Recent PubMed citations on APS, a form of hypercoagulation

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Arthritis Rheum. 2005 Mar;52(3):841-6.

" Electroencephalography in the assessment of neuropsychiatric

manifestations in antiphospholipid syndrome and systemic lupus

erythematosus. "

Lampropoulos CE, Koutroumanidis M, Reynolds PP, Manidakis I,

GR, D'Cruz DP.

St. ' Hospital, London, UK.

OBJECTIVE: To describe the prevalence and clinical associations of

abnormalities on electroencephalography (EEG) in patients with

antiphospholipid syndrome (APS) and/or systemic lupus erythematosus

(SLE) who have neuropsychiatric symptoms.

METHODS: The study group comprised 57 patients (age </=50 years)

with manifestations of neuropsychiatric illness. Patients with

stroke, epilepsy, or other encephalopathies were excluded. Fourteen

patients had APS, 24 patients were positive for antiphospholipid

antibodies (aPL), and 19 patients had SLE without aPL. All patients

underwent EEG and brain magnetic resonance imaging (MRI) while they

were awake.

RESULTS: Abnormal EEG findings (showing mainly bitemporal slow

activity) were recorded in 37 of 57 patients (65%). Abnormal EEG

findings were observed in all patients with APS and in 17 of 24 aPL-

positive patients (71%), compared with 6 of 19 patients with SLE

(32%) (P < 0.001 and P < 0.05, respectively). There was an

association between abnormal EEG findings and the frequency of aPL

positivity (at least 2 positive results) (P = 0.002). Three EEG

recordings showed potentially epileptiform activity. Results of

brain MRI were abnormal in 18 (31.6%) of 57 patients: 8 in the APS

group (57.1%), 7 in the aPL-positive group (29.2%), and 3 in the SLE

group (15.8%). None of the patients with normal EEG findings had

abnormal MRI results. Thus, brain MRI findings were normal in the

majority of patients. Patients with abnormal EEG results were more

likely to report memory problems (P < 0.001).

CONCLUSION: Our findings suggest that EEG abnormalities are common

and correlate with the presence of aPL even in the absence of brain

abnormalities on MRI. EEG should be considered in aPL-positive

patients with neuropsychiatric symptoms, because use of

antiaggregants or anticoagulation may need to be considered.

PMID: 15751063 [PubMed - in process]

Scand J Rheumatol. 2004;33(6):365-72.

" The systemic nature of the antiphospholipid syndrome. "

Marai I, Zandman-Goddard G, Shoenfeld Y.

Department of Internal Medicine 'B' and Centre for Autoimmune

Diseases, Sheba Medical Centre, Tel-Hashomer, Israel.

Antiphospholipid syndrome (APS, ' syndrome) is a systemic

autoimmune disorder characterized by arterial and/or venous

thrombosis and recurrent foetal loss, accompanied by mild to

moderate thrombocytopaenia and elevated titres of antiphospholipid

antibodies (aPLs): lupus anticoagulant (LAC) and/or anticardiolipin

(aCL) antibodies.

APS was defined originally in 1983 in systemic lupus erythematosus

(SLE) patients, but later it was found that APS can be primary or

secondary to other autoimmune diseases or malignancy. During the

past 20 years many organs have been reported to be involved in this

syndrome and the clinical manifestations are seen in every medical

field.

Moreover, many aPLs have been found in APS besides aCLs and LACs,

which bind to the autoantigen beta-2-glycoprotein I (beta2GPI).

Treatment for APS, based on antiplatelet and anticoagulation drugs,

is dependent on various parameters, including whether SLE is also

present, classical vs non-classical manifestations of the diseases,

women with APS based on pregnancy morbidity, the presence of

elevated aCL antibody titres in the absence of clinical

manifestations, and catastrophic APS.

PMID: 15794193 [PubMed - in process]

Ann Rheum Dis. 2005 Mar 18; [Epub ahead of print]

" Close Association between valvular heart disease and central

nervous system manifestations in the antiphospholipid syndrome. "

Krause I, Lev S, Fraser A, Blank M, Lorber M, Stojanovich L,

Rovensky J, Chapman J, Shoenfeld Y.

Rabin Medical Center Beilinson Campus, Petah-Tikva, Sackler Faculty

of Medicine, Tel-Aviv University, Israel.

OBJECTIVES: Heart valves lesions and central nervous system

involvement are among the most common manifestations of the

antiphospholipid syndrome (APS). In the present study we evaluated

possible inter- relations between these manifestations in a large

group of APS patients.

METHODS: Two hundred eighty four APS patients were retrospectively

evaluated, 159 of whom had primary APS (PAPS). Cardiac-CNS

associations were determined for the entire study population, and

for subgroups of patients with PAPS or APS associated to SLE.

RESULTS: Significant associations where found between cardiac

vegetations and epilepsy (p<0.02), and between cardiac valves

thickening or dysfunction and migraine (p=0.002). Borderline

association was found between valvular vegetations and migraine

(p=0.09). A significant association was also found between all

valvular lesions and stroke/TIA. Sub-analyses revealed that patients

with PAPS had significant associations between cardiac valves

pathology and all CNS manifestations, while patients with APS

associated to SLE presented no such associations.

CONCLUSIONS: Our study point to potential different biological

behaviors in PAPS than in APS associated to SLE. According to our

results, the presence of cardiac valves pathology may be a risk

factor for several CNS involvements in PAPS.

PMID: 15778242 [PubMed - as supplied by publisher]

Rev Med Interne. 2005 Mar;26(3):189-95. Epub 2005 Jan 5. Related

Articles, Links

[in Process Citation]

[Article in French]

Letranchant L, Ruivard M, Dauphin C, Chanet V, Philippe P.

