Lupus anticoagulant: a marker for stroke and venous thrombosis in primary Sjogren's syndrome

Author(s)

Pasoto, Sandra Gofinet ^{[1, 2]} ; Chakkour, Henrique Pires ^[1] ; Natalino, Renato Romera ^[1] ; Viana, Vilma S. T. ^[1] ; Bueno, Cleonice ^[1] ; Lianza, Alessandro Cavalcanti ^[3] ; de Andrade, Jose Lazaro ^[3] ; Neto, Mauricio Levy ^[1] ; Fuller, Ricardo ^[1] ; Bonfa, Eloisa ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Hosp Clin, Div Rheumatol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Disciplina Reumatol, BR-01246903 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Hosp Clin, Div Echocardiog, Sao Paulo - Brazil

• Document type: Journal article
• Source: CLINICAL RHEUMATOLOGY; v. 31, n. 9, p. 1331-1338, SEP 2012.
• Web of Science Citations: 19

Abstract

Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) have been described in primary Sjogren's syndrome (pSS) with controversial findings regarding aPL prevalence and their association with thrombotic events. We evaluated 100 consecutive pSS patients (American-European criteria) and 89 age-gender-ethnicity-matched healthy controls for IgG/IgM anticardiolipin (aCL), IgG/IgM anti-beta2-glycoprotein-I (a beta 2GPI), and lupus anticoagulant (LA) (positivity according to APS Sydney's criteria). Clinical analysis followed standardized interview and physical examination assessing thrombotic and nonthrombotic APS manifestations and thrombosis risk factors. aPLs were detected in 16 % patients and 5.6 % controls (p = 0.035). LA was the most common aPL in patients (9 %), followed by a beta 2GPI (5 %) and aCL (4 %). Thrombotic events occurred in five patients {[}stroke in two, myocardial infarction in one and deep-vein thrombosis (DVT) in four], but in none of controls (p = 0.061). Mean age at time of stroke was 35 years. Three patients with thrombotic events (including the two with stroke) had APS (Sydney's criteria) and were positive exclusively for LA. Comparison of patients with (n = 16) and without (n = 84) aPL revealed similar mean age, female predominance, and ethnicity (p > =0.387). Frequencies of livedo reticularis (25 vs. 4.8 %, p = 0.021), stroke (12.5 vs. 0 %, p = 0.024), and DVT (18.8 vs. 1.2 %, p = 0.013) were significantly higher in APL + patients. Conversely, frequencies of hypertension, dyslipidemia, diabetes, obesity, smoking, sedentarism, and hormonal contraception were similar in patients with or without aPL (p a parts per thousand yenaEuro parts per thousand 0.253). Our study identified LA as an important marker for APS in pSS, particularly for stroke in young patients, warranting routine evaluation of these antibodies and rigorous intervention in modifiable risk factors. (AU)

• FAPESP's process: 10/10013-4 - Serum autoantibodies in primary Sjögren's syndrome: study of clinical associations and possible correlations with antibodies to viral antigens (EBV and HTLV-1)
• Grantee: Sandra Gofinet Pasoto
• Support Opportunities: Regular Research Grants
• FAPESP's process: 10/13463-0 - Antiphospholipid antibodies in primary Sjogren's syndrome: prevalence and clinical associations
• Grantee: Henrique Pires Chakkour
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• FAPESP's process: 10/10017-0 - Serum Autoantibodies in Primary Sjögren's Syndrome: Study of Clinical Associations and Possible Correlations with Antibodies to Viral Antigens (EBV and HTLV-1)
• Grantee: Renato Romera Natalino
• Support Opportunities: Scholarships in Brazil - Scientific Initiation