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Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients
Open accessAbstract
OBJECTIVE: To analyze the clinical and immunologic manifestations of antiphospholipid syndrome (APS) in a large cohort of patients and to define patterns of disease expression. METHODS: The clinical and serologic features of APS (Sapporo preliminary criteria) in 1,000 patients from 13 European countries were analyzed using a computerized database. RESULTS: The cohort consisted of 820 female patients (82.0%) and 180 male patients (18.0%) with a mean +/- SD age of 42 +/- 14 years at study entry. "Primary" APS was present in 53.1% of the patients; APS was associated with systemic lupus erythematosus (SLE) in 36.2%, with lupus-like syndrome in 5.0%, and with other diseases in 5.9%. A variety of thrombotic manifestations affecting the majority of organs were recorded. A catastrophic APS occurred in 0.8% of the patients. Patients with APS associated with SLE had more episodes of arthritis and livedo reticularis, and more frequently exhibited thrombocytopenia and leukopenia. Female patients had a higher frequency of arthritis, livedo reticularis, and migraine. Male patients had a higher frequency of myocardial infarction, epilepsy, and arterial thrombosis in the lower legs and feet. In 28 patients (2.8%), disease onset occurred before age 15; these patients had more episodes of chorea and jugular vein thrombosis than the remaining patients. In 127 patients (12.7%), disease onset occurred after age 50; most of these patients were men. These patients had a higher frequency of stroke and angina pectoris, but a lower frequency of livedo reticularis, than the remaining patients. CONCLUSION: APS may affect any organ of the body and display a broad spectrum of manifestations. An association with SLE, the patient's sex, and the patient's age at disease onset can modify the disease expression and define specific subsets of APS.
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“We had more male patients (29% vs. 18%) and primary APS cases (62% vs. 53%).”
From Clinical course of high‐risk patients diagnosed with antiphospholipid syndrome (2010) · cites this paper as [25]
In the citing paper
“Less than half of the patients reported by Cervera et al. were LA positive.”
From Clinical course of high‐risk patients diagnosed with antiphospholipid syndrome (2010) · cites this paper as [25]
In the citing paper
“This selected cohort of patients differed from the large cohort described by Cervera et al. [25,26] in several aspects.”
From Clinical course of high‐risk patients diagnosed with antiphospholipid syndrome (2010) · cites this paper as [25]
In the citing paper
“Our data come close to the data from Cervera et al., if we only considered primary APS patients (female/male ratio drops to 3.5:1) [25].”
From Clinical course of high‐risk patients diagnosed with antiphospholipid syndrome (2010) · cites this paper as [25]
In the citing paper
“These recurrences not only influence morbidity but are also the most common cause of death in APS [25].”
From Clinical course of high‐risk patients diagnosed with antiphospholipid syndrome (2010) · cites this paper as [25]
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“Migraine is one of the most prominent complaints in patients with APS ( 6 , 7), doi:10.1111/j.1468-2982.2008.01646.x”
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“Importantly and in relevance to this study, some patients with APS suffer from epilepsy: among a cohort of 1000 APS patients, epilepsy was found in 7% [26]; in a more recent study of 500 APS patients, epilepsy was found in 9% [28].”
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“Apart from thrombosis and pregnancy-related features, numerous other clinical features were linked to APS during its evolution into a distinct syndrome, although the data for these have not been strong enough to result in them being included as independent and specific criteria for APS.9 For example, thrombocytopenia…”
BackgroundInfluentialPerforation de la cloison nasale et maladies systémiques
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“APS may affect any organ of the body, leading to a broad spectrum of manifestations [3].”
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“Primary and secondary aPS are more common in women than in men, with a male‑to‑female ratio of ~1:3.5 for primary aPS and 1:7 for secondary aPS (32).”
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“This has been coined as primary APS (PAPS) [8].”
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“The recently reported Euro-Phospholipid Project found a 39% incidence of deep vein thrombosis and 14% incidence of pulmonary embolus (PE) in patients with antiphospholipid antibody syndrome.(65)”
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Hughes syndrome and epilepsy: when to test for antiphospholipid antibodies?
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“Não há predominância de raça na SAF.(20)”
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“Irrespective of any VTE manifestations, up to 90% of patients with untreated APS had an obstetric history of miscarriage [7,8]. do not support the prophylactic administration of heparin to treat women with maternal hereditary thrombophilia in subsequent pregnancies.”
