MedWorm: Antiphospholipid Syndrome

Elevated NK Cell Cytotoxicity, CD158a Expression in NK Cells and Activated T Lymphocytes in Peripheral Blood of Women with IVF Failures

American Journal of Reproductive Immunology — Wed, 17 Mar 2010 00:00:00 +0100

Citation Chernyshov VP, Sudoma IO, Dons'koi BV, Kostyuchyk AA, Masliy YV. Elevated NK cell cytotoxicity, CD158a expression in NK cells and activated T lymphocytes in peripheral blood of women with IVF failures. Am J Reprod Immunol 2010Problem The aim of this study was to evaluate the role of elevated natural killer cytotoxicity (NKc) in women with multiple implantation failures (IF) in vitro fertilization[ndash]embryo transfer (IVF[ndash]ET) cycles.Methods of study Seventy-nine antiphospholipid antibodies-negative women with IF including 33 women with elevated NKc were selected for investigation. K-562 cell line was used to evaluate NKc. Lymphocyte subsets, intracellular cytokines [interferon (IFN)-[gamma], interleukin (IL)-4, tumour necrosis factor, IL-10], expression of activating marker...

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Anti-annexin II antibody is associated with thrombosis and/or pregnancy morbidity in antiphospholipid syndrome and systemic lupus erythematosus with thrombosis

Rheumatology International — Sun, 14 Mar 2010 11:26:20 +0100

This study investigated the prevalence of antibody against annexin II (A2) in patients with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). It also explored the role of this antibody in thrombosis. Purified recombinant A2 was used in ELISA to measure the levels of IgG anti-A2 antibody in 101 APS patients, 41 SLE patients with thrombosis, 124 SLE patients without thrombosis, and 120 healthy controls. The positive rates of IgG anti-A2 antibody in APS patients and SLE patients with thrombosis were 21.8 and 26.8%, respectively. Both values are significantly higher than that in SLE patients without thrombosis (6.5%). IgG anti-A2 antibody is associated with thrombosis and/or pregnancy morbidity (P < 0.001). The data show that the levels of anti-A2 antibo...

Development of various arrhythmias and conduction disturbances following corticosteroid therapy for systemic lupus erythematosus with antiphospholipid syndrome

Modern Rheumatology — Fri, 12 Mar 2010 06:51:26 +0100

Abstract A 45-year-old Chinese woman with active systemic lupus erythematosus, lupus anticoagulant positive, was admitted to our hospital. Electrocardiography on admission was normal. Though anti-Sjögren’s syndrome A (anti SS-A/Ro) antibodies were negative and ultrasound cardiographic findings were normal, she developed various arrhythmias/conduction disturbances shortly after starting corticosteroid. Nearly all were resolved with continuous corticosteroid and aspirin therapy before discharge. Vasculitis, the presence of antiphospholipid antibodies, and platelet aggregation due to corticosteroid were possible mechanisms underlying the arrhythmias/conduction disturbances. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10165-010-0283-9Authors Yu Kasama...

Antiphospholipid syndrome in dermatology: An update

Indian Journal of Dermatology, Venereology and Leprology — Thu, 11 Mar 2010 14:10:55 +0100

Rai Reena, Sekar C Shanmuga, Kumaresan MIndian Journal of Dermatology, Venereology, and Leprology 2010 76(2):116-124Antiphospholipid syndrome (APS) is characterized by the presence of antiphospholipid antibodies, recurrent thrombosis, and fetal loss. Antiphospholipid antibodies are a family of autoantibodies that recognize various combinations of phospholipids, phospholipid-binding proteins, or both. APS can occur in the absence of underlying or associated disease (primary APS) or in combination with other diseases (secondary APS). The exact pathogenic mechanism by which these antibodies cause thrombosis is not known; however, several hypotheses, such as activation of platelet and endothelial cells and interference with the coagulation system, have been proposed. Diagnosis is based on the ...

Real-time three-dimensional echocardiography in evaluating Libman-Sacks vegetations

European Journal of Echocardiography — Thu, 11 Mar 2010 09:46:29 +0100

Libman–Sacks endocarditis, characterized by sterile fibrofibrinous vegetations that have the potential to develop anywhere on the endocardial surface, was originally reported in 1924. The mitral valve is most commonly affected, followed by the aortic valve, whereas tricuspid and pulmonary valves are seldom involved. Libman–Sacks vegetations can be found in ~1 of 10 patients with systemic lupus erythematosus by transoesophageal echocardiography (TTE), and they are variably associated with lupus duration, disease activity, anticardiolipin antibodies, and antiphospholipid syndrome manifestations. The capability to perform real-time 3D (RT3D) imaging in the evaluation of Libman–Sacks vegetation size may strengthen the already established role of transthoracic echocardiogram a...

Persistency of low levels of anticardiolipin and anti-Beta2 Glycoprotein1 in thrombosis.

European Journal of Internal Medicine — Tue, 09 Mar 2010 15:36:28 +0100

CONCLUSION: Consistency of low titres of antiphospholipid antibody levels may be associated with a higher risk of thrombotic events overall. PMID: 20206880 [PubMed - as supplied by publisher] (Source: European Journal of Internal Medicine)

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What Is Antiphospholipid Syndrome (Hughes Syndrome)? What Causes Antiphospholipid Syndrome?

Immune System / Vaccines News From Medical News Today — Tue, 09 Mar 2010 08:00:00 +0100

Antiphospholipid Syndrome, also known as Antiphospholipid Antibody Syndrome, APS, APLS, Hughes Syndrome, or Sticky Blood is an immune disorder in which there are abnormal antibodies linked to abnormal blood clots within veins and arteries - especially in the legs, as well as problems with pregnancy, such as recurring miscarriages and premature births... (Source: Immune System / Vaccines News From Medical News Today)

Neonatal arterial iliac thrombosis in type-I protein C deficiency: a case report

Italian Journal of Pediatrics — Mon, 08 Mar 2010 00:00:00 +0100

A male infant born by caesarean section at 38 weeks of gestational age (B.W. 4055g; Apgar 9-10), in the first two hours of life his right leg became hypovascularizated.Normal values of leukocities, red cells, haematocrit, hemoglobin, platelets. C-Reactive Protein negative. Electrolytes and coagulation tests were normal. Normal vitamin K coagulation proteins levels. Serological tests for TORCH (IgM) and Parvovirus (IgG and IgM) were negative.Sonography showed a reduced blood flow in the iliac artery and reported a 1 cm long vessel thrombosis.From 8 hours of life we administred an intravenous infusion of unfractionated heparin (UFH) 75 UI/Kg for the first 10 minutes then 28 UI/Kg/h.On the 2nd day tests were performed to assess absence of inhibiting-clot factors. The dosage of homocysteine, p...

