinical use of anti-dsDNA antibodies. A panel of medical laboratory and clinical experts on SLE discussed such issues based on their clinical experience in a first meeting, establishing a series of recommendations. The proceedings of this first meeting, plus an exhaustive review of the literature, were used to compose a paper draft. The panel subsequently discussed and refined this draft in a second meeting, the result of which is this paper. This document is relevant to clinical laboratories as it guides to improving diagnosis and monitoring of SLE. Simultaneously, it will help laboratories compile more informative reports, not limited to a mere number. It is also relevant to clinical doctors who wish to better understand laboratory methods so that they can do a more efficient, better-aimed laboratory test ordering.
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Affiliation(s)
- Ricardo Rojo
- Specialist Consultant at the Immunology Department of the University Hospital of A Coruña, Spain
| | - Jaime Calvo Alén
- Head of the Rheumatology Department at the Araba University Hospital, Vitoria, Spain
| | - Álvaro Prada
- Head of Section at the Immunology Laboratory of the University Hospital of Donostia, Spain
| | | | - Garbiñe Roy
- Head of the Autoimmunity Section at the Immunology Department of the Ramón y Cajal University Hospital, Madrid, Spain
| | - Marcos López-Hoyos
- Head of the Immunology Department at the Marqués de Valdecilla-IDIVAL University Hospital, Santander. Full Professor, Molecular Biology Department at the University of Cantabria, Santander, Spain.
| | - Ricard Cervera
- Head of the Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Paloma Sánchez Mateos
- Full Professor at the Complutense University, and Specialist Consultant at the Immunology Department of the Gregorio Marañón General University Hospital, Madrid, Spain
| | - Aurora Jurado Roger
- Head of Section at the Immunology and Allergology Department of the Reina Sofía University Hospital, Córdoba, Spain
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18
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Contreras I, Navarro-Otano J, Rodríguez-Pintó I, Güemes A, Alves E, Rios-Garcés R, Espinosa G, Alejaldre A, Beneyto A, Ramkissoon CM, Vehi J, Cervera R. Optimizing Noninvasive Vagus Nerve Stimulation for Systemic Lupus Erythematosus: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48387. [PMID: 37831494 PMCID: PMC10612000 DOI: 10.2196/48387] [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: 04/21/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus is a chronic, multisystem, inflammatory disease of autoimmune etiology occurring predominantly in women. A major hurdle to the diagnosis, treatment, and therapeutic advancement of this disease is its heterogeneous nature, which presents as a wide range of symptoms such as fatigue, fever, musculoskeletal involvement, neuropsychiatric disorders, and cardiovascular involvement with varying severity. The current therapeutic approach to this disease includes the administration of immunomodulatory drugs that may produce unfavorable secondary effects. OBJECTIVE This study explores the known relationship between the autonomic nervous system and inflammatory pathways to improve patient outcomes by treating autonomic nervous system dysregulation in patients via noninvasive vagus nerve stimulation. In this study, data including biomarkers, physiological signals, patient outcomes, and patient quality of life are being collected and analyzed. After completion of the clinical trial, a computer model will be developed to identify the biomarkers and physiological signals related to lupus activity in order to understand how they change with different noninvasive vagus nerve stimulation frequency parameters. Finally, we propose building a decision support system with integrated noninvasive wearable technologies for continuous cardiovascular and peripheral physiological sensing for adaptive, patient-specific optimization of the noninvasive vagus nerve stimulation frequency parameters in real time. METHODS The protocol was designed to evaluate the efficacy and safety of transauricular vagus nerve stimulation in patients with systemic lupus erythematosus. This multicenter, national, randomized, double-blind, parallel-group, placebo-controlled study will recruit a minimum of 18 patients diagnosed with this disease. Evaluation and treatment of patients will be conducted in an outpatient clinic and will include 12 visits. Visit 1 consists of a screening session. Subsequent visits up to visit 6 involve mixing treatment and evaluation sessions. Finally, the remaining visits correspond with early and late posttreatment follow-ups. RESULTS On November 2022, data collection was initiated. Of the 10 participants scheduled for their initial appointment, 8 met the inclusion criteria, and 6 successfully completed the entire protocol. Patient enrollment and data collection are currently underway and are expected to be completed in December 2023. CONCLUSIONS The results of this study will advance patient-tailored vagus nerve stimulation therapies, providing an adjunctive treatment solution for systemic lupus erythematosus that will foster adoption of technology and, thus, expand the population with systemic lupus erythematosus who can benefit from improved autonomic dysregulation, translating into reduced costs and better quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT05704153; https://clinicaltrials.gov/study/NCT05704153. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48387.
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Affiliation(s)
- Ivan Contreras
- Modeling, Identification and Control Engineering (MICELab), Institut d'Informatica i Applicacions, Universitat de Girona, Girona, Spain
- Professor Serra Húnter, Universitat de Girona, Girona, Spain
| | | | - Ignasi Rodríguez-Pintó
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Amparo Güemes
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Eduarda Alves
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | | | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | | | - Aleix Beneyto
- Modeling, Identification and Control Engineering (MICELab), Institut d'Informatica i Applicacions, Universitat de Girona, Girona, Spain
| | - Charrise Mary Ramkissoon
- Modeling, Identification and Control Engineering (MICELab), Institut d'Informatica i Applicacions, Universitat de Girona, Girona, Spain
| | - Josep Vehi
- Modeling, Identification and Control Engineering (MICELab), Institut d'Informatica i Applicacions, Universitat de Girona, Girona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
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19
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesus G, Delluc A, Desai S, De Sancho M, Devreese KM, Diz-Kucukkaya R, Duarte-Garcia A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol 2023; 75:1687-1702. [PMID: 37635643 DOI: 10.1002/art.42624] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included 4 phases: 1) Phase I, criteria generation by surveys and literature review; 2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; 3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and 4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2 -glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Counties Manukau Health District, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico DF, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, F-75004 Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, and Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, and GlaxoSmithKline, Collegeville, Pennsylvania
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy, and University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas
| | - Cecile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, F-59000 Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Francis Guillemin
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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20
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesús G, Delluc A, Desai S, Sancho MD, Devreese KM, Diz-Kucukkaya R, Duarte-García A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis 2023; 82:1258-1270. [PMID: 37640450 DOI: 10.1136/ard-2023-224609] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [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: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2-glycoprotein I antibodies). Patients accumulating at least three points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria vs the 2006 revised Sapporo classification criteria had a specificity of 99% vs 86%, and a sensitivity of 84% vs 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California, USA
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington, USA
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York, New York, USA
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Ontario, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York, USA
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Orsolini
- Department of Rheumatology, University Hospitals of Verona, Verona, Italy
| | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
- University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Cécile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Francis Guillemin
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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21
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Xipell M, Lledó GM, Egan AC, Tamirou F, Del Castillo CS, Rovira J, Gómez-Puerta JA, García-Herrera A, Cervera R, Kronbichler A, Jayne DRW, Anders HJ, Houssiau F, Espinosa G, Quintana LF. From systemic lupus erythematosus to lupus nephritis: The evolving road to targeted therapies. Autoimmun Rev 2023; 22:103404. [PMID: 37543287 DOI: 10.1016/j.autrev.2023.103404] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
Systemic lupus erythematosus is a chronic autoimmune disease characterized by loss of tolerance against nuclear and cytoplasmic self-antigens, induction of immunity and tissue inflammation. Lupus nephritis (LN), the most important predictor of morbidity in SLE, develops in almost 30% of SLE patients at disease onset and in up to 50-60% within the first 10 years. Firstly, in this review, we put the pathogenic mechanisms of the disease into a conceptual frame, giving emphasis to the role of the innate immune system in this loss of self-tolerance and the induction of the adaptive immune response. In this aspect, many mechanisms have been described such as dysregulation and acceleration of cell-death pathways, an aberrant clearance and overload of immunogenic acid-nucleic-containing debris and IC, and the involvement of antigen-presenting cells and other innate immune cells in the induction of this adaptive immune response. This result in a clonal expansion of autoreactive lymphocytes with generation of effector T-cells, memory B-cells and plasma cells that produce autoantibodies that will cause kidney damage. Secondly, we review the immunological pathways of damage in the kidney parenchyma, initiated by autoantibody binding and immune complex deposition, and followed by complement-mediated microvascular injury, activation of kidney stromal cells and the recruitment of leukocytes. Finally, we summarize the rationale for the treatment of LN, from conventional to new targeted therapies, focusing on their systemic immunologic effects and the minimization of podocytary damage.
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Affiliation(s)
- Marc Xipell
- Department of Nephrology and Renal Transplantation, Clinic Barcelona, Spain; Reference Center for Complex Glomerular Diseases of the Spanish Health System (CSUR), Department of Medicine, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gema M Lledó
- Department of Autoimmune Diseases, Clínic Barcelona, Spain; Reference Center for Systemic Autoimmune Diseases of the Spanish Health System (CSUR), Department of Medicine, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Allyson C Egan
- Vasculitis and Lupus Service, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, United Kingdom
| | - Farah Tamirou
- Rheumatology Department, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium; Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Belgium
| | | | - Jordi Rovira
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José A Gómez-Puerta
- Department of Rheumatology, Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Adriana García-Herrera
- Department of Pathology, Clínic Barcelona, Spain; Reference Center for Complex Glomerular Diseases of the Spanish Health System (CSUR), Department of Medicine, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Clínic Barcelona, Spain
| | - Andreas Kronbichler
- Vasculitis and Lupus Service, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David R W Jayne
- Vasculitis and Lupus Service, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Frédéric Houssiau
- Vasculitis and Lupus Service, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, United Kingdom
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Clínic Barcelona, Spain; Reference Center for Systemic Autoimmune Diseases of the Spanish Health System (CSUR), Department of Medicine, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Clinic Barcelona, Spain; Reference Center for Complex Glomerular Diseases of the Spanish Health System (CSUR), Department of Medicine, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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22
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Schreiber K, Giles I, Costedoat-Chalumeau N, Nelson-Piercy C, Dolhain RJ, Mosca M, Förger F, Fischer-Betz R, Molto A, Tincani A, Pasquier E, Marin B, Elefant E, Salmon J, Bermas BL, Sammaritano L, Clowse MEB, Chambers C, Buyon J, Inoue SA, Agmon-Levin N, Aguilera S, Emadi SA, Andersen J, Andrade D, Antovic A, Arnaud L, Christiansen AA, Avcin T, Badreh-Wirström S, Bertsias G, Bini I, Bobirca A, Branch W, Brucato A, Bultink I, Capela S, Cecchi I, Cervera R, Chighizola C, Cobilinschi C, Cuadrado MJ, Dey D, Etomi O, Espinosa G, Flint J, Fonseca JE, Fritsch-Stork R, Gerosa M, Glintborg B, Skorpen CG, Goulden B, Graversgaard C, Gunnarsson I, Gupta L, Hetland M, Hodson K, Hunt BJ, Isenberg D, Jacobsen S, Khamashta M, Levy R, Linde L, Lykke J, Meissner Y, Moore L, Morand E, Navarra S, Opris-Belinski D, Østensen M, Ozawa H, Perez-Garcia LF, Petri M, Pons-Estel GJ, Radin M, Raio L, Rottenstreich A, Ruiz-Irastorza G, Tunjić SR, Rygg M, Sciascia S, Strangfeld A, Svenungsson E, Tektonidou M, Troldborg A, Vinet E, Vojinovic J, Voss A, Wallenius M, Andreoli L. Global comment on the use of hydroxychloroquine during the periconception period and pregnancy in women with autoimmune diseases. Lancet Rheumatol 2023; 5:e501-e506. [PMID: 38251494 DOI: 10.1016/s2665-9913(23)00215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Karen Schreiber
- Danish Centre for Expertise in Rheumatology (CeViG), Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark (KS); Institute for Regional Health, Southern Danish University, Odense, Denmark.
