Antiphospholipid syndrome in Asians: clinical manifestations, serological markers and outcome of the National University of Singapore/National University Hospital antiphospholipid cohort

Abstract

Background: There is a paucity of studies on antiphospholipid syndrome (APS) in Asian patients. Aim: This is the first study in Singapore to describe the clinical features, serological markers and outcomes of one of the largest cohort of APS patients in South‐east Asia. Method: One hundred and forty‐six patients were studied. Results: Within the study group, 89 were primary APS and 57 secondary APS. Age range: 16–84 years (mean Age: 50.1 years). Male : female ratio: 1 : 2.1. Racial distribution: Chinese, 69.2%; Malays, 18.5%; Indians, 11.7%. Systemic lupus erythematosus was the commonest disease associated in 48 patients (32.9%), while 17 (11.6%) had lupus‐like disease. Eighty‐two (56.2%) patients had arterial thrombosis, 37 (25.3%) patients had venous thrombosis, 14 (9.6%) had arterial and venous thrombosis while 17 (11.6%) had obstetric manifestations; 28.8% had thrombocytopenia. Clinical manifestations were diverse with neurological (49.3%), cardiac (40%), renal (23.6%) involvement. There were also several unusual presentations. Recurrent thrombosis occurred in 24.6%. Two had catastrophic APS and there were 12 deaths (9.6%). Antiphospholipid antibody testing included lupus anticoagulant, serum aCL IgG, IgM and IgA, anti‐β2 glycoprotein I (aβ2‐GPI) IgG, IgM, and IgA. The serological positivity rates of the various antiphospholipid antibodies were reported. aβ2‐GPI was positive in 67% of those tested, of which aβ2‐GPI IgA was the most common subtype. The presence of the aβ2‐GPI was associated with recurrent venous thrombosis. Conclusion: The clinical manifestations of APS in Asian patients were diverse and multisystemic. Recurrent thrombosis rate was high with significant morbidity and mortality.

The clinical and laboratory manifestations profile of antiphospholipid syndrome among Saudi Arabia population: Examining the applicability of Sapporo criteria

“…The percentage of vascular thrombosis and pregnancy morbidity were higher in our study as compare to the Kuwait patient populations. In Singapore, Yoon et al 2002 published the first cohort of APS in Asia which included 146 patients [6] and reported the most common manifestation of arterial thrombosis and venous thrombosis, which was similar to our study. In Europe, the Euro-Phospholipid Project Group (EPPG), so far, reported the largest APS cohort, which included 1000 patients from 13 European countries, with 82% female and population median age at diagnosis of 31 years of age.…”

“…The comparison of our study and studies conducted in other countries (Kuwait [23] , Singapore [6] and 13 European countries [7] ) on APS manifestation profiles is showed in Table 5 . 32 patients were included in the Kuwait study, 37.5% of them had primary APS (PAPS) and 62.5% had secondary APS (SAPS) [23] .…”

“…All over the world, the disease manifestations were studied in some countries like Singapore and Europe where the included patients were fulfilling the Sapporo criteria [6] , [7] . To our best knowledge, in Saudi Arabia, no study has been done to assess the APS clinical presentation on a large number of patients particularly those whom had fulfilled the 2006 updated international classification criteria.…”

Neuroretinitis as an initial presentation of lupus-like illness with antiphospholipid syndrome

“…The most common ocular manifestations reported in two local cohorts of APS from Singapore were retinal vein thrombosis and optic neuritis. 8,9 Neuroretinitis or idiopathic optic disc edema with macular star (ODEMS) is an optic neuropathy characterized by optic disc swelling, peripapillary and macular hard exudates and, often, vitreous cells. 10 Most patients present with acute unilateral painless loss of vision.…”

Prevalence and clinicopathologic findings of antiphospholipid syndrome nephropathy in Thai systemic lupus erythematosus patients who underwent renal biopsies

“…There is a paucity of similar studies in the Asian population for comparison. The largest cohort study of APS patients in Singapore, 10 which included 57 secondary APS patients (49 of them were SLE patients) revealed 14 patients with TMA. However, the study did not specify how many of them were in the SLE group and whether the diagnosis of TMA was biopsy proven.…”