[Editorial] Raising awareness of antiphospholipid antibody syndrome

LANCET — Fri, 05 Mar 2010 00:00:00 +0100

Speaking to the BBC last week, Graham Hughes, who first described antiphospholipid syndrome in 1983, urged for more efforts to raise awareness of this disorder, which often remains undiagnosed and untreated with catastrophic consequences, such as multiple miscarriages, or stroke at a young age. (Source: LANCET)

Risk quantification in antiphospholipid syndrome

Future Medicine: Women's Health — Fri, 26 Feb 2010 15:39:42 +0100

Women's Health , March 2010, Vol. 6, No. 2, Pages 179-182. (Source: Future Medicine: Women's Health)

Impact of high titre of antiphospholipid antibodies on postoperative outcome following pulmonary endarterectomy [ESCVS article - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Fri, 26 Feb 2010 01:18:44 +0100

Conclusions: The presence of high titre of IgG isotype a-PL antibodies significantly influences preoperative characteristics of patients undergoing PEA. Furthermore, despite that no significant differences were shown in major end points, the presence of high titre of a-PL did interfere with postoperative course as caused by an increased rate of minor and transient neurological impairment (TNI). An accurate monitoring especially during hypothermic circulatory arrest (CA) period seems, therefore, mandatory in this subgroup of patients undergoing PEA. (Source: Interactive CardioVascular and Thoracic Surgery)

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Prospective cohort studies on risk factors for cardiovascular events in systemic lupus erythematosus: a major challenge

Arthritis Research and Therapy — Mon, 22 Feb 2010 00:00:00 +0100

Cardiovascular disease (CVD) has been identified as a major contributor to morbidity and mortality in patients with systemic lupus erythematosus (SLE). The aetiology of premature CVD in SLE is supposed to be multifactorial, including traditional coronary artery disease (CAD) risk factors, antiphospholipid antibodies, metabolic and inflammatory factors. Despite the overwhelming interest in CVD in SLE research, prospective studies evaluating risk factors for hard endpoints, i.e. cardiovascular events, are relatively scarce. The article by Gustafsson and colleagues suggests that prothrombotic factors play an important role in SLE related CVD while the influence of traditional CAD risk factors might be limited. (Source: Arthritis Research and Therapy)

Clinical and geographical variation in prophylactic and therapeutic treatments for pre-eclampsia in the UK

BJOG: An International Journal of Obstetrics and Gynaecology — Mon, 22 Feb 2010 00:00:00 +0100

Conclusions Prophylactic and treatment regimes for pre-eclampsia in the UK vary by region and risk group. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Clinical and geographical variation in prophylactic and therapeutic treatments for pre-eclampsia in the UK.

BJOG : An International Journal of Obstetrics and Gynaecology — Mon, 22 Feb 2010 00:00:00 +0100

Conclusions Prophylactic and treatment regimes for pre-eclampsia in the UK vary by region and risk group. PMID: 20175876 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

Neurological manifestations of antiphospholipid syndrome

European Journal of Clinical Investigation — Sat, 20 Feb 2010 00:00:00 +0100

Eur J Clin Invest 2010 Neurologic disorders are among the most comum and important clinical manifestations associated with the antiphospholipid syndrome (APS). It is characterized by diverse neurological manifestations. These include stroke, transient ischaemic attack, Sneddon's syndrome, convulsions/epilepsy, dementia, cognitive deficits, headaches/migraine, chorea, multiple sclerosis-like, transverse myelitis, ocular symptoms and Guillain-Barré syndrome. Our study group recently reported a correlation between primary APS and peripheral neuropathy. Only one study investigated the occurrence of peripheral neuropathy in patients diagnosed with PAPS through electrophysiological study and showed alterations in 35% of patients. The mechanism of nervous system involvement in APS is considered ...

A case of pulmonary tuberculosis presenting as diffuse alveolar haemorrhage: is there a role for anticardiolipin antibodies?

BMC Infectious Diseases — Sat, 20 Feb 2010 00:00:00 +0100

Conclusions: The transient presence of anticardiolipin antibodies in association with an unusual clinical presentation of pulmonary tuberculosis is intriguing although a causal relationship cannot be established. (Source: BMC Infectious Diseases)

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Renal cortical necrosis at presentation in a patient with systemic lupus erythematosus: an autopsy case report

Clinical Rheumatology — Fri, 19 Feb 2010 06:42:51 +0100

Abstract Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder. Renal involvement has the worst prognosis. However, renal cortical necrosis is extremely unusual in SLE. In this case report, we describe the autopsy findings in a young female patient with SLE presenting with renal failure. At autopsy, there was Libmann–Sacks endocarditis with multiorgan infarcts and renal cortical necrosis. Secondary antiphospholipid antibodies contribute to the cardiac and renal manifestations in SLE. We discuss the incidence and pathogenesis of endocarditis with differential diagnosis for cortical necrosis in a patient of SLE. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10067-010-1395-5Authors Megha S. Uppin, Nizam’s Institute of Medical Scien...

Ischemic Left Ventricular Systolic Dysfunction as First Manifestation of Primary Antiphospholipid Syndrome in a Young Patient

Clinical Cardiology — Wed, 17 Feb 2010 00:00:00 +0100

No Abstract. (Source: Clinical Cardiology)

Anetodermic Primary Cutaneous B-Cell Lymphoma: A Unique Clinicopathological Presentation of Lymphoma Possibly Associated With Antiphospholipid Antibodies [Observation]

Archives of Dermatology — Mon, 15 Feb 2010 20:50:43 +0100

Conclusions Anetodermic primary cutaneous B-cell lymphoma is a rare and unique clinicopathological manifestation not only of marginal-zone lymphoma, as previously described, but also of follicle-center cell lymphoma. This type of secondary anetoderma, like primary anetoderma, might be associated with immunologic disorders, particularly antiphospholipid antibodies. (Source: Archives of Dermatology)

Peripheral neuropathy in patients with primary antiphospholipid (Hughes') syndrome.

Lupus — Mon, 15 Feb 2010 00:00:00 +0100

In conclusion, peripheral neuropathy is a common asymptomatic abnormality in patients with PAPS. The routine performance of NCS may be considered when evaluating such patients. PMID: 20156929 [PubMed - as supplied by publisher] (Source: Lupus)

Impaired Fibrinolysis in the Antiphospholipid Syndrome

Current Rheumatology Reports — Tue, 09 Feb 2010 17:47:59 +0100

This article discusses the function of the fibrinolytic system and reviews studies that have reported alterations in fibrinolytic pathways that may contribute to thrombosis in patients with APL. Some of these mechanisms include elevations in plasminogen activator inhibitor-1 levels, inhibitory antibodies against tPA or other components of the fibrinolytic system, antibodies against annexin A2, and finally, antibodies to β2-glycoprotein-I (β2GPI) that block the ability of β2GPI to stimulate tPA-mediated plasminogen activation. Content Type Journal ArticleDOI 10.1007/s11926-009-0075-4Authors Katie A. Krone, Cleveland Clinic Lerner College of Medicine 9500 Euclid Avenue Cleveland OH 44195 USAKristi L. Allen, NC10 Lerner Research Institute Department of Cell Biology 9500 Euclid Aven...

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Effects of anti-cardiolipin antibodies and IVIg on annexin A5 binding to endothelial cells: implications for cardiovascular disease.