| | - Ian Giles
- Centre for Rheumatology, UCL Division of Medicine, London, UK
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France; Université Paris Cité, Paris, France
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK (CN-P, OE)
| | - Radboud Jem Dolhain
- Erasmus MC, University Medical Centre, Department of Rheumatology, Rotterdam, Netherlands
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Frauke Förger
- Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland
| | - Rebecca Fischer-Betz
- Department for Rheumatology and Hiller Research Institute, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Molto
- Rheumatology Department, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University, Brescia, Italy
| | - Elisabeth Pasquier
- Département de Médecine Interne et Pneumologie, CHRU de Brest, Hôpital de la Cavale Blanche, Brest, France; INSERM, Centre d'Investigation Clinique 1412, CHRU de Brest, Brest, France
| | - Benoit Marin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes, F75012, Paris, France
| | - Elisabeth Elefant
- AP-HP, Sorbonne Université, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes, F75012, Paris, France
| | - Jane Salmon
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York, USA
| | | | - Lisa Sammaritano
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Megan E B Clowse
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina Chambers
- Department of Paediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Jill Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Saori Abe Inoue
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Nancy Agmon-Levin
- The Zabludowicz Centre for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Danieli Andrade
- Rheumatology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Aleksandra Antovic
- Department of Medicine, Division of Rheumatology Karolinska Institutet and Rheumatology, Karolinska University Hospital Stockholm, Sweden
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Références Maladies Auto-Immunes, Strasbourg, France
| | - Alice Ashouri Christiansen
- Danish Center for Expertise in Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Badreh-Wirström
- Senior European and Regulatory Affairs Project Manager, EULAR PARE, Brussels, Belgium
| | - George Bertsias
- Rheumatology, University of Crete School of Medicine, Iraklio, Greece; Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Greece
| | | | - Anca Bobirca
- Department of Internal Medicine and Rheumatology, Dr I Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ware Branch
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milano, Fatebenefratelli Hospital, Milano, Italy
| | - Irene Bultink
- Department of Rheumatology, Amsterdam Rheumatology and immunology Centre, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Susanna Capela
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Irene Cecchi
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Cecilia Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Paediatric Rheumatology Unit, ASST Pini, CTO, Milan, Italy
| | - Claudia Cobilinschi
- Department of Internal Medicine and Rheumatology Sânta Maria Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Dzifa Dey
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, University of Ghana Medical School, Accra, Ghana
| | - Oseme Etomi
- Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK (CN-P, OE)
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Julia Flint
- Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - João-Eurico Fonseca
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa and Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ruth Fritsch-Stork
- Health Care Centre Mariahilf, ÖGK and Rheumatology Department at the Sigmund Freud Private University, Vienna, Austria
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Research Centre for Adult and Paediatric Rheumatic Diseases, University of Milan, Milan, Italy; Clinical Rheumatology Unit, ASST G Pini and CTO, Milan, Italy
| | - Bente Glintborg
- DANBIO and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Carina Gøtestam Skorpen
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway; Department of Rheumatology Ålesund, Helse More og Romsdal, Ålesund, Norway
| | - Bethan Goulden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Rheumatology Research, UCL Division of Medicine, University College London, London; Women's Health, University College London Hospital, London, UK
| | - Christine Graversgaard
- Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark; Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Iva Gunnarsson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden; Solna and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Merete Hetland
- DANBIO and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ken Hodson
- UK Teratology Information Service, Newcastle upon Tyne, UK
| | - Beverley J Hunt
- Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Isenberg
- Centre for Rheumatology, UCL Division of Medicine, London, UK
| | - Søren Jacobsen
- Copenhagen Research Centre for Autoimmune Connective Tissue Diseases, COPEACT, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Louise Linde
- Copenhagen Research Centre for Autoimmune Connective Tissue Diseases, Lupus and Vasculitis Clinic, Copenhagen university hospital, Rigshospitalet, Denmark
| | - Jacob Lykke
- Department of Obstetrics, Copenhagen university hospital, Rigshospitalet, Denmark
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
| | - Louise Moore
- Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland
| | - Eric Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Sandra Navarra
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Daniela Opris-Belinski
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines; Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monika Østensen
- Department of Rheumatology, Sorlandet Hospital Kristiansand, Kristiansand, Norway (MØ)
| | - Hiroki Ozawa
- Immuno-Rheumatology Centre, St Luke's International Hospital, Tokyo, Japan
| | | | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Massimo Radin
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Amihai Rottenstreich
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra and Northwell, New York, NY, USA; Laboratory of Blood and Vascular Biology, Rockefeller University, New York, NY, USA; Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, University of the Basque Country, Bizkaia, Spain
| | | | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Savino Sciascia
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Anja Strangfeld
- Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Elisabet Svenungsson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Tektonidou
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Evelyne Vinet
- McGill University, McGill University Health Centre, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jelena Vojinovic
- University of Nis, Faculty of Medicine, Clinic for Pediatrics University Clinical Center Nis, Nis, Serbia
| | - Anne Voss
- Department of Rheumatology C, Odense University Hospital, Odense, Denmark
| | - Marianne Wallenius
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St Olavs Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia, Brescia, Italy
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Zuo Y, Navaz S, Tsodikov A, Kmetova K, Kluge L, Ambati A, Hoy CK, Yalavarthi S, de Andrade D, Tektonidou MG, Sciascia S, Pengo V, Ruiz-Irastorza G, Michael Belmont H, Gerosa M, Fortin PR, de Jesus GR, Ware Branch D, Andreoli L, Rodriguez-Almaraz E, Petri M, Cervera R, Willis R, Karp DR, Li QZ, Cohen H, Bertolaccini ML, Erkan. D, Knight JS. Anti-Neutrophil Extracellular Trap Antibodies in Antiphospholipid Antibody-Positive Patients: Results From the Antiphospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Clinical Database and Repository. Arthritis Rheumatol 2023; 75:1407-1414. [PMID: 36862141 PMCID: PMC10758259 DOI: 10.1002/art.42489] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/18/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE This study aimed to elucidate the presence, antigen specificities, and potential clinical associations of anti-neutrophil extracellular trap (anti-NET) antibodies in a multinational cohort of antiphospholipid (aPL) antibody-positive patients who did not have lupus. METHODS Anti-NET IgG/IgM levels were measured in serum samples from 389 aPL-positive patients; 308 patients met the classification criteria for antiphospholipid syndrome. Multivariate logistic regression with best variable model selection was used to determine clinical associations. For a subset of the patients (n = 214), we profiled autoantibodies using an autoantigen microarray platform. RESULTS We found elevated levels of anti-NET IgG and/or IgM in 45% of the aPL-positive patients. High anti-NET antibody levels are associated with more circulating myeloperoxidase (MPO)-DNA complexes, which are a biomarker of NETs. When considering clinical manifestations, positive anti-NET IgG was associated with lesions affecting the white matter of the brain, even after adjusting for demographic variables and aPL profiles. Anti-NET IgM tracked with complement consumption after controlling for aPL profiles; furthermore, patient serum samples containing high levels of anti-NET IgM efficiently deposited complement C3d on NETs. As determined by autoantigen microarray, positive testing for anti-NET IgG was significantly associated with several autoantibodies, including those recognizing citrullinated histones, heparan sulfate proteoglycan, laminin, MPO-DNA complexes, and nucleosomes. Anti-NET IgM positivity was associated with autoantibodies targeting single-stranded DNA, double-stranded DNA, and proliferating cell nuclear antigen. CONCLUSION These data reveal high levels of anti-NET antibodies in 45% of aPL-positive patients, where they potentially activate the complement cascade. While anti-NET IgM may especially recognize DNA in NETs, anti-NET IgG species appear to be more likely to target NET-associated protein antigens.
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Affiliation(s)
- Yu Zuo
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sherwin Navaz
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alex Tsodikov
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katarina Kmetova
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lyndsay Kluge
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amala Ambati
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire K. Hoy
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Srilakshmi Yalavarthi
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | | | | - D. Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ricard Cervera
- Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
| | - Rohan Willis
- University of Texas Medical Branch, Galveston, TX, USA
| | - David R. Karp
- Division of Rheumatic Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Quan-Zhen Li
- Department of Immunology, Immune Phenotyping Core Facility, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - Doruk Erkan.
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jason S. Knight
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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24
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Pelegrín L, Morató M, Araújo O, Figueras-Roca M, Zarranz-Ventura J, Adán A, Cervera R, Casaroli-Marano RP, Budi V, Barrera-López L, Ríos J, Hernández-Rodríguez J, Espinosa G. Preclinical ocular changes in systemic lupus erythematosus patients by optical coherence tomography. Rheumatology (Oxford) 2023; 62:2475-2482. [PMID: 36331348 DOI: 10.1093/rheumatology/keac626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/28/2022] [Accepted: 10/18/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE The aim of the present study was to detect preclinical changes in SLE patients in retinal microvascularization or retinal and optical nerve structure by optical coherence tomography. METHODS This cross-sectional, single-centre study aimed to describe structural changes [macular and retinal nerve fibre layer (RNFL) thickness] by structural spectral-domain optical coherence tomography (SD-OCT) and perifoveal vascular [vessel density (VD) and vascular perfusion (VP) and foveal avascular zone (FAZ) structural parameters] findings by OCT angiography (OCTA) in 78 SLE patients and 80 healthy volunteers. In addition, we analysed their association with clinical and laboratory parameters, medications received, disease duration, and SLE activity and damage. RESULTS Structural parameters by SD-OCT and perifoveal vascular parameters by OCTA were decreased in SLE patients compared with controls. OCTA parameters (VD, VP and FAZ circularity) and macular thickness were also decreased in patients with longer disease duration (>10 years). The presence of aPLs was associated with a decreased RNFL thickness, mainly in the inferior quadrants. Patients developing APS also showed decreased RNFL thickness and OCTA flow changes. SD-OCT and OCTA results were not associated with disease activity. Foveal structural parameters were lower in patients with higher damage score. CONCLUSION SD-OCT and OCTA can detect preclinical structural and microcirculatory changes in SLE patients. Structural and perifoveal vascular macular changes in SLE patients are related to disease duration. Macular structural parameters were impaired in patients with higher disease damage. APS seems to be associated with preclinical damage to the optic nerve and impairment of the perifoveal microvasculature.
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Affiliation(s)
- Laura Pelegrín
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Montse Morató
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Olga Araújo
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marc Figueras-Roca
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Javier Zarranz-Ventura
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ricardo P Casaroli-Marano
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Vanesa Budi
- Retina and Uveitis Unit, Department of Ophthalmology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lucía Barrera-López
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José Ríos
- Department of Medical Statistics Platform, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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25
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Villarreal JZ, Pérez-Anker J, Puig S, Xipell M, Espinosa G, Barnadas E, Larque AB, Malvehy J, Cervera R, Pereira A, Martinez-Pozo A, Quintana LF, García-Herrera A. Ex vivo confocal microscopy detects basic patterns of acute and chronic lesions using fresh kidney samples. Clin Kidney J 2023; 16:1005-1013. [PMID: 37260998 PMCID: PMC10229294 DOI: 10.1093/ckj/sfad019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Ex vivo confocal microscopy is a real-time technique that provides high-resolution images of fresh, non-fixed tissues, with an optical resolution comparable to conventional pathology. The objective of this study was to investigate the feasibility of using ex vivo confocal microscopy in fusion mode (FuCM) and the haematoxylin and eosin (H&E)-like digital staining that results for the analysis of basic patterns of lesion in nephropathology. METHODS Forty-eight renal samples were scanned in a fourth-generation ex vivo confocal microscopy device. Samples were subjected to confocal microscopy imaging and were then processed using conventional pathology techniques. Concordance between the techniques was evaluated by means of the percentage of agreement and the κ index. RESULTS Agreement between conventional microscopy and H&E-like digital staining was strong (κ = 0.88) in the evaluation of acute tubular damage and was substantial (κ = 0.79) in the evaluation of interstitial fibrosis, interstitial inflammation, arterial and arteriolar lesions. H&E-like digital staining also allows rapid identification of extracapillary proliferation (κ = 0.88), necrosis and segmental sclerosis (κ = .88) in the glomerular compartment, but the results reported here are limited because of the small number of cases with these glomerular findings. CONCLUSIONS FuCM proved to be as effective as conventional techniques in evaluating the presence of acute tubular necrosis and interstitial fibrosis changes, but in fresh tissue. The ease of acquisition of ex vivo confocal microscopy images suggests that FuCM may be useful for rapid evaluation of kidney biopsies and to restructure the clinical workflow in renal histopathology.
