Antiphospholipid antibodies in thromboangiitis obliterans

Abstract

Thromboangiitis obliterans (TAO) and antiphospholipid syndrome (APS) share the clinical characteristics of arterial thrombosis and recurrent thrombophlebitis. Although the association of anticardiolipin antibodies (aCLa) and TAO has been previously recognized, the prevalence and the clinical impact of this association remains unclear. aCLa were measured by double ELISA in patients with TAO (n=47), premature atherosclerosis (pASO) (n=48) and otherwise healthy individuals (n=48). Antibody status was then compared to clinical presentation and outcomes in patients meeting the diagnostic criteria for TAO. The prevalence of aCLa was signi cantly higher in patients with TAO (36%) compared to either pASO (8%; p=0.01) or healthy individuals (2%; p,0.001). Patients with TAO and a high antibody titer tended to be younger and suffer a signi cantly higher rate of major amputations compared to those without the antibody (100% versus 17%; p=0.003). Clinical features of TAO not signicantly altered by the presence of aCLa included upper limb involvement, digital necrosis, supercial thrombophlebitis (or deep venous thrombosis). Protein C, protein S, and anti-thrombin III were normal in all individuals.TAO is associated with an increased prevalence of aCLa. The presence of a high antibody titer in these patients is associated with increased morbidity, including major limb amputation. In patients meeting the diagnostic criteria for TAO, screening for aCLa should be considered. Although attractive, the ef cacy of chronic anticoagulation in this setting remains to be proven.

Elevated IgG titers to periodontal pathogens related to Buerger disease

“…Maslowski et al suggested that anticardiolipin antibodies are important for the pathogenesis of Buerger disease patients [14]. Patients with generalized periodontitis had a significantly greater prevalence of IgG or IgM anticardiolipin antibodies, and these antibodies were significantly higher in smoker than non-smoker patients [15].…”

Are anticardiolipin antibodies really important in thromboangiitis obliterans (Buerger’s disease)?

“…In this issue of Vascular Medicine, Maslowski and colleagues 6 report on the association of elevated anticardiolipin antibodies (aCLa) in 47 patients with thromboangiitis obliterans who were evaluated between 1990 and 1996. Using a double antibody sandwich enzyme-linked immunosorbent assay (ELISA) and reporting the data as an antibody-binding index (BI), the investigators reported a prevalence of elevated aCLa in 36% of patients with Buerger's disease compared to 8% of patients with premature atherosclerosis and 2% of healthy controls.…”

Thromboangiitis Obliterans or Buerger's Disease

“…Several studies have focused on the presence of antiphospholipid antibodies (Casellas et al 1993). A report on 47 patients with TAO, 48 patients with juvenile atherosclerosis and 48 healthy subjects showed that antiphospholipid antibodies are more elevated (36%) in TAO patients than in patients with juvenile atheroma (8%, p = 0.01) or healthy subjects (2%, p \ 0.001) (Maslowski et al 2002). However, these studies had numerous methodological limitations, and other observations are necessary to confirm this hypothesis (Olin 2002).…”