Scandinavian Journal of Rheumatology — Sun, 07 Feb 2010 13:08:03 +0100

Conclusions: Decreased ANXA5 binding to endothelium, mediated by aPL, is a novel mechanism of atherothrombosis that can be countered by IVIg in vitro. IVIg per se could, to a lesser degree, cause decreased ANXA5 binding in NHS, which raises the possibility that some antibodies in IVIg can be involved in a side-effect reported in IVIg treatment, namely atherothrombosis and CVD. Increasing ANXA5 binding, either by addition of ANXA5 or by use of neutralizing antibodies in IVIg, represents a possible therapeutic strategy that deserves further study. PMID: 20132075 [PubMed - in process] (Source: Scandinavian Journal of Rheumatology)

Correlation between beta-2-glycoprotein I gene polymorphism and anti-beta-2 glycoprotein I antibodies in patients with multibacillary leprosy

Archives of Dermatological Research — Sat, 06 Feb 2010 17:59:44 +0100

Abstract Antiphospholipid antibodies, such as anti-β2-glycoprotein I (β2GPI), are present in multibacillary leprosy (MB) patients; however, MB patients do not usually present with antiphospholipid antibody syndrome (APS), which is characterized by thromboembolic phenomena (TEP). Rare cases of TEP occur in leprosy patients, but the physiopathology of this condition remains unclear. In this case–control study, we examined whether single-nucleotide polymorphisms (SNPs) of the β2GPI gene contributed to the risk of leprosy and APS co-morbidity. SNPs Ser88Asn, Leu247Val, Cys306Gly and Trp316Ser were identified in 113 Brazilian leprosy patients. Additionally, anti-β2GPI antibodies and plasma concentrations of β2GPI were quantified. The Ser88Asn, Cys306Gly and Trp316Ser SNP...

Monitoring plasma heparin concentration in a patient with antiphospholipid syndrome.

International Journal of Hematology — Fri, 05 Feb 2010 00:00:00 +0100

Authors: Inaba T, Yuki Y, Nishino S, Komatsu S, Ishino H, Tsuji H, Fujita N PMID: 20135243 [PubMed - as supplied by publisher] (Source: International Journal of Hematology)

Arterial and venous thrombosis are associated with different angiogenic cytokine patterns in patients with the antiphospholipid syndrome.

Lupus — Thu, 04 Feb 2010 00:00:00 +0100

Authors: Smadja DM, Gaussem P, Roncal C, Fischer AM, Emmerich J, Darnige L Antiphospholipid syndrome (APS) is defined as a combination of antiphospholipid antibodies, arterial and/or venous thrombosis, and, in women, recurrent fetal loss. The mechanisms underlying this prothrombotic tendency are unclear. Here we determined plasma levels of the angiogenic growth factors vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and stromal cell-derived factor-1 (SDF-1) in 34 patients with APS (median age 40 years) compared with 180 healthy controls and with 80 age-matched deep-venous thrombosis patients in whom the diagnosis of APS had been excluded. All of the patients met updated APS criteria and two-thirds of them were triply positive for antiphospholipid antibodies (l...

Antiphospholipid Antibodies Limit Trophoblast Migration by Reducing IL-6 Production and STAT3 Activity

American Journal of Reproductive Immunology — Wed, 03 Feb 2010 00:00:00 +0100

This study demonstrates that aPL limit trophoblast cell migration by downregulating trophoblast IL-6 secretion and STAT3 activity. As heparin was unable to prevent these effects, our findings may explain why women with antiphospholipid syndrome, treated with heparin, remain at risk of developing obstetrical syndromes, associated with impaired deep placentation, such as pre-eclampsia. (Source: American Journal of Reproductive Immunology)

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Neuropsychiatric disorders revealing primary antiphospholipid syndrome in an elderly patient

Neurology — Mon, 01 Feb 2010 21:02:05 +0100

(Source: Neurology)

Antiphospholipid Syndrome and Acute HIV Infection.

Emerging Infectious Diseases — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Diaz JS, Octavio JG, Fernandez-Guerrero ML To the Editor: Patients with acute HIV infection frequently experience a syndrome characterized by fever, sore throat, lymphadenopathy, maculopapular rash, and lymphomonocytosis, which mimics acute infectious mononucleosis, 3-6 weeks after primary infection (1). Aseptic meningitis, encephalitis, and peripheral neuropathy are the most commonly observed features. In contrast, antiphospholipid syndrome complicated with pulmonary emboli is not commonly associated with acute retroviral syndrome. The following case should prompt clinicians to consider an expanded clinical scope of initial signs and symptoms for acute HIV infection. PMID: 20113589 [PubMed - in process] (Source: Emerging Infectious Diseases)

Coagulation disorders and the risk of retinal vein occlusion.

Thrombosis and Haemostasis — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Kuhli-Hattenbach C, Scharrer I, Lüchtenberg M, Hattenbach LO Over the past years, there has been a dramatic increase in the number of identifiable causes of thrombophilia. However, to date, there are no large, prospective studies to assess an optimal, cost-effective approach with regard to screening and case finding for thrombophilic risk factors in patients presenting with retinal vessel occlusion. Two hundred twenty-eight patients with retinal vein occlusion (RVO) and 130 age-matched healthy controls were prospectively screened for thrombophilic risk factors. Both cohorts were divided into three subgroups, depending on the patients' age at the time of the RVO or a previous thromboembolic event. Patient age </=45 years was associated with a high prevalence of coagulat...

Autoantibodies in the autoimmune rheumatic diseases

Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: The detection of autoantibodies to a variety of antigenic targets plays an important role in the diagnosis of autoimmune rheumatic disease. Rheumatoid factor, antinuclear antibodies and antineutrophil cytoplasmic antibodies have been the key in the diagnosis of rheumatoid arthritis (RA), systemic lupus erythematosus and systemic vasculitis for many years. Antibodies against cyclic citrullinated peptides have been shown to be specific for rheumatoid arthritis and may predict the development of erosive disease, and are being increasingly used in the assessment of patients with RA. There is increasing interest in the use of anti-C1q antibodies for the detection and monitoring of lupus nephritis as this assay appears to be more sensitive than anti-DNA antibodies. Antibodies against �...

Antiphospholipid syndrome

Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Antiphospholipid syndrome (APS) is an autoimmune disorder in which autoantibody production can lead to a hypercoagulable state, pregnancy failure and/or a multitude of other systemic manifestations. In recent times, research into the antiphospholipid antibodies has increased our understanding of the pathogenic process and encouraged improved detection of antiphospholipid antibodies. However, the precise nature of the pathology of APS remains challenging, as does the management of this disorder. This review outlines the key features of APS, including the laboratory tests and their interpretation, and offers advice regarding the management of patients with APS both in the medical and obstetric settings. (Source: Medicine)

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Prevalence and Clinical Associations of Lupus Anticoagulant, Anticardiolipin Antibodies, and Anti-beta2-glycoprotein I Antibodies in Patients with Systemic Lupus Erythematosus.