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Affiliation(s)
- Jesús Z Villarreal
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Fundación Hospital Clinic, Barcelona, Spain
| | - Javiera Pérez-Anker
- Fundación Hospital Clinic, Barcelona, Spain
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Susana Puig
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Marc Xipell
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Esther Barnadas
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Ana B Larque
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - J Malvehy
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Arturo Pereira
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Antonio Martinez-Pozo
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Adriana García-Herrera
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
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26
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Barilaro G, Cervera R. Mortality and causes of death in systemic lupus erythematosus revisited. Eur J Intern Med 2023; 112:27-28. [PMID: 37037722 DOI: 10.1016/j.ejim.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Giuseppe Barilaro
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases, Member of ERN-ReCONNET/RITA, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases, Member of ERN-ReCONNET/RITA, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain.
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27
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Gkrouzman E, Willis R, Andrade D, Tektonidou MG, Pengo V, Ruiz-Irastorza G, Belmont HM, Fortin PR, Gerosa M, Signorelli F, Atsumi T, Branch DW, Nalli C, Rodriguez-Almaraz E, Petri MA, Cervera R, Knight JS, Efthymiou M, Cohen H, Bertolaccini ML, Erkan D, Roubey R. Associations Among Antiphospholipid Antibody Types, Isotypes, and Titers: An AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Study. J Transl Med 2023; 103:100147. [PMID: 37044248 DOI: 10.1016/j.labinv.2023.100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/18/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Several antiphospholipid antibody (aPL) profiles ("triple" and lupus anticoagulant [LA] positivity) are associated with a higher risk for clinical manifestations of antiphospholipid syndrome (APS). Further risk is correlated with higher levels of anticardiolipin antibody (aCL) and anti-β2 glycoprotein-I antibody (aβ2GPI), and with aPL persistence. Given that the 3 aPL tests detect partially overlapping sets of antibodies, the primary goal of this study was to characterize the associations among aPL tests using AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) core laboratory data. The APS ACTION Registry includes annually followed adult patients with positive aPL based on the Revised Sapporo Classification Criteria. We analyzed baseline and prospective core laboratory data of the registry for associations among aPL tests using the Spearman rank correlation with Bonferroni-adjusted significance level for multiple comparisons. An aPL Load was calculated based on 6 tests (aCL IgG/IgM/IgA and aβ2GPI IgG/IgM/IgA); a receiver operating characteristic curve was used to evaluate the diagnostic performance of the aPL Load in predicting LA positivity. In 351 patients simultaneously tested for LA, aCL, and aβ2GPI, the frequency of moderate-to-high (≥40 U) titers of aCL and aβ2GPI IgG/IgM/IgA was higher in patients who were positive for LA vs those who were negative. An aPL Load was calculated for each patient to assess the overall aPL burden. For every 1-point increase in the aPL Load, the possibility of a positive LA test increased by 32% (odds ratio, 1.32; 95% CI, 1.2-1.5; P < .001). Based on core laboratory data from a large international registry, most aPL enzyme-linked immunosorbent assay ≥40 U and a high calculated aPL Load combining 6 aPL enzyme-linked immunosorbent assays were predictive of a positive LA. These data suggest that the combined quantitative burden of aPL may provide a mechanistic explanation of a positive LA.
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Affiliation(s)
- Elena Gkrouzman
- Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Rohan Willis
- University of Texas Medical Branch, Galveston, Texas
| | | | | | | | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, UPV/EHU, Bizkaia, The Basque Country, Spain
| | | | - Paul R Fortin
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | | | | | | | - D Ware Branch
- James R. and Jo Scott Research Chair, University of Utah and Intermountain Healthcare, Salt Lake City, Utah
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Michelle A Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ricard Cervera
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
| | - Maria Efthymiou
- Haemostasis Research Unit, Department of Hematology, University College London, London, United Kingdom
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Hematology, University College London, London, United Kingdom
| | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Robert Roubey
- University of North Carolina, Chapel Hill, North Carolina
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28
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Esteve-Valverde E, Alijotas-Reig J, Belizna C, Marques-Soares J, Anunciacion-Llunell A, Feijóo-Massó C, Sáez-Comet L, Mekinian A, Ferrer-Oliveras R, Lefkou E, Morales-Pérez S, Hoxha A, Tincani A, Nalli C, Pardos-Gea J, Marozio L, Maina A, Espinosa G, Cervera R, De Carolis S, 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, Miró-Mur F. Corrigendum to "Low complement levels are related to poor obstetric outcomes in women with obstetric antiphospholipid syndrome. The EUROAPS Registry Study Group" [Placenta. 136 (2023 Apr 3) 29-34]. Placenta 2023; 138:20. [PMID: 37146536 DOI: 10.1016/j.placenta.2023.04.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Enrique Esteve-Valverde
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain.
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall D'Hebron University Hospital, Barcelona, Spain; Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Belizna
- Vascular and Coagulation Department, University Hospital Angers and CNRS, 6015 INSERM 1083 Unit, Angers, France
| | - Joana Marques-Soares
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall D'Hebron University Hospital, Barcelona, Spain
| | | | - Carlos Feijóo-Massó
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Luis Sáez-Comet
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Arsene Mekinian
- AP-HP, Hôpital Saint-Antoine, Service de médecine interne and Inflammation- Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ, Paris, France
| | | | - Elmina Lefkou
- Haematology Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Stephanie Morales-Pérez
- Internal Medicine Department, Althaia Healthcare University Network of Manresa, Systemic Autoimmune Disease Unit, Manresa, Barcelona, Spain
| | - Ariela Hoxha
- General Internal Medicine Unit, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine-DIMED, University of Padua, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Josep Pardos-Gea
- Systemic Autoimmune Diseases Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Luca Marozio
- Department of Obstetrics and Gynaecology, Università di Torino, Torino, Italy
| | - 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
| | - 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, Italy
| | - 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, Italy
| | - Maria Gerosa
- Division of Rheumatology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Cecilia B Chighizola
- Division of Rheumatology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Patrizia Rovere-Querini
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan, Italy
| | - Valentina Canti
- Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Sara Tabacco
- Department of Gynecology Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Anna Arnau
- Research and Innovation Unit, Althaia Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | - Francesc Miró-Mur
- Systemic Autoimmune Diseases Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Monte TCS, Mateo PF, Izquierdo MG, Cervera R, López N, Pallares L, Torres MJÁ, Ortega SP. An online survey of the Spanish Lupus Patient Association (FELUPUS): patient perceptions and experiences. Clin Rheumatol 2023; 42:1259-1265. [PMID: 36627527 PMCID: PMC9838362 DOI: 10.1007/s10067-023-06500-3] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES A survey conducted by the Spanish Lupus Federation (FELUPUS) shows the results on perceptions and experiences of the people who live with lupus in Spain. The information was gathered anonymously from May 21st to June 30th, 2020. The aim of the study was to monitor the impact of the disease on quality of life, as well as to measure the impact of organ damage in lupus patients. METHODS A national survey was conducted among people with lupus living in Spain who belong to the Spanish Lupus Patient Association (FELUPUS). Online interviews of approximately 25 min were completed. The information was gathered anonymously from May 21st to June 30th, 2020. RESULTS One thousand two hundred sixty-three interviews were completed. 92% had a diagnosis of Systemic Lupus Erythematosus (SLE) and 8% of Cutaneous Lupus Erythematosus (CLE); 95% of the patients surveyed were female. Most of the patients claimed they stay up late, exercising and work/study were the most limited actions due to the disease. 73% of patients considered that there was little knowledge of the disease by society and at the time of diagnosis, the patient's level of knowledge about lupus was low in 92% of them. Regarding organ damage, many patients did not understand the concept of chronicity and irreversibility of the term, relating it erroneously to acute symptoms like fatigue (38%), joint pain (47%) and even to the presence of cutaneous symptoms such as the presence of oral ulcers (17%). CONCLUSIONS The survey highlighted the need for disease awareness campaigns, greater involvement of healthcare professionals and the need to provide more information to lupus patients from the time of diagnosis. Nationally and to our knowledge, this is the survey with the largest number of participants (N = 1263) conducted in patients with lupus. Key Points •A national survey was conducted among people with lupus living in Spain and belonging to patient associations in Spain (FELUPUS). •Nationally and to our knowledge, this is the survey with the largest number of participants (N = 1263) conducted in patients with lupus. •Most of the patients claimed they stay up late, exercising and work/study were the most limited actions due to the disease. •73% of patients considered that there is little knowledge of the disease by society and at the time of diagnosis, the patient's level of knowledge about lupus was low in 92% of them.
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Affiliation(s)
| | | | | | - Ricard Cervera
- Department of Autoimmune Diseases, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Norberto López
- Dermatology Service, Hospital Virgen de La Victoria, Málaga, Spain
| | - Lucio Pallares
- Internal Medicine Service, Hospital Universitario Son Espases, Palma, Spain
| | | | - Silvia Pérez Ortega
- FELUPUS (Spanish Lupus Federation), FELUPUS, Madrid, On Behalf of FELUPUS Spain
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Pons I, Louro J, Sitges M, Vidal B, Cervera R, Espinosa G. Heart Valve Involvement in Patients with Antiphospholipid Syndrome: A Long-Term Follow-Up Study of a Single Centre. J Clin Med 2023; 12:jcm12082996. [PMID: 37109332 PMCID: PMC10145646 DOI: 10.3390/jcm12082996] [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: 03/28/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Valve involvement is the most common cardiac manifestation in antiphospholipid syndrome (APS). The objective of the study was to describe the prevalence, clinical and laboratory features, and evolution of APS patients with heart valve involvement. METHODS A retrospective longitudinal and observational study of all APS patients followed by a single centre with at least one transthoracic echocardiographic study. RESULTS 144 APS patients, 72 (50%) of them with valvular involvement. Forty-eight (67%) had primary APS, and 22 (30%) were associated with systemic lupus erythematosus (SLE). Mitral valve thickening was the most frequent valve involvement present in 52 (72%) patients, followed by mitral regurgitation in 49 (68%), and tricuspid regurgitation in 29 (40%) patients. Female sex (83% vs. 64%; p = 0.013), arterial hypertension (47% vs. 29%; p = 0.025), arterial thrombosis at APS diagnosis (53% vs. 33%; p = 0.028), stroke (38% vs. 21%; p = 0.043), livedo reticularis (15% vs. 3%; p = 0.017), and lupus anticoagulant (83% vs. 65%; p = 0.021) were more prevalent in those with valvular involvement. Venous thrombosis was less frequent (32% vs. 50%; p = 0.042). The valve involvement group suffered from higher mortality (12% vs. 1%; p = 0.017). Most of these differences were maintained when we compared patients with moderate-to-severe valve involvement (n = 36) and those with no or mild involvement (n = 108). CONCLUSIONS Heart valve disease is a frequent manifestation in our cohort of APS patients and is associated with demographic, clinical and laboratory features, and increased mortality. More studies are needed, but our results suggest that there may be a subgroup of APS patients with moderate-to-severe valve involvement with its own characteristics that differs from the rest of the patients with mild valve involvement or without valve involvement.
