Abstract
BackgroundThe antiphospholipid syndrome (APS) is defined by simultaneous presence of vascular clinical events and antiphospholipid antibodies (aPL). The aPL considered as diagnostics are lupus anticoagulant and antibodies anticardiolipin (aCL) and anti-ß2 glycoprotein-I (aB2GP1). During recent years, IgA aB2GP1 antibodies have been associated with thrombotic events both in patients positive, and mainly negative for other aPL, however its value as a pro-thrombotic risk-factor in asymptomatic patients has not been well defined.ObjectiveTo test the role of IgA anti B2GP1 as a risk factor for the development of APS-events (thrombosis or pregnancy morbidity) in asymptomatic population with a 5-year follow-up.Methods244 patients isolated positive for anti-beta2-glycoprotein I IgA (Group-1 study) and 221 negative patients (Group-2 control) were studied. All the patients were negative for IgG and IgM aCL.ResultsDuring the follow-up, 45 patients (9.7%) had APS-events, 38 positive for IgA-aB2GP1 and 7 negative (15.6% vs 3.2%, p<0.001).The incidence rate of APS-events was 3.1% per year in IgA-aB2GP1 positive patients and 0.6% per year in the control group. Arterial thrombosis were the most frequent APS-events (N = 25, 55%) and were mainly observed in Group-1 patients (21 vs 4, p = 0.001). Multivariate analysis were shown as independent risk-factors for the development of APS-events, age, sex (men) and presence of IgA-aB2GP1 (odds ratio 5.25, 95% CI 2.24 to 12.32).ConclusionThe presence of IgA-aB2GP1 in people with no history of APS-events is the main independent risk factor for the development of these types of events, mainly arterial thrombosis.
Highlights
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder defined by the simultaneous presence of antiphospholipid antibodies and at least one clinical feature defined in the International consensus diagnostic criteria: vascular thrombosis or pregnancy morbidity.[1]
Dyslipedimia was identified as a significant mediating factor with a p value of 0.009, so we evaluated a new model of 5 variables in which arterial hypertension (AH), which was the variate with less signification in the previous model, was replaced by dyslipidemia
The incidence of antiphospholipid syndrome (APS)-events in the previously asymptomatic IgA-antibodies anti B2GP1 (aB2GP1) carriers was 3.1% per year, which was similar to 3.18% per year described for untreated asymptomatic aPL-consensus carriers without any prophylactic treatment[27] and is within the reported range (1.36–3.8%) described in previous studies assessing the risk of events in asymptomatic aPL-consensus carriers. [28,29,30] isolated positivity of IgA-aB2GPI in asymptomatic patients who are negative for other aPL seems to be an independent risk factor to develop APS-events
Summary
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder defined by the simultaneous presence of antiphospholipid antibodies (aPL) and at least one clinical feature defined in the International consensus diagnostic criteria: vascular thrombosis or pregnancy morbidity.[1]. Three aPL are considered as laboratory criteria for APS diagnosis: lupus anticoagulant (LA), anticardiolipin antibodies (aCL) and anti-ß2 glycoprotein-I antibodies (aB2GP1). IgM and IgG isotypes of aPL were considered in the consensus established in 2004 in Sydney, Australia, during the 11th International Congress of aPL.[4] In recent years, the pathogenic and diagnostic value of aB2GP1 of IgA isotype (IgA-aB2GP1) have been gaining acceptance in the scientific community and it has been shown to be prothrombotic in animal models.[5] IgA-aB2GP1 have been associated with thrombotic events both in patients with but mainly without other aPLs.[5,6,7,8] This evidence implies that the determination of IgA-aB2GP1 is useful in the diagnosis of patients with thrombosis. The aPL considered as diagnostics are lupus anticoagulant and antibodies anticardiolipin (aCL) and anti-ß2 glycoprotein-I (aB2GP1). IgA aB2GP1 antibodies have been associated with thrombotic events both in patients positive, and mainly negative for other aPL, its value as a pro-thrombotic risk-factor in asymptomatic patients has not been well defined
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