The Korean Journal of Laboratory Medicine — Mon, 01 Feb 2010 00:00:00 +0100

CONCLUSIONS: LAC was the most common antibody detected in Korean SLE patients and is shown to have a significant association with the presence of venous/arterial thrombosis. The measurement of LAC may be clinically useful in identifying patients with SLE who are at a high risk for venous/arterial thrombosis. PMID: 20197721 [PubMed - in process] (Source: The Korean Journal of Laboratory Medicine)

Thrombotic risk assessment in the antiphospholipid syndrome requires more than the quantification of lupus anticoagulants

Blood — Thu, 28 Jan 2010 17:01:59 +0100

Lupus anticoagulants (LACs) are associated with thromboembolic complications (TECs). LACs can be detected by their anticoagulant properties in thrombin generation assays, by the peak height (PH) and lag time (LT). To assess the thrombotic risk in LAC-positive patients, we have expressed the LAC activity quantitatively by PH/LT calibration curves, constructed for mixtures of monoclonal antibodies against β2-glycoprotein I (β2GPI) and prothrombin, spiked in normal plasma. PH/LT was determined in LAC patients, with (n = 38) and without (n = 21) TECs and converted into arbitrary LAC units. LAC titers ranged from 0 to 200 AU/mL, with 5 of 59 patients being negative. In the positive LAC titer population (54 of 59), LAC and anti-β2GPI immunoglobulin G (IgG) titers correlated with T...

Massive gangrene of the stomach due to primary antiphospholipid syndrome: Report of two cases

Surgery Today — Wed, 27 Jan 2010 20:05:36 +0100

This report describes two cases of massive gastric gangrene due to primary APS, which presented in a span of 2 years. In the first case a multiparous, 40-year-old woman presented with acute abdominal pain, hematemesis, and progressive abdominal distension, and was in azotemia and shock. A laparotomy revealed gangrene of the stomach without any other organ involvement. She was managed with a total gastrectomy and esophagojejunal anastomosis. Postoperative serology revealed a persistent elevation of anticardiolipin antibody with no other apparent predisposing cause. The histopathological examination of the specimen revealed characteristic extensive intramural vascular thrombosis without inflammatory changes in the vessel wall, confirming antiphospholipid syndrome. The second patient w...

Venous thromboembolism in southern Chinese patients with systemic lupus erythematosus

Clinical Rheumatology — Tue, 26 Jan 2010 07:03:29 +0100

The objective is to study the annual incidence and standardized incidence ratio (SIR) of venous thromboembolism (VTE) in a cohort of Chinese patients with systemic lupus erythematosus (SLE). VTE events of SLE patients occurring between 1999 and 2008 were identified from our database, and the annual incidence of VTE was calculated according to the cohort size. SIRs were estimated by the ratios of the incidence of VTE in SLE to the general population. In 2008, 516 SLE patients were in our cohort. The mean age of SLE onset was 32.2 ± 14 years and the duration of SLE was 9.3 ± 8.8 years. Fifty-seven percent of the patients had disease duration of ≥5 years. Between 1999 and 2008, 18 episodes of VTE occurred in 14 patients. The incidence of VTE did not show signi...

The Roll of Toll-like Receptors in the Antiphospholipid Syndrome

Current Rheumatology Reports — Fri, 22 Jan 2010 19:56:54 +0100

Abstract The antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombosis, recurrent fetal loss, and the presence of antiphospholipid antibodies (aPL). Recent data support the idea that the thrombotic activity in APS patients is attributed to enhanced cytokine release via activation of certain Toll-like receptors. To investigate these mechanisms more precisely, different experimental approaches were used to investigate this connection in detail. IgG fractions and/or monoclonal aPL, either generated from murine or human B cells were intensely used for stimulation experiments of monocytes, endothelial cells, or dendritic cells. All these stimuli induced an enhanced expression and secretion of cytokines, especially tumor necrosis factor (TNF)-α, cause...

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Use of Rituximab in the Antiphospholipid Syndrome

Current Rheumatology Reports — Fri, 22 Jan 2010 02:11:18 +0100

Abstract B cells are promising targets for treatment in autoimmune diseases. Rituximab, a chimeric anti-CD20 monoclonal antibody that depletes B cells, is approved for use in rheumatoid arthritis and is often used to treat refractory autoimmune thrombocytopenia. There is increasing interest in using rituximab in other autoimmune diseases, including the antiphospholipid syndrome. We reviewed the published clinical experience of rituximab use in patients with the antiphospholipid syndrome. Data are limited to case reports and small case series. In 19 of 21 reported cases, rituximab appeared to have a beneficial clinical effect. Antiphospholipid antibodies levels were significantly decreased in ten of 12 cases. Controlled clinical trials are needed to determine if rituximab i...

Antiphospholipid Antibody Syndrome: Coexistence of Left Ventricular Apical Thrombus and Deep Vein Thrombosis Causing Pulmonary Thromboembolism in a Patient with Systemic Lupus Erythematosus

Echocardiography — Fri, 22 Jan 2010 00:00:00 +0100

We report a 36-year-old woman with a 1-year history of systemic lupus erythematosus who was admitted with acute onset of dyspnea and chest pain. She presented with a classic medical history of antiphospholipid antibody syndrome, including spontaneous abortion, deep venous thrombosis, and clinical manifestations of lupus activation. The differential diagnosis was made after a detailed history and examinations with transthoracic/transesophageal echocardiography, deep venous ultrasonography, chest computed tomography, and coronary angiography. This case demonstrates a left ventricular apical thrombus in angiographically normal coronary arteries and also deep vein thrombosis causing acute pulmonary thromboembolism. Antiaggregant and anticoagulant therapies were initiated as a result of the pre...

{beta}2 Glycoprotein I ({beta}2GPI) binds platelet factor 4 (PF4): implications for the pathogenesis of antiphospholipid syndrome

Blood — Thu, 21 Jan 2010 17:02:35 +0100

Antiphospholipid syndrome (APS) is an autoimmune thrombophilia characterized by arterial/venous thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies that mainly recognize β2 glycoprotein I (β2GPI). To investigate potential platelet ligands of β2GPI, platelet membrane proteins from healthy persons and patients with APS were passed through a β2GPI-affinity column. By using mass spectrometry, platelet factor 4 (PF4) appeared as the dominant β2GPI binding protein. PF4 could bind in vitro, with high-affinity, recombinant β2GPI, and the binding was abrogated by soluble β2GPI. Coprecipitation experiments further confirmed this interaction. In silico molecular docking showed that PF4 tetramers can bind 2 β2GPI molecules simult...

Chronic periaortitis with antiphospholipid syndrome

APLAR Journal of Rheumatology — Thu, 21 Jan 2010 00:00:00 +0100

We describe the first case of antiphospholipid syndrome in a patient with CP. (Source: APLAR Journal of Rheumatology)

Antiphospholipid syndrome, migraine and stroke.

Lupus — Thu, 21 Jan 2010 00:00:00 +0100

Authors: Hughes G PMID: 20093324 [PubMed - as supplied by publisher] (Source: Lupus)

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High risk for recurrent TE in APS patients

MedWire News - Thrombosis — Mon, 18 Jan 2010 15:41:45 +0100

Patients with antiphospholipid syndrome who are triple positive for antiphospholipid antibodies have a high risk for recurrent thromboembolism, Italian researchers have found. (Source: MedWire News - Thrombosis)

Author's response to ‘Statins for the treatment of obstetric complications in Antiphospholipid Syndrome?’