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Affiliation(s)
- Isaac Pons
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for Systemic Autoimmune Diseases of the Catalan and Spanish Health Systems, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Internal Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), 08240 Manresa, Spain
| | - Joana Louro
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for Systemic Autoimmune Diseases of the Catalan and Spanish Health Systems, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Marta Sitges
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Bàrbara Vidal
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for Systemic Autoimmune Diseases of the Catalan and Spanish Health Systems, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for Systemic Autoimmune Diseases of the Catalan and Spanish Health Systems, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
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Esteve-Valverde E, Alijotas-Reig J, Belizna C, Marques-Soares J, Anunciacion-Llunell A, Feijóo-Massó C, Sáez-Comet L, Mekinian A, Ferrer-Oliveras R, Lefkou E, Morales-Pérez S, Hoxha A, Tincani A, Nalli C, Pardos-Gea J, Marozio L, Maina A, Espinosa G, Cervera R, De Carolis S, 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, Miró-Mur F. Low complement levels are related to poor obstetric outcomes in women with obstetric antiphospholipid syndrome. The EUROAPS Registry Study Group. Placenta 2023; 136:29-34. [PMID: 37028222 DOI: 10.1016/j.placenta.2023.04.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Obstetric antiphospholipid syndrome (OAPS) is an autoimmune disease related to antiphospholipid antibodies (aPL) with primaryinflammatory injury followed by clot cascade activation and thrombus formation. Complement system activation and their participation in aPL-related thrombosis is unclosed. METHODS We haveanalysed adverse pregnancy outcomes (APO) related to low complement (LC) levels in a cohort of 1048 women fulfilling classification criteria for OAPS. RESULTS Overall, 223 (21.3%) women presented LC values, during pregnancy. The length of pregnancy was shorter in OAPS women with LC compared to those with normal complement (NC) (median: 33 weeks, interquartile range: [24-38] vs. 35 weeks [27-38]; p = 0.022). Life new-born incidence was higher in patients with NC levels than in those with LC levels (74.4% vs. 67.7%; p = 0.045). Foetal losses were more related to women with triple or double aPL positivity carrying LC than NC values (16.3% vs. 8.0% NC; p = 0.027). Finally, some placental vasculopathies were affected in OAPS patients with LC as late Foetal Growth Restriction (FGR >34 weeks) rise to 7.2% in women with LC vs. 3.2% with NC (p = 0.007). DISCUSSION Data from our registry indicate that incidence of APO was higher in OAPS women with LC levels and some could be reverted by the correct treatment.
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Talarico R, Ramirez GA, Barreira SC, Cardamone C, Triggianese P, Aguilera S, Andersen J, Avcin T, Benistan K, Bertsias G, Bortoluzzi A, Bouillot C, Bulina I, Burmester GR, Callens S, Carreira PE, Cervera R, Cutolo M, Damian L, Della-Torre E, Faria R, Fonseca JE, Galetti I, Hachulla E, Iaccarino L, Jacobsen S, Khmelinskii N, Limper M, Marinello D, Meyer A, Moroncini G, Nagy G, Olesinska M, Pamfil C, Pileckyte M, Pistello M, Rednic S, Richez C, Romão VC, Schneider M, Sciascia S, Scirè CA, Simonini G, Smith V, Sulli A, Tani C, Tas SW, Tincani A, Vonk MC, Tektonidou M, Mosca M. ERN ReCONNET points to consider for treating patients living with autoimmune rheumatic diseases with antiviral therapies and anti-SARS-CoV-2 antibody products. Clin Exp Rheumatol 2023; 41:543-553. [PMID: 36916322 DOI: 10.55563/clinexprheumatol/jpargp] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/16/2023]
Abstract
Recent studies have shown that people who are immunocompromised may inadvertently play a role in spurring the mutations of the virus that create new variants. This is because some immunocompromised individuals remain at risk of getting COVID-19 despite vaccination, experience more severe disease, are susceptible to being chronically infected and remain contagious for longer if they become infected and considering that immunocompromised individuals represent approximately 2% of the overall population, this aspect should be carefully considered. So far, some autoimmune rheumatic disease (ARD) patients with COVID-19 have been treated with antiviral therapies or anti-SARS-CoV-2 antibody products. However, there is no homogeneous approach to these treatment strategies. This issue was addressed within the European Reference Network (ERN) on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ReCONNET) in a discussion among experts and patient's representatives in the context of the rare and complex connective tissue diseases (rCTDs) covered by the Network. ERN ReCONNET is one of the 24 ERNs launched by the European Commission in 2017 with the aim of tackling low prevalence and rare diseases that require highly specialised treatment and promoting concentration of knowledge and resources through virtual networks involving healthcare providers (HCPs) across the European Union (EU). Considering the urgent need to provide guidance not only to the rCTDs community, but also to the whole ARDs community, a multidisciplinary Task Force, including expert clinicians and European Patient Advocacy Group (ePAG) Advocates, was created in the framework of ERN ReCONNET with the aim of developing overarching principles (OP) and points-to-consider (PtC) on a homogenous approach to treat immunocompromised patients with ARDs (with a particular focus on CTDs) affected by COVID-19 using antiviral therapies and anti-SARS-CoV-2 antibody products. The present work reports the final OP and PtC agreed by the Task Force.
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Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, and Università Vita-Salute San Raffaele, Milan, Italy
| | - Sofia C Barreira
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Chiara Cardamone
- Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Aguilera
- Spanish Association for Antiphospholipid Syndrome (SAF España), Elche, Spain
| | | | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Karelle Benistan
- AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Centre de Référence des Syndromes d'Ehlers-Danlos non vasculaires, Garches, France
| | - George Bertsias
- Rheumatology and Clinical Immunology, University of Crete Medical School, Heraklion, Greece
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, Rheumatology Section, University of Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy
| | | | - Inita Bulina
- Department of Internal Diseases, Rheumatology Centre, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steven Callens
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium
| | - Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Universidad Complutentense de Madrid, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Laura Damian
- Department of Rheumatology, County Emergency Clinical Hospital Cluj, Iuliua Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Emanuel Della-Torre
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, and Università Vita-Salute San Raffaele, Milan, Italy
| | - Raquel Faria
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto; UMIB, Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto; ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - João E Fonseca
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Université de Lille, CHU Lille, France
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine-DIMED, University Hospitalof Padova, AO Padova, Italy
| | - Søren Jacobsen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, COPEACT, Rigshospitalet, Copenhagen, Denmark
| | - Nikita Khmelinskii
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alain Meyer
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, and Clinica Medica, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Gyorgy Nagy
- Department of Rheumatology and Clinical Immunology, Department. of Internal Medicine and Oncology, Semmelweis University, Budapest; Heart and Vascular Center, Semmelweis University, Budapest, and Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest; Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
| | - Marzena Olesinska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Cristina Pamfil
- Department of Rheumatology, County Emergency Clinical Hospital Cluj, Iuliua Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Margarita Pileckyte
- Department of Rheumatology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mauro Pistello
- Retrovirus Centre, Department of Translational Medicine and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Simona Rednic
- Department of Rheumatology, County Emergency Clinical Hospital Cluj, Iuliua Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christophe Richez
- Department of Rheumatology, CHU Bordeaux (Groupe Hospitalier Pellegrin), Bordeaux, France
| | - Vasco C Romão
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), San Giovanni Bosco Hub Hospital, Turin, Italy, and Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | | | - Gabriele Simonini
- NEUROFARBA Department, Rheumatology Unit, Meyer Children's University Hospital, University of Florence, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent, and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology and Clinical Immunology, Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Italy
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, and Rheumatology Unit, University of Pisa, Italy
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Coloma JL, Martínez-Zamora, Tàssies D, Reverter JC, Espinosa G, Cervera R, Carmona F. Serological autoimmune profile of systemic lupus erythematosus in deep and non-deep endometriosis patients. J Reprod Immunol 2023; 156:103827. [PMID: 36773494 DOI: 10.1016/j.jri.2023.103827] [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: 10/25/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Several studies have reported a high prevalence of autoimmune diseases such as systemic lupus erythematosus (SLE) in endometriosis patients. The aim of this study was to evaluate the SLE autoimmune antibody profile in patients with deep (DE) and non-deep endometriosis (Non-DE). MATERIALS AND METHODS Four groups of premenopausal patients were evaluated: patients with DE (n = 50); patients with ovarian endometriomas (Non-DE; n = 50); healthy patients without endometriosis (C group; n = 45); and SLE patients without endometriosis (SLE group; N = 46). Blood samples were obtained and the standard SLE autoimmune profile was evaluated in all patients. Pain symptoms related to endometriosis and clinical SLE manifestations were also recorded. RESULTS The DE group presented a statistically significant higher proportion of patients with antinuclear antibodies (ANA) (20%) compared to the Non-DE group (4%) and C group (2.2%). Levels of complement were more frequently lower among DE and Non-DE patients although differences did not reach statistical significance. Similarly, anti-dsDNA antibodies and anticoagulant lupus were positive in more patients of the DE group but did not reach statistical significance. The DE group complained of more arthralgia and asthenia compared to the Non-DE and C groups. CONCLUSIONS The results of this study showed higher positivity of ANA and greater arthralgia and asthenia in patients with DE compared with Non-DE patients and healthy controls, suggesting that they may have a higher susceptibility to autoimmune diseases and present more generalized pain.
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Affiliation(s)
- J L Coloma
- Department of Gynaecology, Institut Clínic of Gynaecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, Faculty of Medicine-University of Barcelona, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel, 170, 08036 Barcelona, Spain
| | - Martínez-Zamora
- Department of Gynaecology, Institut Clínic of Gynaecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, Faculty of Medicine-University of Barcelona, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel, 170, 08036 Barcelona, Spain.
| | - D Tàssies
- Department of Hemotherapy and Hemostasis, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - J C Reverter
- Department of Hemotherapy and Hemostasis, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - G Espinosa
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - F Carmona
- Department of Gynaecology, Institut Clínic of Gynaecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, Faculty of Medicine-University of Barcelona, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel, 170, 08036 Barcelona, Spain
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Pires da Rosa G, Ferreira E, Sousa-Pinto B, Bettencourt P, Espinosa G, Cervera R. Patients with laboratory criteria of anti-phospholipid syndrome and 'non-criteria' manifestations: a multicenter cohort. Scand J Rheumatol 2023; 52:190-195. [PMID: 35723613 DOI: 10.1080/03009742.2022.2082114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Patients with laboratory criteria for anti-phospholipid syndrome (APS) but presenting only 'non-criteria' clinical manifestations are scarcely characterized in the literature. We aimed to analyse a cohort of these patients regarding the most prevalent manifestations, antibody profile, and treatments, while establishing a comparison with definite APS patients. METHOD A retrospective analysis was conducted of individuals fulfilling APS laboratory criteria assessed in two tertiary European hospitals between 2005 and 2020. Patients without clinical criteria but with non-criteria manifestations (termed 'clinical non-criteria') and age-/gender-matched controls were included. RESULTS Altogether, 75 clinical non-criteria patients were analysed, with haematological (thrombocytopenia, haemolytic anaemia) and 'mild' neurological manifestations (white-matter lesions, migraine) as the most prevalent non-obstetric involvements. These patients displayed more thrombocytopenia [odds ratio (OR) = 3.6, 95% confidence interval (CI) 1.7-7.6; p = 0.001] than controls with APS, but severe manifestations, such as valvular heart disease (p < 0.001), livedoid vasculopathy, seizures, chorea, transverse myelitis, bone necrosis, and alveolar haemorrhage, occurred only in definite APS patients. Corticosteroids were required by 40% of patients with thrombocytopenia. Manifestations in anticoagulated patients included white-matter lesions, nephropathy, superficial vein thrombosis, amaurosis fugax, and livedoid vasculopathy. Suspicion of progression towards systemic lupus erythematosus (SLE) occurred in 19% of non-SLE individuals. CONCLUSION 'Clinical non-criteria' patients displayed significant treatment use, predominantly haematological involvement, and less severe manifestations than definite APS controls. Some patients may additionally progress to future SLE. The impact of certain manifestations flags them as potential future contributors to classifying individuals as definite APS.