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“[1] Women are more likely to suffer from the disease than men.[2] Women of childbearing”
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Population-based Study of 24 Autoimmune Diseases Carried Out in a Brazilian Microregion
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“7%) event, per report.(38) Moreover APS is the most common cause of stroke in young adults - less than 45 years-old.”
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“With a prevalence of roughly 1 in 2000, a defining feature of APS is its ability to promote thrombosis in vascular beds of all sizes, including both arterial and venous circuits [1,2].”
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“In APS, a mild thrombocytopenia (platelet count between 30 and 100 G/L) is observed in 22% of cases [17], which appears secondary to antibodies directed against platelet membrane glycoprotein (GP) IbIX and GPIIbIIIa [18,19].”
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“As previously mentioned, CAPS occurs in less than 1% of APS patients, and CAPS in young subjects is extremely rare, accounting for only a small percentage of all APS patients [18].”
BackgroundTreatment of the antiphospholipid syndrome
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“5 % [26].”
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“Moreover, Ruff et al. found that β2-glycoprotein I non-orthologous mimotopes expressing gut resident Roseburia intestinalis cross-reacted with self-reactive CD4 + memory T lymphocyte clones and pathogenic autoantibodies in APS [74], which can sometimes be concomitant with SLE [133].”
Antiphospholipidsyndrom und retinale venöse Verschlüsse
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“Nevertheless, thrombosis of peripheral arteries was not a common feature of APS, according to a large European cohort.(4) A few studies of patients with PAD have looked at the whole profile of aCL antibodies, including the immunoglobulin A (IgA) isotype.”
BackgroundChorea in primary antiphospholipid syndrome is associated with rheumatic fever
Appenzeller, S., Yeh, S., Maruyama, M., Barros, S. M., & de Carvalho, J. F. (2011) · Rheumatology International · doi:10.1007/s00296-011-2120-7 · Cited by 19
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“However, APS is commonly found in 15% of women with recurrent pregnancy losses [4,6,7].”
BackgroundRetractedMusculoskeletal manifestations of the antiphospholipid syndrome
Noureldine, M. H. A., Khamashta, M. A., Merashli, M., Sabbouh, T. M., Hughes, G. R. V., & Uthman, I. W. (2016) · Lupus · doi:10.1177/0961203316636467 · Cited by 19
Kj, K., Baek, I.-W., Park, K.-S., Kim, W.-U., & Cs, C. (2016) · Lupus · doi:10.1177/0961203316658557 · Cited by 19
Severe antiphospholipid antibody syndrome – response to plasmapheresis and rituximab
Gkogkolou, P., Ehrchen, J. M., & Goerge, T. (2017) · Journal of Dermatological Treatment · doi:10.1080/09546634.2017.1282599 · Cited by 19
Pablo, R. Q., Muñoz, P., López‐Hoyos, M., Calvo, V., Riancho, L., & Martínez-Taboada, V. M. (2017) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2017.04.016 · Cited by 19
Cardiovascular Disease in Antiphospholipid Syndrome
Polytarchou, K., Varvarousis, D., & Manolis, A. S. (2019) · Current Vascular Pharmacology · doi:10.2174/1570161117666190830101341 · Cited by 19
Skoczyńska, M., Crowther, M. A., Chowaniec, M., Ponikowska, M., Chaturvedi, S., & Legault, K. (2020) · Lupus · doi:10.1177/0961203320917460 · Cited by 19
“Discussion CAPS is a rare condition that affects <1% of the APLA-positive population.(11) It is characterized by rapid development of thrombosis in multiple microvascular beds.”
BackgroundThrombotic microangiopathy in rheumatology: a link between thrombosis and autoimmunity
Nasonov, E. L., Reshetnyak, T. M., & Alekberova, Z. S. (2020) · Terapevticheskii arkhiv · doi:10.26442/00403660.2020.05.000697 · Cited by 19
Anti-phosphatidylserine-prothrombin complex antibodies in patients with localized scleroderma.
Hasegawa, M., Fujimoto, M., Hayakawa, I., Matsushita, T., Nishijima, C., Yamazaki, H., Takehara, K., & Sato, S. (2006) · PubMed · Cited by 19
Antiphospholipid Antibodies and Malignancy
Pham, C., & Shen, Y.-M. (2008) · Hematology/Oncology Clinics of North America · doi:10.1016/j.hoc.2007.10.004 · Cited by 19
Neonatal outcome in patients with rheumatic disease
Motta, M., Tincani, A., Lojacono, A., Faden, D. F., Gorla, R., Airó, P., Neri, F., Gasparoni, A., Ciardelli, L. M., Silvestri, A. D., et al. (2004) · Lupus · doi:10.1191/0961203403lu2002oa · Cited by 19
Zhang, J., Li, C., Han, X., Chen, Z., Adhikari, B. K., Wang, Y., Wang, Y., & Sun, J. (2021) · Annals of Medicine · doi:10.1080/07853890.2021.1962964 · Cited by 18
“Since the first diagnosis of APS, the clinical manifestations of digestive system have been reported successively [5,6].”