Journal of Reproductive Immunology — Mon, 18 Jan 2010 00:00:00 +0100

In my paper “Pravastatin prevents miscarriage in antiphospholipid antibody-treated mice” [J. Reprod. Immunol. 82 (November (2)) (2009) 126–131], I do not recommend the use of statin drugs to prevent human pregnancy loss. The first sentence of the concluding paragraph of my review article reads “We recognize that these studies were conducted in mice and that clinical trials are needed to confirm its application to humans”. I reiterate here that statin drugs should not be used in pregnant women without the evidence basis of a properly designed clinical trial to demonstrate efficacy in that setting. (Source: Journal of Reproductive Immunology)

Statins for the treatment of obstetric complications in antiphospholipid syndrome?

Journal of Reproductive Immunology — Fri, 15 Jan 2010 00:00:00 +0100

In her paper, “Pravastatin prevents miscarriages in antiphospholipid antibody-treated mice,” [J. Reprod. Immunol. 2009;82(November (2)):126–31] Dr. Girardi's conclusions go well beyond her data when she recommends the use of statin drugs to prevent human pregnancy loss. (Source: Journal of Reproductive Immunology)

How to manage RI venography in pre-orthopedic surgery patients

Annals of Nuclear Medicine — Tue, 12 Jan 2010 18:23:05 +0100

Conclusion The preoperative identification of patients with VTE by RIV might be useful for perioperative management and the evaluation of preventive measures against postoperative VTE. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s12149-009-0334-5Authors Kaori Terazawa, University Hospital of Tokushima Department of Radiology Kuramoto-cho 3-18-15 Tokushima Tokushima 770-8503 JapanHideki Otsuka, University Hospital of Tokushima Department of Radiology Kuramoto-cho 3-18-15 Tokushima Tokushima 770-8503 JapanYoichi Otomi, University Hospital of Tokushima Department of Radiology Kuramoto-cho 3-18-15 Tokushima Tokushima 770-8503 JapanNaomi Morita, University Hospital of Tokushima Department of Radiology Kuramoto-cho 3-18-15 Tokushima Tokushima 770-8503 Ja...

Research on thrombophilic factors in arterial and venous thrombotic events: a 6-year investigation register

Jornal Vascular Brasileiro — Tue, 12 Jan 2010 16:51:41 +0100

CONCLUSION: The presence of genetic thrombophilic factors in patients with venous and/or arterial thrombotic events, independently of age or presence of other associated factors, was significant. (Source: Jornal Vascular Brasileiro)

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Echocardiography at diagnosis of antiphospholipid syndrome provides prognostic information on valvular disease evolution and identifies two subtypes of patients.

Lupus — Tue, 12 Jan 2010 00:00:00 +0100

Authors: Pardos-Gea J, Ordi-Ros J, Avegliano G, Cortés-Hernández J, Balada E, Evangelista A, Vilardell M The evolution of valvular disease in antiphospholipid syndrome (APS) is barely known. In order to evaluate whether the presence or absence of valvular disease at the time of diagnosis of APS, assessed by an initial echocardiogram, predicts its subsequent evolution, we performed a prospective cohort study. We included 53 patients with APS. An initial transthoracic echocardiogram was performed on patients at the time of diagnosis of APS. Serial echocardiograms were conducted along a 12-year follow-up. Final echocardiograms were used for comparative purposes. We started with 29 patients (54%) with and 24 (45%) without valvulopathy at initial echo. At the final echocardiogram,...

High-density lipoprotein inversely relates to its specific autoantibody favoring oxidation in thrombotic primary antiphospholipid syndrome.

Lupus — Mon, 11 Jan 2010 00:00:00 +0100

Authors: Ames PR, Matsuura E, Batuca JR, Ciampa A, Lopez LL, Ferrara F, Iannaccone L, Delgado Alves J Abnormalities of the lipid profile partly explain the atherogenic tendency of systemic lupus erythematosus but the picture is unclear in thrombotic primary antiphospholipid syndrome (PAPS). Herein we compare the lipid profile, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (CHO), apolipoprotein A (ApoA-I), apolipoprotein B (ApoB), tryglicerides (TRY)), anti-lipoprotein antibodies, beta-2-glycoprotein I complexed to oxidized low-density lipoprotein (oxLDL-ss2GPI) and C-reactive protein (CRP) from thrombotic PAPS (n = 34), thrombotic patients with inherited thrombophilia (IT; n = 36), subjects persistently positive for antiphospholipid antibodies (aPL, n...

Update on the Diagnosis, Treatment, and Prognosis of the Catastrophic Antiphospholipid Syndrome

Current Rheumatology Reports — Fri, 08 Jan 2010 21:42:17 +0100

Abstract The catastrophic antiphospholipid syndrome (APS) is a potentially life-threatening condition, the diagnosis of which requires a high degree of clinical awareness on the part of attending physicians. Patients with APS present with 1) clinical evidence of multiple organ involvement developed over a very short time; 2) histopathologic evidence of multiple small-vessel occlusions; and 3) laboratory confirmation of the presence of antiphospholipid antibodies, usually in high titer. A combination of anticoagulants, corticosteroids, intravenous immunoglobulins, and plasma exchanges is the basic treatment for all patients with this severe condition. Unfortunately, despite current therapies, the mortality rate is still high (around 30%). However, once patients with catastr...

The difficult distinction between antiphospholipid syndrome and thrombotic thrombocytopenic purpura

British Journal of Haematology — Fri, 08 Jan 2010 00:00:00 +0100

(Source: British Journal of Haematology)

Intensity of Warfarin Coagulation in the Antiphospholipid Syndrome

Current Rheumatology Reports — Thu, 07 Jan 2010 22:26:42 +0100

Abstract Antiphospholipid syndrome is a condition with an increased propensity for both arterial and venous thrombosis. Compared with the normal population there is also a higher rate of recurrence. Most evidence exists for the use of warfarin in the secondary prevention of thromboembolism, aiming for an international normalized ratio between 2.0 and 3.0. Care must be taken with all anticoagulants because of the increased risk of bleeding. Several other strategies are available if warfarin fails, including the addition of aspirin, increasing the warfarin target range, and use of heparin. Content Type Journal ArticleDOI 10.1007/s11926-009-0070-9Authors Mark Crowther, McMaster University Division of Hematology and Thromboembolism St Joseph’s Hospital, 50 Charlton Ave, E...