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Affiliation(s)
- G Pires da Rosa
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - E Ferreira
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - B Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of PortoMEDCIDS , Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - P Bettencourt
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Internal Medicine, Hospital CUF, Porto, Portugal
| | - G Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Pérez-Isidro A, Xipell M, Llobell A, De Moner N, Lledó GM, Cervera R, Prieto-González S, Quintana LF, Espinosa G, García-Ormaechea M, Ruiz-Ortiz E, Viñas O. Anti-dsDNA B-Cell ELISpot as a Monitoring and Flare Prediction Tool in SLE Patients. J Clin Med 2023; 12:jcm12041295. [PMID: 36835833 PMCID: PMC9958982 DOI: 10.3390/jcm12041295] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Anti-dsDNA autoantibodies quantification and complement levels are widely used to monitor disease activity in systemic lupus erythematosus (SLE). However, better biomarkers are still needed. We hypothesised whether the dsDNA antibody-secreting B-cells could be a complementary biomarker in disease activity and prognosis of SLE patients. Fifty-two SLE patients were enrolled and followed for up to 12 months. Additionally, 39 controls were included. An activity cut-off (comparing active and non-active patients according to clinical SLEDAI-2K) was established for SLE-ELISpot, chemiluminescence and Crithidia luciliae indirect immunofluorescence tests (≥11.24, ≥374.1 and ≥1, respectively). Assays performances together with complement status were compared regarding major organ involvement at the inclusion and flare-up risk prediction after follow-up. SLE-ELISpot showed the best performance in identifying active patients. High SLE-ELISpot results were associated with haematological involvement and, after follow-up, with an increased hazard ratio for disease flare-up (3.4) and especially renal flare (6.5). Additionally, the combination of hypocomplementemia and high SLE-ELISpot results increased those risks up to 5.2 and 32.9, respectively. SLE-ELISpot offers complementary information to anti-dsDNA autoantibodies to evaluate the risk of a flare-up in the following year. In some cases, adding SLE-ELISpot to the current follow-up protocol for SLE patients can improve clinicians' personalised care decisions.
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Affiliation(s)
- Albert Pérez-Isidro
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Marc Xipell
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Nephrology and Renal Transplantation, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Complex Glomerular Disease (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Arturo Llobell
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Noemí De Moner
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
| | - Gema M. Lledó
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Ricard Cervera
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Sergio Prieto-González
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Luis F. Quintana
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Nephrology and Renal Transplantation, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Complex Glomerular Disease (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Gerard Espinosa
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Mila García-Ormaechea
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Lime Tree Surgery NHS, Worthing BN14 0DL, UK
| | - Estíbaliz Ruiz-Ortiz
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Correspondence: (E.R.-O.); (O.V.)
| | - Odette Viñas
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Correspondence: (E.R.-O.); (O.V.)
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Bello N, Meyers KJ, Workman J, Marcano Belisario J, Cervera R. Systematic Literature Review and Meta-analysis of Venous Thromboembolism Events in Systemic Lupus Erythematosus. Rheumatol Ther 2023; 10:7-34. [PMID: 36471199 PMCID: PMC9931974 DOI: 10.1007/s40744-022-00513-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
The objective of this work was to conduct a systematic literature review (SLR) and meta-analysis (MA) to evaluate the relative risk (RR) of venous thromboembolism (VTE) events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients with systemic lupus erythematosus (SLE) compared with patients without SLE, as well as the absolute risk (AR) (measured by incidence proportion) and incidence rate (IR) of VTE events in patients with SLE. The SLR was conducted using Embase, MEDLINE, and MEDLINE In-Process to identify observational studies evaluating the risk of VTE, DVT, and PE events in adult patients with SLE compared with the general population, published January 2000 to September 2020. Random-effects models were used as the primary approach in the MA. Heterogeneity was assessed on the basis of the I2 value. Sensitivity analyses were performed to assess the robustness of results to various conditions, and subgroup analysis was performed for the AR of VTE by antiphospholipid status (aPLs) and antiphospholipid syndrome (APS). Of the 50 publications included for data extraction, 44 contained data for consideration in the MA of any one of the measures of interest (RR, AR, or IR) for VTE, DVT, or PE. The pooled RR indicates statistically significantly higher risk of VTE (RR 4.38, 95% confidence interval 2.63-7.29) in patients with SLE compared with the general population. Considerable heterogeneity was present in nearly all MA (I2 = 75-100%). Moreover, a higher pooled AR of VTE was estimated in patients with SLE with aPLs (n/N = 0.13) and APS (n/N = 0.63) compared with patients with SLE without aPLs/APS (n/N = 0.07). Overall, there was evidence of an increased risk of VTE, DVT, and PE in patients with SLE compared with the general population.
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Affiliation(s)
| | | | | | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
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Chighizola CB, Pregnolato F, Andrade D, Tektonidou M, Pengo V, Ruiz-Irastorza G, Belmont HM, Gerosa M, Fortin P, Branch DW, Andreoli L, Petri MA, Cervera R, Knight JS, Willis R, Efthymiou M, Cohen H, Erkan D, Bertolaccini ML. Fluctuation of Anti-Domain 1 and Anti-Β2 Glycoprotein I Antibody Titers Over Time in Patients with Persistently Positive Antiphospholipid Antibodies. Arthritis Rheumatol 2023; 75:984-995. [PMID: 36704930 DOI: 10.1002/art.42459] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/07/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This work aims at evaluating longitudinally titers of antibodies against β2-glycoprotein I (β2GPI) and domain 1 (anti-D1), identifying predictors of the variation of anti-D1 and anti-β2GPI antibody titers and clarifying whether antibody titer fluctuations predict thrombosis in a large international cohort of patients persistently positive for antiphospholipid antibodies (aPL), the "APS ACTION Registry". METHODS Patients with available blood samples from at least 4 time points were included. Anti-β2GPI and anti-D1 IgG were tested by chemiluminescence (BioFlash, INOVA Diagnostics). RESULTS In a cohort of 230 patients, anti-D1 and anti-β2GPI titers decreased significantly over time (p<0.0001 and p=0.010, respectively). After adjustment for age, gender, and number of positive aPL tests, the fluctuation of anti-D1 and anti-β2GPI titers was associated with treatment with hydroxychloroquine (HCQ) at each time-point. Treatment with HCQ, but not immunosuppressors, was associated with 1.3-fold and 1.4-fold decrease in anti-D1 and anti-β2GPI titers, respectively. Incident vascular events were associated with 1.9-fold and 2.1-fold increase of anti-D1 and anti-β2GPI titers, respectively. Anti-D1 and anti-β2GPI titers at the time of thrombosis were lower compared to the other time-points: 1.6-fold decrease in anti-D1 titers and 2-fold decrease in anti-β2GPI titers conferred an OR for incident thrombosis of 6.0 (95%CI 0.62-59.3) and 9.4 (95%CI 1.1-80.2), respectively. CONCLUSIONS Treatment with HCQ and incident vascular events significant predicted anti-D1 and anti-β2GPI titer fluctuation over time. Both anti-D1 and anti-β2GPI titers drop around the time of thrombosis, with potential clinical relevance. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cecilia B Chighizola
- University of Milan, Pediatric Rheumatology Unit, ASST G. Pini - CTO, Milan, Italy
| | - Francesca Pregnolato
- University of Milan, Pediatric Rheumatology Unit, ASST G. Pini - CTO, Milan, Italy
| | | | - Maria Tektonidou
- National and Kapodistrian University of Athens, First Department of Propaedeutic and Internal Medicine, Laiko Hospital, Athens, Greece
| | - Vittorio Pengo
- University of Padua, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - Guillermo Ruiz-Irastorza
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, BioCruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Spain
| | - H Michael Belmont
- New York University, Hospital for Joint Diseases, New York, United States of America
| | - Maria Gerosa
- University of Milan, Clinical Rheumatology Unit, Milan, Italy
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Department of Obstetrics, Salt Lake City, United States of America
| | - Laura Andreoli
- University of Brescia, Rheumatology Unit, Brescia, Italy
| | - Michelle A Petri
- Johns Hopkins University School of Medicine, Rheumatology, Baltimore, United States of America
| | - Ricard Cervera
- Hospital Clínic de Barcelona, Department of Autoimmune Diseases, Barcelona, Spain
| | - Jason S Knight
- University of Michigan, Division of Rheumatology, Ann Arbor, United States of America
| | - Rohan Willis
- University of Texas Medical Branch, Internal Medicine, Galveston, United States of America
| | - Maria Efthymiou
- University College London, Department of Haematology, London, United Kingdom
| | - Hannah Cohen
- University College London, Department of Haematology, London, United Kingdom
| | - Doruk Erkan
- Hospital for Special Surgery, Rheumatology, New York, United States of America
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Abstract
Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic. Most COVID-19 patients are asymptomatic or have flu-like symptoms. However, around 15% of the patients may have severe disease, including unilateral or bilateral pneumonia with acute respiratory distress syndrome and progressive hypoxemia that may require mechanical ventilation assistance. A systemic inflammatory response syndrome occurs in the most severe forms of COVID-19, with multiorgan involvement which can be life threatening caused by a cytokine storm. Although what best characterizes COVID-19 are the manifestations of the respiratory system, it has been shown that it also acts at the cardiovascular level, producing coagulation abnormalities, which causes thrombotic events mainly in the arteries/arterioles, microcirculation and venous system, and potentially increased mortality risk. This multiorgan vascular disease overlaps with other known microangiopathies, such as thrombotic microangiopathy or paroxysmal nocturnal hemoglobinuria, where complement overactivation plays an important role in the pathophysiology of thrombosis. Furthermore, coagulopathy secondary to COVID-19 occurs in the context of an uncontrolled inflammatory response, reminiscent of APS, especially in its catastrophic form. This review summarizes the current knowledge regarding the relationship between COVID-19 and the APS.
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Affiliation(s)
- Manuel Serrano
- Department of Immunology, Healthcare Research Institute I+12, Hospital 12 de Octubre, Madrid, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Antonio Serrano
- Department of Immunology, Healthcare Research Institute I+12, Hospital 12 de Octubre, Madrid, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain,Corresponding author at: Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
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Barilaro G, Coloma-Bazan E, Chacur A, Della Rocca C, Perez-Isidro A, Ruiz-Ortiz E, Viñas O, Tàssies Penella D, Reverter JC, Molina Andujar A, Cervera R, Espinosa G. Persistence of antiphospholipid antibodies over time and its association with recurrence of clinical manifestations: A longitudinal study from a single centre. Clin Exp Rheumatol 2022; 21:103208. [PMID: 36202304 DOI: 10.1016/j.autrev.2022.103208] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To analyze the antiphospholipid antibody (aPL) persistence over time in patients with antiphospholipid syndrome (APS) and its association with clinical recurrence and to identify predictors of aPL persistence over time. PATIENTS AND METHODS 200 patients with a diagnosis of APS and at least three follow-up aPL determinations were included. Persistent aPL profile was defined as the presence of lupus anticoagulant (LAC) and/or IgG/IgM anticardiolipin (aCL) and/or IgG/IgM anti-β2 glycoprotein-I (aβ2GPI) (> 99th percentile) antibodies in at least 66% of follow-up measurements. Multilevel mixed-effect generalized linear models with logit link were used. RESULTS 112 (56%) patients maintained persistent aPL profiles over time, while 88 (44%) were transient. Median follow-up time was 172.5 months. Follow-up time did not affect the odds of aPL persistence in multivariate analysis (p = 1.00). Baseline triple aPL positivity [OR 78 (95%CI 16.9-359.7, p < 0.001)] and double aPL positivity [OR = 7.6 (95%CI 3.7-15.7, p < 0.001)] correlated with persistent aPLs over time, while isolated LAC [OR = 0.26 (95% CI 0.08-0.49, p = 0.002)] or isolated IgG/IgM aCL [OR = 0.20 (95% CI 0.11-0.59, p = 0.004)] positivity, were predictors of transient aPL profile. Patients with persistent aPLs had higher rate of clinical recurrence in comparison to patients with transient aPLs [OR = 2.48 (95%CI 1.34-4.58, p = 0.003)]. CONCLUSIONS More than half of patients with baseline medium-high titer aPL positivity had persistent positive aPLs over time. Patients with persistent aPLs were more prone to present recurrence of clinical manifestations. Multiple aPL positivity increased the odds of a persistent aPL profile over time, while isolated LAC and aCL positivity decreased it.