Service de medecine interne et hematologie, Hotel-Dieu, CHU de

Clermont-Ferrand, boulevard Malfrey, 63038 Clermont-Ferrand cedex

01, France.

Purpose. - If there is cardiac valve vegetation and the blood

cultures are negatives we need to look for slow growing bacteria,

fungi, Legionella pneumophilia, Bartonella henselae and quintana,

Brucella melitensis and abortus, iella burneti, Chlamydiae

pneumoniae by serologic tests. The diagnosis of non- infectious

endocarditis could be considered only if these results were

negative. The main purpose of this study was to describe the

clinical and echocardiographic signs of non-infectious endocarditis

cases observed in two different wards.

Methods. - This study was done retrospectively during a five-year

period in a cardiology and an internal medicine wards. The selection

criteria are: the proof of at least one cardiac valve vegetation,

observed on echocardiography, negative blood cultures and negative

serologic tests as described above.

Results. - Six non-bacterial endocarditis were described. Four

Libman-Sacks endocarditis, two associated with a primary

antiphospholipid syndrom revealed by an acute ischemia of leg for

one patient and by an eclampsia for another and the other two

associated with a systemic lupus erythematous revealed by fever for

one patient and by neurologic symptoms for the other. One

fibroblastic endocarditis associated to an essential

hypereosinophilia and one marastic endocarditis associated to a

metastatic mucin-producing cancer.

Conclusions. - For these six cases, a complete physical examination,

a CBC for hypereosinophylia, a dosage of antiphospholipid antibodies

and a thoraco-abdominal CT-scan allowed the etiologic diagnosis of

non infectious endocarditis. Libman Sacks endocarditis associated

with an antiphospholipid syndrome is the main etiology for which a

long-term anticoagulation treatment was not followed.

PMID: 15777581 [PubMed - in process]

Orv Hetil. 2005 Jan 30;146(5):203-7.

[is the primary antiphospholipid syndrome a forerunner of SLE?]

[Article in Hungarian]

Tarr T, Muzes G, Pitlik E, Lakos G, Csepany T, Soltesz P, Zeher M,

Szegedi G, Kiss E.

Debreceni Egyetem Orvos- es Egeszsegtudomanyi Centrum, Altalanos

Orvostudomanyi Kar, Belgyogyaszati Intezet, III. Belgyogyaszati

Klinika, Klinikai Immunologiai Tanszek.

INTRODUCTION: Antiphospholipid syndrome is a multi-organ autoimmune

disorder, characterized by arterial and venous thrombotic events,

and a well-defined group of recurrent foetal wasteage due to

pathologic antibodies against phospholipids and protein co-factors.

Antiphospholipid antibodies can be formed in primary

antiphospholipid syndrome, but also in other conditions, most often

in systemic lupus erythematosus. This may modify the outcome of

lupus increasing the risk for thrombotic complications. Less is

known about the outcome in primary antiphospholipid syndrome,

whether it may precede the development of systemic lupus.

AIMS: Authors hereby describe the case of four patients with primary

antiphospholipid syndrome in whom the disease progressed to systemic

lupus erythematosus.

RESULTS: Lupus followed the primary antiphospholipid syndrome within

around a three-year period. It was indicated by the appearance of

different antinuclear autoantibodies and clinical complications,

such as polyarthritis, nephritis and hematologic disturbances. All

of the patients presented cerebrovascular accident as the thrombotic

manifestation. All but one, were around forty years old, and had a

milder form of lupus. Symptoms of the antiphospholipid syndrome

determined the outcome. On the other hand, a typical lupus developed

in the youngest patient.

CONCLUSIONS: According to present cases antiphospholipid syndrome

may be considered as the initiative phase of SLE, but APS being a

separate entity also may associate to lupus. Present observations

indicate the importance of follow-up the patients with APS by

immunologic respect. Future prospective, multi-centre studies with

larger number of cases are needed to provide further evidence on the

fact that patients with APS may acquire other autoimmune disorder.

Publication Types:

Case Reports

Review

Review, Tutorial

PMID: 15773587 [PubMed - indexed for MEDLINE]

Pol Arch Med Wewn. 2004 Oct;112(4):1229-33.

[Venous thromboembolism in 15-years old boy with the

antiphospholipid syndrome]

[Article in Polish]

Gora K, Chlewicka I, Pruszczyk P.

Katedra i Klinika Chorob Wewnetrznych i Nadcisnienia Tetniczego AM w

Warszawie.

We present a 15-year-old boy with massive venous thrombosis who was

admitted to hospital with non-specific complaints. The

transesophageal echocardiography and spiral computer tomography

showed pulmonary embolism. A coagulation screen was performed to

identify hypercoagulability. The lupus anticoagulant was revealed

and the diagnosis of the antiphospholipid syndrome was establish.

Therapeutic options in such condition are discussed and review of

relevant literature is presented.

PMID: 15773436 [PubMed - in process]

Zh Mikrobiol Epidemiol Immunobiol. 2005 Jan-Feb;(1):96-100. Related

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[Epitope mimicry and its role in the development of autoimmune

reactions]

[Article in Russian]

[No authors listed]

The role of molecular mimicry in the development of some autoimmune

diseases, such as rheumatism, rheumatoid arthritis, the n-Barre

syndrome, the antiphospholipid syndrome, multiple sclerosis, is

reviewed. The data on the presence in bacteria and viruses antigenic

determinants similar to those in human tissues are presented. The

phenomenon of epitope mimicry is considered in the light of the

latest research in the field of IgE autoreactivity, which may take

part in the pathogenesis of allergic diseases.

PMID: 15773413 [PubMed - in process]