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Antibodies to Serine Proteases in the Antiphospholipid Syndrome

Current Rheumatology Reports — Thu, 07 Jan 2010 22:26:40 +0100

Abstract It is generally accepted that the major autoantigen for antiphospholipid antibodies (aPL) in the antiphospholipid syndrome (APS) is β2-glycoprotein I (β2GPI). However, a recent study has revealed that some aPL bind to certain conformational epitope(s) on β2GPI shared by the homologous enzymatic domains of several serine proteases involved in hemostasis and fibrinolysis. Importantly, some serine protease–reactive aPL correspondingly hinder anticoagulant regulation and resolution of clots. These results extend several early findings of aPL binding to other coagulation factors and provide a new perspective about some aPL in terms of binding specificities and related functional properties in promoting thrombosis. Moreover, a recent immunological and pathological s...

Influence of gender on the clinical and laboratory spectra of patients with primary antiphospholipid syndrome

Rheumatology International — Thu, 07 Jan 2010 22:18:38 +0100

The objectives of this cross-sectional study were to evaluate the differences between males and females in the clinical and biochemical manifestations of primary antiphospholipid antibody syndrome (PAPS). The method involved 49 patients (38 premenopausal females and 11 males) diagnosed with PAPS (according to the Sapporo criteria) and their demographic data, clinical data, medications used and antiphospholipid antibodies were analyzed. The results of this study are as follows. Both the groups of patients were statistically similar regarding age, race, weight and body mass index. However, males were significantly taller than females (172 ± 8.9 vs. 159.2 ± 6.2 cm, p < 0.0001). The duration of disease was similar for females and males. The prevalen...

Differential expression of protease-activated receptors in monocytes from patients with primary antiphospholipid syndrome

Arthritis and Rheumatism — Thu, 07 Jan 2010 00:00:00 +0100

To investigate the expression of protease-activated receptors (PARs), their potential regulation by anticardiolipin antibodies (aCL), and their association with the expression of other molecules relevant to thrombosis in monocytes obtained from 62 patients with primary antiphospholipid syndrome (APS).Monocytes were isolated from peripheral blood mononuclear cells by magnetic depletion of nonmonocytes. Expression of tissue factor (TF) and PARs 1-4 genes was measured by quantitative real-time reverse transcription-polymerase chain reaction. Cell surface TF and PARs 1-4 expression was analyzed by flow cytometry. For in vitro studies, purified normal monocytes were incubated with purified APS patient IgG, normal human serum IgG, or lipopolysaccharide, in the presence or absence of specific mon...

Heart valve surgery in patients with the antiphospholipid syndrome: analysis of a series of nine cases [Original articles]

European Journal of Cardio-Thoracic Surgery — Mon, 04 Jan 2010 16:40:24 +0100

Conclusions: Heart valve surgery in patients with antiphospholipid syndrome may carry considerable early and late mortality and morbidity. Thrombo-embolic complications are the most common complications. Mechanical prostheses have been used at our Institution in the previous years; however, today, after reviewing our historical results, we reconsider our general strategy and believe that tissue heart valve prostheses are the possible ideal substitutes, minimising the risks of morbidity and mortality due to the hypercoagulable state of APS. (Source: European Journal of Cardio-Thoracic Surgery)

Free flap failure in an anticardiolipin antibody-positive patient with neoplasm-A case report

Microsurgery — Mon, 04 Jan 2010 00:00:00 +0100

We present herein a case of massive arterial thrombosis of a free rectus abdominal musculocutaneous flap used for reconstructive surgery of gingival carcinoma that could not be rescued. A 54-year-old woman underwent the operation. She had experienced two miscarriages in her 20s, but medical history was otherwise uneventful. Intraoperatively, the anastomosed artery often showed massive arterial thrombosis, and the flaps had become necrotic after bilateral flaps were used. Laboratory findings, 7 days postoperatively, showed high levels of immunoglobulin G anticardiolipin antibody. This value normalized by 2 months postoperatively after using chemotherapy. This case does not match the criteria for antiphospholipid syndrome, but some English-language reports have shown rising antiphospholipid ...

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Effectiveness of a new immuno-assay for the diagnosis of heparin-induced thrombocytopenia and improved specificity when detecting IgG antibodies.

Thrombosis and Haemostasis — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Pouplard C, Leroux D, Regina S, Rollin J, Gruel Y The diagnosis of heparin-induced thrombocytopenia (HIT) is based on clinical criteria and biological assays. Most immunoassays detect antibodies (either IgG alone or additionally IgA and IgM) against PF4 immobilised in wells of microtiter plates with stoichiometric concentrations of polyanion (heparin or polyvinylsulfonate). We studied whether diagnostic sensitivity and/or specificity for HIT could be improved using a novel assay in which unfractionated heparin is immobilised alone to the microwells, with PF4 (and, potentially, other heparin-dependent antigen proteins) provided by adding platelet lysate during the procedure. Samples from 101 patients with suspected HIT and from 101 controls (including 50 with antiphospholipid a...

Anesthetic management of right atrial mass removal and pulmonary artery thrombectomy in a patient with primary antiphospholipid antibody syndrome.

Annals of Cardiac Anaesthesia — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Rawat SK, Mehta Y, Vats M, Mishra Y, Khurana P, Trehan N Antiphospholipid antibody syndrome (APLAS) characterises a clinical condition of arterial and venous thrombosis associated with phospholipids directed antibodies. APLAS occurs in 2% of the general population. However, one study demonstrated that 7.1% of hospitalised patients were tested positive for at least one of the three anticardiolipin antibody idiotype. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging in these patients. Here, we present a case of right atrial mass removal and pulmonary thrombectomy in a patient of APLAS. PM...

Microembolic signals in systemic lupus erythematosus and other cerebral small vessel diseases

Journal of Neurology — Wed, 23 Dec 2009 22:22:25 +0100

Abstract Microembolic signals (MES) are detected by transcranial Doppler (TCD), and are mainly observed in cardiac and large-artery diseases; however they might also be observed in conditions affecting small vessels of the brain. We aimed to review the current medical literature related to MES assessed by TCD in patients with cerebral small vessel disease. We conducted a systematic review in PubMed and selected the articles with information on this topic. Systemic lupus erythematosus (SLE) is the disease with more articles; pooled data showed a frequency of MES of 14.9%. MES were more frequent in SLE patients with antiphospholipid antibodies and ischemic stroke. MES have also been described in other diseases such as primary antiphospholipid syndrome, Sneddon’s syndrome, ...

Pancreatitis in Systemic Lupus Erythematosus: Frequency and Associated Factors - A Review of the Hopkins Lupus Cohort.

J Rheumatol — Wed, 23 Dec 2009 00:00:00 +0100

CONCLUSION: Hypertriglyceridemia appears to be a strong associate of pancreatitis in SLE, but antiphospholipid antibodies are not. SLE patients with psychosis and pleurisy are at increased risk for pancreatitis. PMID: 20032096 [PubMed - as supplied by publisher] (Source: J Rheumatol)

Antiphospholipid Syndrome Handbook (Bertolaccini et al.)