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Affiliation(s)
- Giuseppe Barilaro
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
| | - Emmanuel Coloma-Bazan
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Alejandro Chacur
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Carlo Della Rocca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina 04100, Italy
| | - Albert Perez-Isidro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Estibaliz Ruiz-Ortiz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Odette Viñas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Dolors Tàssies Penella
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Department of Hemotherapy and Hemostasis, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Joan Carles Reverter
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Department of Hemotherapy and Hemostasis, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Alicia Molina Andujar
- Department of Nephrology and Renal Transplantation, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
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Floris A, Piga M, Laconi R, Espinosa G, Lopalco G, Serpa Pinto L, Kougkas N, Sota J, Lo Monaco A, Govoni M, Cantarini L, Bertsias G, Correia J, Iannone F, Cervera R, Vasconcelos C, Mathieu A, Cauli A. Accrual of organ damage in Behçet’s syndrome: trajectory, associated factors, and impact on patients’ quality of life over a 2-year prospective follow-up study. Arthritis Res Ther 2022; 24:253. [PMID: 36397162 PMCID: PMC9670626 DOI: 10.1186/s13075-022-02947-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to investigate the trajectory of damage accrual, associated factors, and impact on health-related quality of life (HR-QoL) in a multicenter cohort of patients with Behçet’s syndrome (BS) over 2 years of follow-up. Methods Patients recruited in the BS Overall Damage Index (BODI) validation study were prospectively monitored for 2 years and assessed for damage accrual, defined as an increase ≥1 in the BODI score, and HR-QoL was evaluated by the SF-36 questionnaire. Logistic and multiple linear regression models were built to determine factors associated with damage accrual and impairment in the different SF-36 domains. Results During follow-up, 36 out of 189 (19.0%) patients had an increase ≥1 in the BODI score with a mean (SD) difference of 1.7 (0.8) (p <0.001). The incidence rate of damage accrual was stable over time, regardless of the disease duration. Out of 61 new BODI items, 25 (41.0%) were considered related to glucocorticoid (GC) use. In multivariate analysis, duration of GC therapy (OR per 1-year 1.15, 95% CI 1.07–1.23; p <0.001) and occurrence of ≥1 disease relapse (OR 3.15, 95% CI 1.09–9.12; p 0.038) were identified as predictors of damage accrual, whereas the use of immunosuppressants showed a protective effect (OR 0.20, 95% CI 0.08–0.54, p<0.001). Damage accrual was independently associated with the impairment of different physical domains and, to a greater extent, in emotional domains of the SF-36 questionnaire. Female sex, higher disease activity, and fibromyalgia were also significantly associated with impairment in HR-QoL. Conclusion In BS, organ damage accrues over time, also in long-standing disease, resulting in an impairment of the perceived physical and mental health. Adequate immunosuppressive treatment, preventing disease flares and minimizing exposure to GCs have a crucial role in lowering the risk of damage accrual. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02947-y.
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Barilaro G, Della Rocca C, Esteves A, Cervera R, Espinosa G. The adjusted Global Anti-Phospholipid Syndrome Score as predictor of damage accrual measured by Damage Index for APS: a longitudinal study. Rheumatology (Oxford) 2022:6772508. [DOI: 10.1093/rheumatology/keac619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To analyze the association between the average “adjusted” Global anti-phospholipid syndrome Score (aGAPSS) over time, as a surrogate of disease activity, and change in Damage Index for APS (DIAPS) during follow-up in patients with thrombotic and non-thrombotic APS.
Methods
200 APS patients (138 primary, 62 associated to other autoimmune diseases) were included. DIAPS change was calculated as the difference between basal DIAPS and DIAPS at the end of follow-up. The aGAPSS was calculated for each patient at baseline and on a yearly basis for up to 6 years (minimum 3 years). The average score per patient was computed and considered the reference aGAPSS. Linear regression models were designed to analyze the association between mean aGAPSS and DIAPS change. Moreover, factors associated to high (increase of DIAPS ≥1 during follow-up) vs low (increase of DIAPS <1 during follow-up) damage accrual were assessed.
Results
A higher mean aGAPSS value was associated to a DIAPS increase during follow-up (b = 0.04, p< 0.001) in the multivariate analysis. Higher mean aGAPSS values were found in patients with a DIAPS increase ≥1 during follow-up compared with patients with an increase of < 1 point [9.22 (95% C.I. 7.58–10.86) vs 6.72 (95% C.I. 6.0–7.43), p= 0.003]. aGAPSS increased the odds a DIAPS increment of ≥ 1 point during follow-up [OR = 1.12 (95% C.I. 1.04–1.21, p= 0.003].
Conclusions
Our data support the utility of longitudinal assessing of the aGAPSS score in predicting damage accrual, measured by DIAPS, in APS.
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Affiliation(s)
- Giuseppe Barilaro
- Hospital Clinic, Universitat de Barcelona Department of Autoimmune Diseases, , Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
| | - Carlo Della Rocca
- Sapienza University Department of Medico-Surgical Sciences and Biotechnologies, , Latina, 04100, Italy
| | - Alexandra Esteves
- Hospital Clinic, Universitat de Barcelona Department of Autoimmune Diseases, , Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Hospital Clinic, Universitat de Barcelona Department of Autoimmune Diseases, , Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
| | - Gerard Espinosa
- Hospital Clinic, Universitat de Barcelona Department of Autoimmune Diseases, , Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
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Munguía-Realpozo P, Mendoza-Pinto C, García-Carrasco M, Escarcega RO, Berra-Romani R, Etchegaray-Morales I, Pérez-Aquino L, Ramírez-Hernández A, Méndez-Martínez S, Cervera R. Higher body mass index and disease duration are associated with increased risk of left ventricular diastolic dysfunction in women with systemic lupus erythematosus. Lupus 2022; 31:1639-1648. [PMID: 36123774 DOI: 10.1177/09612033221128433] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with systemic lupus erythematosus (SLE) have an increased cardiovascular (CV) risk. Insulin resistance (IR), which is higher in patients with SLE, adversely impacts left ventricular (LV) remodeling and function. The aims were to determine LV dysfunction and evaluate the influence of potential risk factors on subclinical LV dysfunction in women with SLE, including IR. METHODS This cross-sectional study included adult women with SLE without diabetes mellitus (DM), hypertension or severe obesity. Diastolic dysfunction (DD) was verified according to current guidelines. Insulin resistance was estimated using the Quantose score. RESULTS We included 77 women. The frequency of IR was 65%. All participants had a normal ejection fraction (EF), and 11 (15.7%) had abnormal LV global longitudinal strain (GLS). Twenty-three (32.8%) had DD. The GLS% and global circumferential strain (GCS)% did not differ in patients with and without IR (-20.8 ± 3.1 vs -20.5 ± 2.1; p = 0.61 and -27.9 ± 4.4 vs -27.4 ± 3.7; p = 0.57, respectively). The prevalence of DD was 38.1% in patients with IR versus 25% in those without (p = 0.30). E/e' and E/A ratios did not differ between groups (6.6 ± 1.9 vs 6.6 ± 1.5; p = 0.98 and 1.3 ± 0.3 vs 1.3 ± 0.2; p = 0.27). Higher BMI (OR: 1.2, 95% CI 1.1-1.5) and disease duration (OR: 1.2, 95% CI 1.1-1.4) were associated with DD. CONCLUSIONS Patients with overweight/obesity may be at higher risk of LV dysfunction. Although IR was high in our patients with SLE was not associated with systolic dysfunction or DD. Body mass index and disease duration were associated with an increased risk of DD.
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Affiliation(s)
- Pamela Munguía-Realpozo
- Rheumatology Department, Medicine School, 37767Meritorious Autonomous University of Puebla, Puebla, Mexico.,Systemic Autoimmune Diseases Research Unit-CIBIOR, Specialities Hospital, CMN, Mexican Social Security Institute, Puebla, Mexico
| | - Claudia Mendoza-Pinto
- Rheumatology Department, Medicine School, 37767Meritorious Autonomous University of Puebla, Puebla, Mexico.,Systemic Autoimmune Diseases Research Unit-CIBIOR, Specialities Hospital, CMN, Mexican Social Security Institute, Puebla, Mexico
| | - Mario García-Carrasco
- Rheumatology Department, Medicine School, 37767Meritorious Autonomous University of Puebla, Puebla, Mexico.,Systemic Autoimmune Diseases Research Unit-CIBIOR, Specialities Hospital, CMN, Mexican Social Security Institute, Puebla, Mexico
| | | | - Roberto Berra-Romani
- Department of Biomedicine, Medicine School, 3972Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Rheumatology Department, Medicine School, 37767Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Liliana Pérez-Aquino
- Systemic Autoimmune Diseases Research Unit-CIBIOR, Specialities Hospital, CMN, Mexican Social Security Institute, Puebla, Mexico
| | | | | | - Ricard Cervera
- Department of Autoimmune Disease, Hospital Clinic, Barcelona, Spain
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Barilaro G, Esteves A, Della Rocca C, Perez-Isidro A, Araujo O, Pires da Rosa G, Ruiz-Ortiz E, Penella DT, Viñas O, Reverter JC, Cervera R, Espinosa G. Predictive value of the Adjusted Global Anti-Phospholipid Syndrome Score on clinical recurrence in APS patients: A longitudinal study. Rheumatology (Oxford) 2022; 62:1576-1585. [PMID: 35997555 DOI: 10.1093/rheumatology/keac485] [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: 05/12/2022] [Revised: 07/31/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the effect of the average adjusted global APS score (aGAPSS) over time on recurrence of clinical manifestations in APS patients through a retrospective longitudinal study. METHODS The study included 200 patients with APS. The aGAPSS was calculated for each patient at baseline and on a yearly basis for either up to 6 years (minimum 3 years) or just before the clinical event in patients who experienced clinical recurrence. The mean score per patient was computed. In patients under vitamin K antagonists (VKA) the percentage of time spent within the therapeutic range (TTR) was calculated. Cox-regression analysis was performed to determine the cut-off value of the aGAPSS with the strongest association with clinical recurrence. RESULTS Higher average aGAPSS values were found in patients who experienced clinical recurrence in comparison to patients who did not [8.81 (95% C.I. 7.53-10.08) vs 6.38 (95% C.I. 5.64-7.12), p = 0.001], patients with thrombotic recurrence compared to patients with obstetric recurrence [9.48 (95% C.I. 8.14-10.82) vs 4.25 (95% C.I. 0.85-7.65), p = 0.006], and patients with arterial thrombosis compared to patients with venous thrombosis [10.66 (S.D. 5.48) vs 6.63 (S.D. 4.42), p = 0.01]. aGAPSS values > 13 points were associated with the highest risk of recurrence in multivariate analysis [HR = 3.25 (95% C.I. 1.93-5.45, p < 0.0001]. TTR was not statistically different between patients who had thrombosis recurrence and patients who had not. CONCLUSIONS Our data support the role of periodic (annual) monitoring of the aGAPSS score in predicting clinical recurrence in patients with APS.
