Discordant effects of prednisone on anticardiolipin antibodies and the lupus anticoagulant

Background and Purpose-The aim of our study was to characterize the patient profile and prognostic value associated with high positive IgG (Ͼ100 GPL) anticardiolipin antibodies (aCL). Methods-We studied the clinical, laboratory, radiological, and prospective historical features of ischemic cerebrovascular disease in patients with Ͼ100 GPL titers. From our neurology department, 27 consecutive patients were prospectively identified and followed up (mean follow-up time, 34 months). Results-The mean age of our cohort was 41 years. Lupuslike illness occurred in 3; 23 had primary antiphospholipid syndrome, including 3 who met criteria for Sneddon's syndrome; 1 patient had progressive systemic sclerosis. Cerebral infarcts occurred in 74% and were recurrent in 37%. Systemic ischemic events, most commonly deep vein thrombosis, occurred in 37%. Tobacco use was documented in 85%, hyperlipidemia in 74%, hypertension in 44%, and diabetes mellitus in 7% of patients. A prominent headache history was present in 67%. Lupus anticoagulant (LA) was present in 72%, approximately one half had positive antinuclear antibodies and thrombocytopenia, and one quarter had a false-positive VDRL. We compared mean GPL levels in patients testing positive for specific laboratory features of antiphospholipid syndrome with those testing negative for these parameters. Only the LA(ϩ) group had a significantly higher mean GPL than the LA(-) group (Pϭ0.006). Brain imaging showed nonlacunar infarcts in 73% and lacunes in 12%. Of 19 cerebral angiograms, 5 (26%) showed large-vessel occlusive disease and 6 (32%) branch obstruction. Echocardiograms were abnormal in 75%: thickened left-sided valves in 33% and vegetations in 12%. Recurrent cerebrovascular ischemic events were observed in 96%, with transient events (mean rate, 25%/y) occurring 5 times more frequently than strokes (mean rate, 5%/y). Using a standardized disability scale blinded to aCL titer, neurological impairment was severe in 7%, moderate in 30%, and mild or nonexistent in 63%, and unrelated to mean GPL value (Pϭ0.567). Titers fluctuated greatly for individual patients, and most did not consistently test as highly positive. An analysis of fluctuation in symptom severity with concurrent GPL values did not show a statistically significant correlation. Compared with historical controls having a wide range of positive titers, the presence of high IgG aCL titers did not confer a worse prognosis for disability and recurrent ischemic events. Conclusions-Our data suggest that cerebrovascular events associated with high positive GPL are frequently multiple and minor (with no disability-titer correlation), present in relatively young patients, and often associated with tobacco abuse, hyperlipidemia, LA, systemic ischemic events, and occult cardiac disease. (Stroke. 1998;29:2245-2253.)

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“…The aCL titer of individual patients fluctuated widely over time, as has been reported by some studies 20,27,43,44 and not found by others.…”

Section: Verro Et Al November 1998supporting

confidence: 48%

Cerebrovascular Ischemic Events With High Positive Anticardiolipin Antibodies

Verro¹,

Levine²,

Tietjen³

1998

Stroke

102

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“…This agrees with an earlier observation that we made on four (additional) patients. 19 In contrast, the KCT assay results of one patient (patient 4, fig 1) remained positive, despite treatment with high dose prednisone, whereas the anticardiolipin antibody levels decreased to normal values, showing the heterogeneity of antiphospholipid antibodies. The discordant effects of treatment with prednisone of lupus anticoagulant and anticardiolipin antibodies must be taken into account when lupus anticoagulant activity or anticardiolipin antibody titres are used to determine the dose of prednisone-for example during pregnancy.…”

Section: Whole Group Analysismentioning

confidence: 90%

Prospective study of fluctuations of lupus anticoagulant activity and anticardiolipin antibody titre in patients with systemic lupus erythematosus.

Out¹,

Vliet²,

Groot³

et al. 1992

Annals of the Rheumatic Diseases

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“…Of interest was the inclusion of heart abnormalities-have all the features of the antiphospholipid syndrome and yet who do not have anticardiolipin antibodies. Some of these patients ao have lupus anticoagulants-highlighting the need in our present state of knowledge to carry out bothtegsts routinely 10. …”

mentioning

confidence: 99%