Springer Medicine titles — Sat, 19 Dec 2009 00:02:11 +0100

Antiphospholipid Syndrome Handbook presents the major clinical features of antiphospholid syndrome, or Hughes’ Syndrome, discussing diagnosis, treatment and management of the illness, in a handy short practical book. Bringing together the various areas of specialization that may encounter antiphospholipid syndrome, a section on clinical features focuses on various organs in ... (Source: Springer Medicine titles)

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Detailed analysis of peripheral blood natural killer (NK) cells in women with recurrent miscarriage

Human Reproduction — Wed, 16 Dec 2009 15:57:18 +0100

CONCLUSION Women with RM have altered peripheral blood NK parameters. NK cells as a percentage of lymphocytes best discriminated RM and control populations. Women with RM and high NK levels may have an immunological disorder. (Source: Human Reproduction)

Increased level of tumor necrosis factor-α in patients with antiphospholipid syndrome: marker not only of inflammation but also of the prothrombotic state

Rheumatology International — Tue, 15 Dec 2009 06:46:30 +0100

In conclusion, the presence of aPL is associated with higher TNF-α level, whereas increased level of sIL-2R is rather connected with definite SLE where inflammatory processes prevail. It might be hypothesized that TNF-α plays a major role in pathogenesis of APS thrombotic phenomena. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00296-009-1314-8Authors Jakub Swadzba, Jagiellonian University Medical College Department of Medicine Krakow PolandTeresa Iwaniec, Jagiellonian University Medical College Department of Medicine Krakow PolandJacek Musial, Jagiellonian University Medical College Department of Medicine Krakow Poland Journal Rheumatology InternationalOnline ISSN 1437-160XPrint ISSN 0172-8172 (Source: Rheumatology International)

Antiphospholipid antibodies present in women with infertility

MedWire News - Ob/Gyn — Mon, 14 Dec 2009 00:00:00 +0100

Antiphospholipid antibodies are more likely to be present in women with a history of unexplained infertility, recurrent implantation failure, or recurrent pregnancy loss than women with normal fertility, US researchers report (Source: MedWire News - Ob/Gyn)

Osteonecrosis secondary to antiphospholipid syndrome: a case report, review of the literature, and treatment strategy

Rheumatology International — Sat, 12 Dec 2009 14:16:09 +0100

In this report, we further discuss the pathogenesis of osteonecrosis and current understanding of the treatment of this disease. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s00296-009-1269-9Authors Waqar Haque, Baylor College of Medicine Department of Medicine One Baylor Plaza, BCM 620 Houston TX 77030 USAHuseyin Kadikoy, Baylor College of Medicine Department of Medicine One Baylor Plaza, BCM 620 Houston TX 77030 USAOmar Pacha, Baylor College of Medicine Department of Medicine One Baylor Plaza, BCM 620 Houston TX 77030 USAJoseph Maliakkal, Baylor College of Medicine Department of Medicine One Baylor Plaza, BCM 620 Houston TX 77030 USAVu Hoang, Baylor College of Medicine Department of Medicine One Baylor Plaza, BCM 620 Houston TX 77030 USAAbdul Abdellatif, Baylor Co...

Primary antiphospholipid syndrome with and without Sneddon’s syndrome

Rheumatology International — Sat, 12 Dec 2009 14:16:00 +0100

In conclusion, an understanding of the relationship between APS and SS is important in order to identify a subgroup for which more rigorous accompaniment and therapy may be necessary. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00296-009-1310-zAuthors Cezar Augusto Muniz Caldas, Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Rheumatology Division Avenida Dr. Arnaldo 455, 3º andar, sala 3190 01246-903 São Paulo SP BrazilJozélio Freire de Carvalho, Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Rheumatology Division Avenida Dr. Arnaldo 455, 3º andar, sala 3190 01246-903 São Paulo SP Brazil ...

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Pulmonary hypertension in systemic lupus erythematosus: relationship with antiphospholipid antibodies and severe disease outcome

Rheumatology International — Thu, 10 Dec 2009 15:15:55 +0100

This study reveals that the presence of PH defines a subgroup of patients with a severe disease and increased mortality. Antiphospholipid antibodies and Raynaud’s phenomenon may contribute to the pathogenesis of PH. We recommend that all patients with SLE, especially those positive for antiphospholipid antibodies and/or with signs of Raynaud’s phenomenon should be regularly evaluated for the development of PH. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00296-009-1255-2Authors Ayse Cefle, Kocaeli University Division of Rheumatology, Medical Faculty Kocaeli TurkeyMurat Inanc, Istanbul Medical Faculty Division of Rheumatology Istanbul TurkeyMehmet Sayarlioglu, Istanbul Medical Faculty Division of Rheumatology Istanbul TurkeySevil Kamali, Istanbul Medical Fac...

Thrombosis in Systemic Lupus Erythematosus

Seminars in Thrombosis and Hemostasis — Thu, 10 Dec 2009 14:19:01 +0100

Semin Thromb Hemost 2009; 35: 621-629DOI: 10.1055/s-0029-1242716ABSTRACTSystemic lupus erythematosus (SLE) is a potentially fatal multiorgan inflammatory disease that primarily affects females. Due to the heterogeneity of clinical manifestations and lack of laboratory tests that are both specific and sensitive for the disease, diagnosis of SLE can often be difficult. Although the precise etiology remains to be fully elucidated, it is probable that various environmental, genetic, and hormonal factors contribute to the development of the disease. Patients with SLE have an increased risk for premature thrombosis and/or atherosclerosis, with up to half experiencing a thrombotic event. Furthermore, antiphospholipid antibodies probably play a key role in the development of thrombosis by affectin...

Role of Thrombophilia in Adverse Obstetric Outcomes and Their Prevention Using Antithrombotic Therapy

Seminars in Thrombosis and Hemostasis — Thu, 10 Dec 2009 14:19:01 +0100

Semin Thromb Hemost 2009; 35: 630-643DOI: 10.1055/s-0029-1242717ABSTRACTA series of case-control studies in the last decade have shown the role of inherited thrombophilia in the occurrence of adverse obstetric outcomes. In small series of cases, it has been proven that rare inherited causes of thrombophilia such as natural anticoagulant deficiencies can be associated with fetal losses. The confirmed presence of antiphospholipid antibodies in plasma, representing an acquired thrombophilic condition, is also an established cause of fetal losses, although other studies with a smaller sample size have found an association with other obstetric complications, namely preeclampsia, fetal growth restriction, and abruption placentae. Case-control studies have been performed regarding the potential a...

Laboratory Investigation of Thrombophilia: The Good, the Bad, and the Ugly

Seminars in Thrombosis and Hemostasis — Thu, 10 Dec 2009 14:19:01 +0100

Semin Thromb Hemost 2009; 35: 695-710DOI: 10.1055/s-0029-1242723ABSTRACTThrombophilia can be broadly defined as an increased tendency toward hypercoagulability and venous thrombosis. There are several defined risk factors for thrombosis, and these are generally distinguished as either acquired or congenital, although sometimes this distinction is blurred because of interrelationships. Congenital risk factors include deficiencies or defects in natural anticoagulants, such as antithrombin, Protein C and Protein S, and genetic polymorphisms such as prothrombin G20210A and cleavage-resistant forms of factor V (in particular factor V Leiden), that lead to a condition commonly known as activated protein C resistance. Acquired risk factors include antiphospholipid antibodies, detected as lupus an...