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Affiliation(s)
- Giuseppe Barilaro
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
| | - Alexandra Esteves
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Carlo Della Rocca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy 04100
| | - Albert Perez-Isidro
- Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS).,Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Olga Araujo
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
| | - Gilberto Pires da Rosa
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
| | - Estibaliz Ruiz-Ortiz
- Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS).,Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Dolors Tàssies Penella
- Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS).,Hemotherapy and Hemostasis Department, ICMHO (Institut Clinic de Malalties Hematologiques i Oncologiques),Hospital Clinic, Barcelona, Catalonia, Spain
| | - Odette Viñas
- Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS).,Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Joan Carles Reverter
- Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS).,Hemotherapy and Hemostasis Department, ICMHO (Institut Clinic de Malalties Hematologiques i Oncologiques),Hospital Clinic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques Pi I Sunyer (IDIBAPS)
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44
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Pires da Rosa G, Ferreira E, Sousa-Pinto B, Rodríguez-Pintó I, Brito I, Mota A, Cervera R, Espinosa G. Comparison of non-criteria antiphospholipid syndrome with definite antiphospholipid syndrome: A systematic review. Front Immunol 2022; 13:967178. [PMID: 36059460 PMCID: PMC9434011 DOI: 10.3389/fimmu.2022.967178] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Patients with laboratory or clinical manifestations suggestive of antiphospholipid syndrome (APS) but not fulfilling the classification criteria constitute a clinical challenge. This study aims to compare non-criteria APS (NC-APS) with definite APS in terms of clinical manifestations, therapies, and outcomes. Methods A systematic review of observational studies comparing definite and NC-APS was performed searching four electronic databases. Data on clinical manifestations, therapies and clinical outcomes was extracted. Results Sixteen studies, assessing a total of 3,798 participants, were included. Seven out of 10 studies found no significant difference in the prevalence of arterial or venous thrombosis between definite and NC-APS, with two studies on seronegative APS also finding no difference in thrombosis recurrence. Seven out of 12 studies found no significant difference in the prevalence of obstetric manifestations between groups, with the remaining exhibiting conflicting results. In 9 studies comparing treatment frequency in obstetric patients, all but one described similar treatment frequency, with the percentage of NC-APS treated during pregnancy ranging from 26% to 100%. In 10 studies comparing pregnancy outcomes of NC-APS versus definite APS, 7 found similar successful pregnancies/live births. Additionally, 5 studies described improvement of live births in both groups with treatment, with three signalling aspirin monotherapy as efficacious as combination therapy in NC-APS. Conclusion This review hints at an absence of marked differences in most evaluated parameters between definite and NC-APS, emphasizing the value of a more active follow-up of these patients. The low-quality available evidence highlights the need for well-defined NC-APS populations in future studies. Systematic Review Registration https://www.crd.york.ac.uk/prospero, identifier CRD42020210674.
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Affiliation(s)
- Gilberto Pires da Rosa
- Department of Autoimmune Diseases, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Dermatovenereology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ester Ferreira
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
| | | | - Iva Brito
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Alberto Mota
- Department of Dermatovenereology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- *Correspondence: Gerard Espinosa,
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45
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Espinosa G, Zamora-Martínez C, Pérez-Isidro A, Neto D, Bravo-Gallego LY, Prieto-González S, Viñas O, Moreno-Castaño AB, Ruiz-Ortiz E, Cervera R. Persistent Antiphospholipid Antibodies Are Not Associated With Worse Clinical Outcomes in a Prospective Cohort of Hospitalised Patients With SARS-CoV-2 Infection. Front Immunol 2022; 13:911979. [PMID: 35812410 PMCID: PMC9257245 DOI: 10.3389/fimmu.2022.911979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/27/2022] [Indexed: 12/11/2022] Open
Abstract
Objective Patients with COVID-19 presented with an elevated prevalence of antiphospholipid antibodies (aPL) but the relationship with thrombosis is controversial. We analysed the persistence of aPL and their association with the clinical outcomes during hospitalisation in a cohort of COVID-19 patients. Patients and Methods We conducted a prospective study including consecutive hospitalised patients with COVID-19 from Hospital Clínic of Barcelona between March 28th and April 22nd, 2020. Clinical outcomes during hospitalisation were thrombosis, intensive care unit (ICU) admission, and severe ventilatory failure. We determined both criteria and non-criteria aPL. Of note, in those patients with a positive result in the first determination, a second sample separated by at least 12 weeks was drawn to test the persistence of aPL. Results One hundred and fifty-eight patients (59.5% men) with a mean age of 61.4 ± 14.9 years old were included. Thrombosis was present in 28 (17.7%) patients, severe respiratory failure in 47 (30.5%), and 30 (18.9%) patients were admitted to ICU. Sixteen (28.6%) patients were positive for the criteria aPL at both determinations and only two (3.6%) of them suffered from thrombosis during hospitalisations (both had aCL IgG). However, they presented with low titers of aCL. Of note, aPL were not related to thrombosis, ICU admission or severe respiratory failure. Conclusion Although aPL were prevalent in our cohort of hospitalised COVID-19 patients and they were persistent in half of tested patients, most determinations were at low titers and they were not related to worse clinical outcomes.
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Affiliation(s)
- Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- *Correspondence: Gerard Espinosa,
| | | | - Albert Pérez-Isidro
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daniela Neto
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luz Yadira Bravo-Gallego
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sergio Prieto-González
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Odette Viñas
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ana Belen Moreno-Castaño
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Pathology, Center for Biomedical Diagnosis, Hospital Clinic, Barcelona, Spain
| | - Estíbaliz Ruiz-Ortiz
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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46
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Lledó-Ibáñez GM, Xipell M, Ferreira M, Solé M, Garcia-Herrera A, Cervera R, Quintana LF, Espinosa G. Kidney biopsy in lupus nephritis after achieving clinical renal remission: paving the way for renal outcome assessment. Clin Kidney J 2022; 15:2081-2088. [PMID: 36325009 PMCID: PMC9613421 DOI: 10.1093/ckj/sfac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 12/03/2022] Open
Abstract
The role of repeat kidney biopsy in lupus nephritis (LN) with renal remission is unclear. The aim of this study was to assess this role in a real-life scenario. This retrospective, single-centre study included 56 patients with LN diagnosed from 1998 to 2019, with an initial kidney biopsy (KB1) at the onset of LN and a second kidney biopsy (KB2) after achieving renal remission. A total of 51 (91.1%) patients were women with a median age of 29.9 years [interquartile range (IQR) 23.4–40.6] at the time of LN diagnosis. KB2s were performed after 41.1 months (IQR 30.1–52.5) of KB1. At the time of KB2, complete renal response was achieved in 51 (91.1%) patients. The median activity index decreased from a baseline value of 6.5 (IQR 2.8–11) to 0 (IQR 0–2) (P < .001). The chronicity index worsened from 1 (IQR 0–2) to 2 (IQR 1–3) (P = .01). In patients with proliferative/mixed forms at KB2, the chronicity index median value increased to 3 (IQR 1.5–4), as well as interstitial fibrosis and tubular atrophy \documentclass[12pt]{minimal}
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}{}$\ge $\end{document}25%, from 5.4% to 13.5%. Persistent histological active LN (activity index ≥2) was present in 11 (19.6%) KB2s. There were no differences when comparing immunological parameters between both groups (activity index ≥2 versus <2) at KB2, nor in the percentage of patients who presented renal flare. Immunosuppressive treatment was withdrawn in 35 (62.5%) patients and maintained/switched in 21 (37.5%). Afterward, new renal flare occurred in 9 patients per group (25.7% and 43%, respectively), after a median time of 39 months (IQR 6.5–55) and 7 months (IQR 6–30), respectively. There was no difference in the number of patients who developed chronic kidney disease [n = 14 (25%)] according to the treatment. In conclusion, KB2 provides valuable information to guide immunosuppressive maintenance therapy.
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Affiliation(s)
- Gema Maria Lledó-Ibáñez
- Department of Autoimmune Diseases-Reference Centre (CSUR) for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona , Barcelona, Catalonia , Spain
| | - Marc Xipell
- Department of Nephrology and Renal Transplantation – Reference Center (CSUR) for Glomerular Complex Diseases of the Spanish Health System, Hospital Clínic, Department of Medicine, University of Barcelona, IDIBAPS , Barcelona, Catalonia , Spain
| | - Manuel Ferreira
- Department of Autoimmune Diseases-Reference Centre (CSUR) for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona , Barcelona, Catalonia , Spain
| | - Manel Solé
- Department of Pathology – Reference Center (CSUR) for Glomerular Complex Diseases of the Spanish Health System, Hospital Clínic, Department of Medicine, University of Barcelona, IDIBAPS , Barcelona, Catalonia , Spain
| | - Adriana Garcia-Herrera
- Department of Pathology – Reference Center (CSUR) for Glomerular Complex Diseases of the Spanish Health System, Hospital Clínic, Department of Medicine, University of Barcelona, IDIBAPS , Barcelona, Catalonia , Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases-Reference Centre (CSUR) for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona , Barcelona, Catalonia , Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation – Reference Center (CSUR) for Glomerular Complex Diseases of the Spanish Health System, Hospital Clínic, Department of Medicine, University of Barcelona, IDIBAPS , Barcelona, Catalonia , Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases-Reference Centre (CSUR) for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona , Barcelona, Catalonia , Spain
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47
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Ponce A, Rodríguez-Pintó I, Basauli JM, Espinosa G, Erkan D, Shoenfeld Y, Cervera R. The clinical significance of low complement levels in patients with catastrophic antiphospholipid syndrome: A descriptive analysis of 73 patients from the "Catastrophic antiphospholipid syndrome registry". Lupus 2022; 31:1218-1225. [PMID: 35686348 DOI: 10.1177/09612033221107583] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the prevalence and clinical significance of low complement levels in patients with catastrophic antiphospholipid syndrome (CAPS). METHODS We reviewed data from the "CAPS Registry" on C3 and/or C4 complement plasma protein levels during acute CAPS episodes. Patients were classified into those with low and normal complement levels. Data on clinical presentation, with special focus on thrombotic microangiopathy (TMA) features, diagnosis of systemic lupus erythematosus (SLE), and antiphospholipid antibody (aPL) profile were reviewed. The chi-square exact test was performed to evaluate differences between categorical data. RESULTS The "CAPS Registry" includes 566 patients with a total of 578 episodes of CAPS. Data on complement plasma protein levels was available in 73 episodes from the same number of patients. Low levels of C3 and/or C4 complement plasma proteins were detected in 42 (58%) CAPS episodes. Low complement levels were more common in SLE patients (55% SLE vs. 19% No SLE; p<0.001). The frequencies of clinical TMA (72% vs. 80%; p=0.4) or TMA syndrome (86% vs. 84%, p=0.9), frequency of triple aPL triple positivity (67% vs 33%; p=0.3), or the mortality (35% vs. 31%; p=0.7) were similar between low and normal complement groups. CONCLUSION In our study, low levels of C3 and C4 plasma proteins are detected in 58% episodes of CAPS, which were not associated with clinical presentation including TMA features, aPL triple positivity, or mortality.