BackgroundAntiphospholipid Syndrome-Related Pulmonary Embolism: Clinical Characteristics and Early Recognition
Shi, M., Gao, W., Jin, Y., Zhu, J., Liu, Y., Wang, T., & Li, C. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.872523 · Cited by 20
Obstetric management of the most common autoimmune diseases: A narrative review
Fernández‐Buhigas, I. (2022) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2022.1031190 · Cited by 20
Šubrt, I., Ulcova‐Gallova, Z., Bibková, K., Mičanová, Z., Hejnalová, M., Černá, M., Hradecký, L., & Novotný, Z. (2008) · American Journal of Reproductive Immunology · doi:10.1111/j.1600-0897.2007.00554.x · Cited by 18
Association of anti-phospholipid antibodies with connective tissue diseases
Rai, R., & Swetha, T. S. (2015) · Indian Dermatology Online Journal · doi:10.4103/2229-5178.153009 · Cited by 18
“in 2002,[8,9] only 2/102 patients in this study showed livedo reticularis and none had positive APLA.”
BackgroundAnticoagulation withdrawal in antiphospholipid syndrome: a retrospective matched-control study
Yelnik, C., Urbanski, G., Drumez, É., Caron, C., Maillard, H., Morell‐Dubois, S., Dubucquoi, S., Launay, D., HACHULLA, E., Hatron, P., et al. (2017) · Lupus · doi:10.1177/0961203317721751 · Cited by 18
Antiphospholipid antibodies and extracellular vesicles in pregnancy
Tong, M., Tsai, B. W., & Chamley, L. (2020) · American Journal of Reproductive Immunology · doi:10.1111/aji.13312 · Cited by 19
Chapter 2 Epidemiology of the Antiphospholipid Syndrome
Mehrani, T., & Petri, M. (2009) · Technical report · doi:10.1016/s1571-5078(08)00402-9 · Cited by 18
Sperati, C. J., & Streiff, M. B. (2010) · American Journal of Hematology · doi:10.1002/ajh.21789 · Cited by 18
Hughes syndrome (the antiphospholipid syndrome): a disease of our time
Hughes, G. R. V. (2010) · Inflammopharmacology · doi:10.1007/s10787-010-0071-3 · Cited by 18
“…only of the hip, but also in a variety of other joints), infarction of bone (‘‘idiopathic’’ metatarsal fracture was reported in sizable series of our patients (Sangle et al. 2004) bowel infarction, infarction of the marrow, pulmonary embolism and rarely pulmonary hypertension (Cervera et al. 2002).”
Current Debates in Antiphospholipid Syndrome: The Acquired Antibody-Mediated Thrombophilia
Öztürk, M. A., Haznedaroğlu, İ. C., Turgut, M., & Göker, H. (2004) · Clinical and Applied Thrombosis/Hemostasis · doi:10.1177/107602960401000201 · Cited by 19
“Neurologic Features in APL Syndrome Recurrent stroke and transient ischemic attacks are the most common neurologic manifestations of APL syndrome (23,29,212,213).”
BackgroundInfluentialPrimary versus secondary antiphospholipid syndrome: Is this lupus or not?
Grossman, J. M. (2004) · Current Rheumatology Reports · doi:10.1007/s11926-004-0023-2 · Cited by 18
Antiphospholipid syndrome presenting as cerebral venous sinus thrombosis: a case series and a review
Shlebak, A. A. (2015) · Journal of Clinical Pathology · doi:10.1136/jclinpath-2015-203077 · Cited by 19
What is known about pediatric antiphospholipid syndrome?
