Independent association of anti–β₂‐glycoprotein I antibodies with macrovascular disease and mortality in scleroderma patients

Abstract

Objective. Systemic sclerosis (SSc; scleroderma) is characterized by a unique widespread vascular involvement that can lead to severe digital ischemia, pulmonary arterial hypertension (PAH), or other organ dysfunction. Microthrombotic events and procoagulation factors such as anti-␤2-glycoprotein I (anti-␤ 2 GPI) or anticardiolipin antibodies (aCL) may be implicated in the development of these manifestations. This study was undertaken to investigate whether anti-␤ 2 GPI and aCL are correlated with macrovascular disease, including ischemic digital loss and PAH, in SSc patients.Methods. Seventy-five SSc patients with a history of ischemic digital loss and 75 matched SSc controls were evaluated. Anticentromere antibodies (ACAs), anti-␤ 2 GPI, and aCL were measured, and clinical associations were determined using conditional and simple logistic regression models.Results. Positivity for anti-␤ 2 GPI was significantly more frequent in SSc patients with digital loss than in patients without digital loss (P ‫؍‬ 0.017), with the IgA isotype of anti-␤ 2 GPI showing the strongest association (odds ratio [OR] 4.0). There was no significant difference in aCL frequency between patients with digital loss and control patients. After adjustment for demographic characteristics, disease type, smoking, and ACA, anti-␤ 2 GPI positivity was significantly associated with active digital ischemia (OR 9.4), echocardiographically evident PAH (OR 4.8), and mortality (OR 2.9). ACA positivity was associated with history of digital loss (OR 3.28), but not with PAH or mortality. History of digital loss was strongly associated with increased mortality (OR 12.5).Conclusion. Anti-␤ 2 GPI is significantly associated with macrovascular disease in SSc and independently predicts mortality. It is unclear whether it has a pathogenetic role or simply reveals the presence of underlying endothelial injury. The use of anti-␤ 2 GPI as a biomarker of vascular disease in SSc should be further explored.

Cardiovascular disease in systemic sclerosis - an emerging association?

“…Boin and colleagues [75] showed that anti-β 2 GPI is associated with both higher mortality and vascular disease, including digital ischemia and PAH, in SSc. The authors did not report on the cause of mortality or the prevalence of cardiovascular disease in their cohort.…”

Vascular Disease in Scleroderma

“…One patient had a history of deep vein thrombosis, and one had exhibited early fetal loss [274]. Boin et al has reported in abstract a survey of 75 scleroderma patients with a history of ischemic digital loss compared to matched (gender, age, disease type) patients [275]. Anti-beta2-GPI antibodies but not aCL were more frequent (39% vs. 19%) in digital loss patients, with anti-beta2-GPI isotype IgA showing the strongest association.…”

Systemic sclerosis presenting with severe digital ischemia. A rare case report

“…[5,6] Smoking is also independently associated with severe digital gangrene. [7] Evaluation should ideally start with meticulous clinical examination, palpation of peripheral pulses and assessing for persistent discoloration (cyanosis or pallor), digital ulceration, extreme tenderness, or frank gangrene.…”