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Affiliation(s)
- Ana Ponce
- Autoimmune Diseases Unit, 16496Hospital de Viladecans, Viladecans, Spain
| | - Ignasi Rodríguez-Pintó
- Department of Autoimmune Diseases, 58955Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - José M Basauli
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, 26744Sheba Medical Center, Tel-Hashomer, Israel.,Ariel University, Ariel, Israel
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
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48
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Erton ZB, Sevim E, de Jesús GR, Cervera R, Ji L, Pengo V, Ugarte A, Andrade D, Andreoli L, Atsumi T, Fortin PR, Gerosa M, Zuo Y, Petri M, Sciascia S, Tektonidou MG, Aguirre-Zamorano MA, Branch DW, Erkan D. Pregnancy outcomes in antiphospholipid antibody positive patients: prospective results from the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ('Registry'). Lupus Sci Med 2022; 9:e000633. [PMID: 35701043 PMCID: PMC9198709 DOI: 10.1136/lupus-2021-000633] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the outcomes of pregnancies in antiphospholipid antibody (aPL)-positive patients since the inception of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Registry. METHODS We identified persistently aPL-positive patients recorded as 'pregnant' during prospective follow-up, and defined 'aPL-related outcome' as a composite of: (1) Preterm live delivery (PTLD) at or before 37th week due to pre-eclampsia (PEC), eclampsia, small-for-gestational age (SGA) and/or placental insufficiency (PI); or (2) Otherwise unexplained fetal death after the 10th week of gestation. The primary objective was to describe the characteristics of patients with and without aPL-related composite outcomes based on their first observed pregnancies following registry recruitment. RESULTS Of the 55 first pregnancies observed after registry recruitment among nulliparous and multiparous participants, 15 (27%) resulted in early pregnancy loss <10 weeks gestation. Of the remaining 40 pregnancies: (1) 26 (65%) resulted in term live delivery (TLD), 4 (10%) in PTLD between 34.0 weeks and 36.6 weeks, 5 (12.5%) in PTLD before 34th week, and 5 (12.5%) in fetal death (two associated with genetic anomalies); and (2) The aPL-related composite outcome occurred in 9 (23%). One of 26 (4%) pregnancies with TLD, 3/4 (75%) with PTLD between 34.0 weeks and 36.6 weeks, and 3/5 (60%) with PTLD before 34th week were complicated with PEC, SGA and/or PI. Fifty of 55 (91%) pregnancies were in lupus anticoagulant positive subjects, as well as all pregnancies with aPL-related composite outcome. CONCLUSION In our multicentre, international, aPL-positive cohort, of 55 first pregnancies observed prospectively, 15 (27%) were complicated by early pregnancy loss. Of the remaining 40 pregnancies, composite pregnancy morbidity was observed in 9 (23%) pregnancies.
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Affiliation(s)
- Zeynep Belce Erton
- Divison of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Ecem Sevim
- Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Guilherme Ramires de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricard Cervera
- Autoimmune Diseases, Hospital Clínic de Barcelona Institut Clínic de Medicina i Dermatologia, Barcelona, Spain
| | - Lanlan Ji
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, Beijing, China
| | - Vittorio Pengo
- Cardiac Thoracic and Vascular Sciences, University of Padova, padua, Italy
| | - Amaia Ugarte
- Internal Medicine, Hospital de Cruces, Barkaldo, Spain
| | - Danieli Andrade
- Rheumatology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Tatsuya Atsumi
- Medicine II, Hokkaido University School of Medicine, Sapporo, Japan
| | - Paul R Fortin
- Medicine - Rheumatology, Centre Hospitalier de l'Université Laval, Quebec City, Quebec, Canada
| | - Maria Gerosa
- Dept. of Clinical & Community Science University of Milano, Division of Rheumatology, Milano, Italy
| | - Yu Zuo
- Internal Medicine/Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Petri
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Savino Sciascia
- Dipartimento di Malattie Rare, Immunologiche, Ematologiche ed Immunoematologiche. Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare (CMID). Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Ospedale Torino Nord Emergenza San G. Bosco ed Università di Torino, Torino, Italy
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - D Ware Branch
- Maternal-Fetal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Maternal- Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Doruk Erkan
- Rheumatology, Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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Laconi R, Floris A, Espinosa G, Lopalco G, Serpa Pinto L, Kougkas N, Sota J, Lo Monaco A, Govoni M, Cantarini L, Bertsias G, Correia J, Iannone F, Cervera R, Vasconcelos C, Mathieu A, Cauli A, Piga M. AB0631 Impact of Behçet’s Syndrome on work activity and productivity: results from a sub-analysis of the BODI Project cohort. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3575] [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
BackgroundBehçet’s Syndrome (BS) is a multisystem recurring inflammatory disorder characterised by a wide spectrum of clinical manifestations, which can vary from limited mucocutaneous lesions up to severe and even life-threatening events.ObjectivesTo evaluate the impact of BS on the patients’ work activity and productivity.MethodsA sub-cohort of 148 patients from the original Behçet’s syndrome Overall Damage Index (BODI) Project study was enrolled. The Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire was administered. Demographics, disease duration, comorbidity, major organ involvement, ongoing therapy, Behçet's Disease Current Activity Form (BDCAF), Physician Global Assessment (PGA), Patient Global Assessment (PtGA), and the BODI were recorded. Multiple regression models were built to investigate the independent effect of BS features on WPAI.ResultsOverall, 97 (65.6%) out of 148 patients who completed the WPAI:GH questionnaire resulted working for pay; 22 out of 97 (27.8%) patients reported missing work in the past week due to their health, accounting for a mean (SD) of 34.4% (17.8) of their working time (absenteeism). The only factor significantly associated with absenteeism in multivariate analysis was the presence of ocular damage, as assessed by the BODI (β 0.255, p = 0.027).Although 93 patients reported that they worked in the previous week, mean 27.3% (30.7) of their actual work productivity was impaired due to their health problem (presenteeism), with only 37 (38.5%) patients reporting no such loss. Factors associated with work impairment were female gender (β 0.319, p = 0.001), higher PtGA (β 0.298, p = 0.002), and an increased BODI score in the last 2 years follow-up (β 0.212 for one-point increased BODI score, p = 0.024).Finally, 99 (66.9%) of the total 148 patients complained of a daily activity impairment, reporting that a mean of 33.3% (30.6) of their regular daily activities had been prevented due to their health problems. Factors significantly associated with patients’ daily activity impairment were younger age at enrolment (β 0.187, p = 0.021), higher BDCAF disease activity (β 0.235, p = 0.002) and fibromyalgia (β 0.324, p = 0.033).ConclusionBS can lead to missing work time and significantly affect both the patient’s work productivity and daily activities. Active disease seems to be one of the major determinants together with a higher burden of damage and the association of some specific comorbidities, such as fibromyalgia.Table 1.WPAI:GH questionnaire resultsVariablesn°Mean (SD)All patients148Patients working for pay97Percent work time missed due to health977.9 (21.7)Percent work time missed due to health (patients with missed time >0) *2234.4 (17.8)Patients who actually worked in the past seven days**93Percent impairment while working due to health9327.3 (30.7)Percent impairment while working due to health (pts with % impairment while working > 0) ***5645.4 (27.2)Percent activity impairment due to health14833.3 (30.6)Percent activity impairment due to health (those with % activity impairment >0)9949.8 (23.9)* Patients working for pay who missed at least on hour of work, 22/97 = 22.7%.** Patients working for pay, but who worked for > 0 hours in the last week = 93/97*** Patients with impairment while working > 0 among patients who actually worked in the previous 7 day = 56/93.Disclosure of InterestsNone declared
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Floris A, Laconi R, Espinosa G, Lopalco G, Serpa Pinto L, Kougkas N, Sota J, Lo Monaco A, Govoni M, Cantarini L, Bertsias G, Correia J, Iannone F, Cervera R, Vasconcelos C, Mathieu A, Cauli A, Piga M. AB0636 Relationship between organ damage and impairment of health-related quality of life in patients with Behçet’s Syndrome: results from a longitudinal extension of the BODI Project. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4060] [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
BackgroundPreventing accrual of organ damage represents a primary goal in the treatment of Behçet’s Syndrome (BS), as it may result in impairment of other outcomes, including the health-related quality of life (HR-QoL).ObjectivesThe objective of this study was to investigate whether the recent accrual of organ damage, rather than its extent at a single time point, correlate with an impairment of the HR-QoL.MethodsA sub-analysis of data from patients recruited in the longitudinal phase of the BODI Project validation cohort was performed. The HR-QoL and damage were measured by the Short-form 36 questionnaire (SF-36) and the BS Overall Damage Index (BODI), respectively, at the baseline visit and at a follow-up (FU) 24 ±3 months later. Then the possible increase of damage over FU was assessed by calculating the difference between the BODI score (Δ-BODI) in the two visits. Then, the relationship between the Δ-BODI and the individual and summary domains of the SF-36 was analysed by building multivariate regression models, including age, gender, concomitant fibromyalgia and/or depression, current disease activity as assessed by the BDCAF, as confounding variables.ResultsFrom the BODI validation cohort, 147 patients were recruitable for this sub-analysis;73 (49.8%) were males. The mean (SD) age and disease duration at enrolment were, respectively, 46.2 (12.4) and 13.4 (10.1) years. BODI score did not influence the SF-36 domains assessed at the baseline visit. In contrast, a significant correlation was recorded between the Δ-BODI and the following SF-36 domains: physical function (PF) (β -0.158 for 1 unit increase in BODI score, p 0.025), role physical (RP) (β -0.150, p 0.044), general health (GH) (β -0.199, p 0.004), role emotional (RE) (β -0.180, p 0.001), mental health (MH) (β -0.244, p 0.001), and the mental components summary (MCS) (-0.203, p 0.008)(Figure 1). Gender, age, fibromyalgia and disease activity were also confirmed to significantly influence HR-QoL (Table 1).Table 1.Multiple regression for the assessment of the relationship between Δ-BODI and SF-36 domainsΔ-BODIMaleAgeFBMDPRBDCAFPhysical function (PF)-0.158 (p 0.025)0.180 (p 0.010)-0.299 (p<0.001)-0.358 (p<0.001)-- (p 0.552)-0.141 (p 0.044)Role-physical (RP)-0.150 (p 0.044)0.154 (p 0.039)-0.212 (p 0.001)-0.278 (p<0.001)-- (0.086)-0.251 (p<0.001)Body-pain (BP)-- 0.8680.266 (p<0.001)-0.286 (p<0.001)-0.276 (p<0.001)-- (p 0.799)-262 (p<0.001)General health (GH)-0.199 (p 0.004)0.187 (p 0.010)-- (0.136)-0.296 (p<0.001)-- (0.861)-0.352 (p<0.001)Vitality (VT)-- (p 0.868)0.238 (p 0.001)-0.178 (p 0.008)-0.213 (0.002)-- (p 0.855)-0.371 (p<0.001)Social function (SF)-- (p 0.239)0.299 (p 0.004)-0.166 (p 0.024)-0.242 (p 0.001)-- (0.831)-0.202 (p 0.010)Role emotional (RE)-0.180 0.003)0.158 (p 0.047)-0.157 (p 0.048)-0.233 (p 0.003)-- (0.531)-0.191 (p 0.016)Mental health (MH)-0.244 (p 0.001)-- (p 0.142)-- (p 0.142)-0.292 (p<0.001)-- (p 0.073)-0.254 (p 0.001)Physical Component Summary (PCS)-- 0.1050.229 (p 0.001)-0.298 (p<0.001)-0.296 (p<0.001)-0.254 (p<0.001)Mental Component Summary (MCS)-0.203 (p 0.008)-- (p 0.068)-- (0.246)-0.255 (p 0.001)-- (0.122)-0.302 (p<0.001)FBM: fibromyalgia; DPR: depressionConclusionThe recent accrual of organ damage, rather than its extent assessed in a single visit, is associated with impairment of different aspects of heath related quality of life, especially those mental related. Such phenomenon is similar to that observed in other systemic rheumatic disease, may be due to coping mechanisms.Disclosure of InterestsNone declared
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