Abstract
ObjectivesTo examine the prevalence and associated factors related to the coexistence of antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) in a cohort of Colombian patients with SLE, and to discuss the coexistence of APS with other autoimmune diseases (ADs).MethodA total of 376 patients with SLE were assessed for the presence of the following: 1) confirmed APS; 2) positivity for antiphospholipid (aPL) antibodies without a prior thromboembolic nor obstetric event; and 3) SLE patients without APS nor positivity for aPL antibodies. Comparisons between groups 1 and 3 were evaluated by bivariate and multivariate analysis.ResultsAlthough the prevalence of aPL antibodies was 54%, APS was present in just 9.3% of SLE patients. In our series, besides cardiovascular disease (AOR 3.38, 95% CI 1.11–10.96, p = 0.035), pulmonary involvement (AOR 5.06, 95% CI 1.56–16.74, p = 0.007) and positivity for rheumatoid factor (AOR 4.68, 95%IC 1.63–14.98, p = 0.006) were factors significantly associated with APS-SLE. APS also may coexist with rheumatoid arthritis, Sjögren's syndrome, autoimmune thyroid diseases, systemic sclerosis, systemic vasculitis, dermatopolymyositis, primary biliary cirrhosis and autoimmune hepatitis.ConclusionsAPS is a systemic AD that may coexist with other ADs, the most common being SLE. Awareness of this polyautoimmunity should be addressed promptly to establish strategies for controlling modifiable risk factors in those patients.
Highlights
Autoimmune diseases (ADs) are chronic conditions initiated by the loss of immunological tolerance to self-antigens, and they represent a heterogeneous group of disorders that affect specific target organs or multiple systems
APS: antiphospholipid syndrome; OR: odds ratio; 95% confidence intervals (CI): 95% confidence interval; CVD: cardiovascular disease; RF: rheumatoid factor; SLE: systemic lupus erythematosus; SS: Sjogren’s syndrome. doi:10.1371/journal.pone.0110242.t002
We found that the positivity for FR IgM was associated with the coexistence of APS and SLE, as well as with the positivity for aPL antibodies
Summary
Autoimmune diseases (ADs) are chronic conditions initiated by the loss of immunological tolerance to self-antigens, and they represent a heterogeneous group of disorders that affect specific target organs or multiple systems. The clinical evidence of the autoimmune tautology highlights the coexistence of distinct ADs within an individual, which corresponds to polyautoimmunity, defined as the presence of more than one AD in a single patient [1,10]. When three or more ADs coexist, this condition is called multiple autoimmune syndrome (MAS) [11]. Factors significantly associated with polyautoimmunity include female gender and familial autoimmunity (i.e., the presence of diverse ADs in multiple members of a nuclear family) [10,12]. Polyautoimmunity represents the effect of a single genotype on diverse phenotypes [1]
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