Meroni, P. L., Argolini, L. M., & Pontikaki, I. (2016) · Expert Review of Hematology · doi:10.1080/17474086.2016.1235969 · Cited by 18
Lung Disease in Antiphospholipid Syndrome
Maioli, G., Calabrese, G., CAPSONI, F., Gerosa, M., Meroni, P. L., & Chighizola, C. B. (2019) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0039-1683994 · Cited by 18
Uthman, I. W., Khalil, I., Sawaya, R. A., & Taher, A. T. (2004) · Clinical Rheumatology · doi:10.1007/s10067-004-0893-8 · Cited by 18
“Keywords Antiphospholipid syndrome Æ Cerebral venous thrombosis Æ Factor V Leiden Æ Lupus anticoagulant Æ Systemic lupus erythematosus Æ Thrombophilia Abbreviations APS: Antiphospholipid syndrome Æ CVT: Cerebral venous thrombosis Æ LAC: Lupus anticoagulant Æ DVT: Deep vein thrombosis Æ SLE: Systemic lupus erythematosu…”
BackgroundInfluentialVascular and connective tissue diseases in the paediatric world
Falcini, F. (2004) · Lupus · doi:10.1191/0961203304lu517rr · Cited by 18
Renal artery stenosis: a new facet of the antiphospholipid (Hughes) syndrome
Sangle, S. R., & D’Cruz, D. P. (2003) · Lupus · doi:10.1191/0961203303lu493ed · Cited by 18
Metadata
- Authors
- Cervera, R., Piette, J., Font, J., Khamashta, M. A., Shoenfeld, Y., Camps, M. T., Jacobsen, S., Lakos, G., Tincani, A., Kontopoulou‐Griva, I., Galeazzi, M., Meroni, P. L., Derksen, R. H. W. M., de Groot, P. G., Gromnica‐Ihle, E., Baleva, M., Mosca, M., Bombardieri, S., Houssiau, F., Gris, J., Quéré, I., Hachulla, E., Vasconcelos, C., Roch, B., Fernández‐Nebro, A., Boffa, M., Hughes, G. R. V., & Ingelmo, M.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- St Thomas' Hospital (GB)
- Sheba Medical Center (IL)
- Hospital Regional Universitario de Málaga (ES)
- University of Debrecen (HU)
- Hippocration General Hospital (GR)
- Ospedale Santa Maria alle Scotte (IT)
- University of Milan (IT)
- University Medical Center Utrecht (NL)
- Immanuel Krankenhaus (DE)
- Medical University of Sofia (BG)
- University of Pisa (IT)
- Cliniques Universitaires Saint-Luc (BE)
- Centre Hospitalier Universitaire de Nîmes (FR)
- Hôpital Claude Huriez (FR)
- Hospital de Santo António (PT)
- University Hospital Carl Gustav Carus (DE)
- Pitié-Salpêtrière Hospital (FR)
- Corresponding author
- Cervera, Ricard
- ORCID
- Venue
- Arthritis & Rheumatism
- Publisher
- Wiley
- Published
- 2002-04
- Volume
- 46
- Issue
- 4
- Pages
- 1019-1027
- ISSN
- 0004-3591 (ISSN-L)
- 1529-0131
- OpenAlex
- W2042958596
- Cited by
- 2,156
- References
- 42
- Citations by year
- 2026: 60 · 2025: 82 · 2024: 110 · 2023: 93 · 2022: 106 · 2021: 130 · 2020: 92 · 2019: 110 · 2018: 99 · 2017: 95 · 2016: 84 · 2015: 94 · 2014: 96 · 2013: 82 · 2012: 85
- FWCI
- 43.59
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Arthritis & Rheumatism (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion, other-oa)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Use Siena air (University of Siena) (submittedVersion)
- Funders
- Comissió Interdepartamental per a la Recerca i la Tecnologia of Catalonia, Spain ((FI/FIAP 1999/00684))
- Fondo de Investigaciones Sanitarias of Spain ((FIS 1999/280))
- IRCCS Istituto Auxologico Italiano of Italy (Ricerca Corrente 2000)
- Institut Electricité-Santé of France
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Rheumatology › Vasculitis and related conditions
- Health Sciences › Medicine › Rheumatology › Systemic Sclerosis and Related Diseases
- Keywords
- antiphospholipid syndrome, systemic lupus erythematosus, thrombosis, catastrophic antiphospholipid syndrome, sex differences, age of onset, livedo reticularis, thrombocytopenia, leukopenia, stroke, myocardial infarction, arterial thrombosis, lupus-like syndrome, chorea, migraine, epilepsy, angina pectoris
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Autoantibodies, Child, Child, Preschool, Diagnosis, Differential, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Cohort Studies, Prevalence, Antiphospholipid Syndrome, Age Distribution, Sex Distribution, Lupus Vasculitis, Central Nervous System
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