Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality

Abstract

Introduction Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in systemic lupus erythematosus(SLE) patients. Our aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome (APS). Materials and methods Patients from the RELESSER-T registry were included. RELESSER-T is a Spanish multicenter, hospital-based, retrospective, SLE registry. Results We included 2398 SLE patients, 1372 of whom were positive for aPL. Overall 1026 patients were classified as SLE, 555 as SLE-APS and817 as SLE-aPL. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than those with SLE-aPL and SLE ( p < 0.001). SLE-APS patients showed higher rates of neuropsychiatric, cardiac, pulmonary, renal and ophthalmological manifestations than the other groups ( p < 0.001). SLE-APS patients presented greater damage accrual with higher SLICC values (1.9 ± 2.2 in SLE-APS, 0.9 ± 1.4 in SLE-aPL and 1.1 ± 1.6 in SLE, p < 0.001) and more severe disease as defined by the Katz index (3 ± 1.8 in SLE-APS, 2.7 ± 1.7 in SLE-aPL and 2.6 ± 1.6 in SLE, p < 0.001). SLE-APS patients showed higher mortality rates ( p < 0.001). Conclusions SLE-APS patients exhibited more severe clinical profiles with higher frequencies of major organ involvement, greater damage accrual and higher mortality than SLE-aPL and SLE patients.

Anticardiolipin Autoantibodies as Useful Biomarkers for the Prediction of Mortality in Septic Patients

“…Our results are in line with Riancho-Zarrabeitia et al who found that antiphospholipid syndrome in patients with systemic lupus erythematosus predicts a more serious disease with higher accrual damage and higher mortality rates [ 35 ].…”

Central nervous system involvement in systemic lupus erythematosus: Data from the Spanish Society of Rheumatology Lupus Register (RELESSER)

“…(32,34,39) Second, the presence of aPL has been linked to NP-SLE but also to greater damage accruals and mortality in our cohort. (40) However, in our study, CVD was identified as a predictor of mortality independently of the effect of other severe SLE involvement such as lupus nephritis and the presence of APS, which were also accounted for in the models. Furthermore, the same findings were found after the inclusion of comorbidities and the use of glucocorticoids in the model.…”

The trends in the incidence and thrombosis-related comorbidities of antiphospholipid syndrome: a 14-year nationwide population-based study

“…Compared with patients diagnosed as having primary APS, patients with APS as well as an SLE history presented increased incidences of arthralgias and arthritis, leukopenia, autoimmune hemolytic anemia, livedo reticularis, epilepsy, and myocardial infarction [ 17 ]. Furthermore, those patients exhibited higher rates of hypertension, dyslipidemia, diabetes, and severe lupus profiles with major organ involvement and higher rates of mortality [ 10 , 49 ]. Their conditions required long-term anticoagulant treatment and immunosuppressive therapy, including high-dose corticosteroids, cyclophosphamide, and azathioprine [ 50 ].…”