Effect of Cyclosporin a on CD80+ and CD86+ Molecules Expression on Dermal Dendrocytes in Psoriatic Plaques

Abstract

Objectives:To determine the more frequently seen clinical and immunologic manifestations in the antiphospholipid syndrome (APS) in patients of 2 referral centers. Methods: We studied 50 patients with the diagnosis of primary or secondary APS, 49 females and 1 male, with ages ranging between 15 and 65-year-old, using a predetermined protocol in which we measured the immunologic and clinical spectrum, including the determination of anticardiolipin antibodies (ACA) and lupus anticoagulant (LA); in some cases we also measured anti-␤ 2-glycoprotein I. Results: The most frequent clinical manifestations were thromboses in several sites detected in 88% of cases; the most common location was the lower extremities (40%) and as pulmonary emboli was detected in 20%. Arthritis was found in 70% of the cases, livedo reticularis in 52%, Raynaud phenomena in 50%, migraine in 40%, hemolytic anemia in 30%, major depressive disorder in 22% and recurrent miscarriage in 18%. Immunologic studies showed antinuclear antibodies (ANA) in 80%, ACA of IgM and IgG isotypes were found in 56% and 44% respectively, LA in 34% and anti-DNA antibodies in 40%. Conclusions:The main clinical manifestations in patients with APS are: lower extremities thromboses, pulmonary emboli, cutaneous, articular and neurologic involvements, with the presence of ACA (isotype IgM). Introduction:The catastrophic antiphospholipid syndrome (CAPS) is characterized by a rapid-progressive thrombosis of small vessels, multiple organ failure in the presence of antiphospholipid antibodies, might be fatal in more than 50% of cases. The risk-factors identified in the develop of CAPS are, bacterial and/or viral infections, surgery, inadequate treatment of systemic lupus erythematosus (SLE), inadequate treatment of antiphospholipid syndrome (APS), or use of estrogens. Objectives: To identify methods to prevent the progression to CAPS in patients with primary and secondary antiphospholipid syndrome (APS). Patients: Patient 1: 28-year-old female with SLE without treatment, with a previous history of 2 fetal losses and 2 normal vaginal deliveries. During the 3rd trimester of her 5th pregnancy the patient presented with fever, hypertension, renal involvement, deep vein thrombosis, cerebral organic syndrome, convulsions and coma. Patient 2: 22-year-old female with SLE, lupus nephropathy classified as WHO class IV, secondary APS and cutaneous vasculitis. Exacerbation of the SLE was secondary to sun exposure and insufficient corticosteroids doses. Methods:The risk-factors were identified and the patients were treated with: 1. High corticosteroid doses. 2. Full anticoagulation with low molecular weight heparin. 3. Aggressive broad-spectrum antibiotic treatment. 4. Intravenous immunoglobulins infusions at the doses of 1g/kg/d for 2 subsequent days. 5. Control of the hematological disorder in the intensive care unit (ICU). Results: The outcomes of both patients were successful as demonstrated by controlling the events and not developing CAPS. Conclusions: Our experience suggests that ever...