Predictors of the first cardiovascular event in patients with systemic lupus erythematosus - a prospective cohort study

Arthritis Research and Therapy — Thu, 10 Dec 2009 00:00:00 +0100

Conclusion: In addition to age, positive aPL, biomarkers indicating increased endothelial cell activity/damage, and absence of thrombocytopenia were independent predictors of CVEs in this prospective study. Our results indicate that activation of the endothelium and the coagulation system are important features in SLE related CVD. Furthermore, we observed that the risk of CVEs seems to differ between subgroups of SLE patients. (Source: Arthritis Research and Therapy)

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Diagnostic significance of anti-annexin-A5 antibody determination

Central European Journal of Medicine — Tue, 08 Dec 2009 06:48:44 +0100

Abstract Anti-annexin A5 antibodies are directed against annexin A5 — a phospholipid-binding protein that belongs to the ubiquitous annexin family. These antibodies were first discovered in 1994 by Matsuda et al. in women with recurrent fetal loss or preeclampsia and in patients with systemic lupus erythematosus and positive lupus anticoagulant and/or anticardiolipin antibodies. Since then anti-annexin A5 antibodies have been the focus of research. In addition to their well known prothrombotic and procoagulant activities the authors discuss the involvement of these antibodies in the pathogenesis of antiphospholipid syndrome, recurrent pregnancy loss, systemic lupus erythematosus and other immune and non-immune disorders. Controversial reports are presented and a possible...

[Thrombosis of the inferior vena cava revealing primary antiphospholipid syndrome: A case report.]

Journal des Maladies Vasculaires — Sat, 05 Dec 2009 00:00:00 +0100

Authors: Berrady R, Khammar Z, Lamchachti L, Lahlou M, Rabhi S, Bono W Thrombosis of the inferior vena cava is a rare clinical expression of primary antiphospholipid syndrome. This case clearly illustrates the clinical manifestations, work-up findings and management principles of thrombosis of the inferior vena cava in primary antiphospholipid syndrome before the stage of complication. The patient was a 24-year-old female with a history of recurrent deep venous thrombosis. She was admitted to the department of internal medicine for dyspnea and pain of the right hypochondria. Physical examination disclosed an edematous ascitic syndrome. The scanner coupled with Doppler ultrasonography showed thrombosis of the inferior vena cava. On these radiological findings, an immunological work-up w...

Left ventricular thrombus mimicking primary cardiac tumor in a patient with primary antiphospholipid syndrome and recurrent systemic embolism.

Cardiology Journal — Thu, 03 Dec 2009 17:14:03 +0100

In this report we describe a 39 year-old man admitted to hospital presenting with left hemiparesis and a peripheral embolism. He had no history of thrombotic events. Transthoracic echocardiography showed a large, polypoid and mobile mass (4.0 x 1.2 cm) attached to the apex of the left ventricle, highly suggestive of primary cardiac tumor. The patient subsequently underwent open heart surgery. The histological examination showed an older thrombus and a fresh thrombus. Post-operative laboratory tests showed lupus anticoagulant activity, confirming the primary APS diagnosis. The patient initiated treatment with oral anticoagulation (INR levels between 2 and 3) and was discharged 29 days after surgery. At ten month follow-up, he was symptom-free with long-term anticoagulation therapy. No evide...

Cerebral venous sinus thrombosis in early pregnancy: An unusual presentation of primary antiphospholipid syndrome

Journal of Obstetrics and Gynaecology Research — Tue, 01 Dec 2009 00:00:00 +0100

Cerebral venous sinus thrombosis, an unusual presentation of antiphospholipid syndrome, is a rare condition in pregnancy, particularly in the first trimester. The authors of this case report present the case of a 20-year-old woman with sudden onset of headaches and hemiparesis in the first trimester of pregnancy. She underwent a computed tomography scan and magnetic resonance imaging. The image findings and the autoimmune serum test were consistent with a cerebral venous sinus thrombosis complicated by primary antiphospholipid syndrome. The patient's hemiparesis improved with subcutaneous low molecular weight heparin and oral aspirin. In the third trimester of pregnancy, she developed seizures that were controlled by antiepileptic drugs. She delivered a healthy baby at 37 weeks' gestation ...

[Usefulness of silica clotting time for detection of lupus anticoagulants.]

The Korean Journal of Laboratory Medicine — Tue, 01 Dec 2009 00:00:00 +0100

CONCLUSIONS: Addition of SCT to dRVVT can improve the detection sensitivity of thrombosis in LA test. And the high normalized LA ratio of SCT may be a useful parameter for detection of recurrent abortion. PMID: 20046079 [PubMed - in process] (Source: The Korean Journal of Laboratory Medicine)

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Risk factors for thrombophilia in young adults presenting with thrombosis.

International Journal of Hematology — Wed, 25 Nov 2009 00:00:00 +0100

Authors: Yokus O, Albayrak M, Balcik OS, Ceran F, Dagdas S, Yilmaz M, Ozet G The increased risk for thrombosis is known as hypercoagulability or thrombophilia. Here, we investigated risk factors for thrombophilia which were screened in young adult patients presenting with thrombotic events or with recurrent abortions with unknown etiology. A total of 115 patients aged between 16 and 50 years who were found to harbor thrombophilia were retrospectively evaluated. The laboratory investigations performed for the assessment of thrombophilia included protein C, protein S, antithrombin III deficiencies, activated protein C resistance, factor V Leiden (FVL), prothrombin 20210A (PT 20210) and methylenetetrahydrofolate reductase (MTHFR) gene mutations, factor VIII elevation, lupus anticoagulant ...

Immune Thrombocytopenia in Patients with Connective Tissue Disorders and the Antiphospholipid Antibody Syndrome

Hematology/Oncology Clinics of North America — Tue, 24 Nov 2009 13:46:34 +0100

It has been theorized that immune thrombocytopenia (ITP) is a syndrome characterized by various defects in immune regulation, resulting in a common phenotype, decreased blood platelets, and symptoms of mucocutaneous bleeding. Most often, successful treatment of the underlying connective tissue disorder with corticosteroids or other disease-modifying agents can simultaneously improve concurrent thrombocytopenia. The best evidence to date would support the targeting of treatment to the connective tissue disorder, expecting a simultaneous improvement in the platelet count. Due to the frequent relapses associated with many of the connective tissue disorders and the frequent use of immunosuppressant agents, splenectomy should be undertaken only in highly refractory patients. Differentiating the...

Moderate versus high-titer persistently anticardiolipin antibody positive patients: Are they clinically different and does high-titer anti-B2-glycoprotein-I antibody positivity offer additional predictive information?

Lupus — Tue, 24 Nov 2009 00:00:00 +0100

The objective of this study was to determine the clinical characteristics of persistently high-titer (>/=80 U) aCL-positive patients compared with those with persistent moderate aCL titers (40-79 U). Second, we analyzed whether high-titer abeta2GPI test adds predictive information in persistently moderate-to-high titer aCL-positive patients. In this cross-sectional study, the primary analysis compared the clinical and aPL characteristics of 58 patients with at least two moderate-titer aCL results to another 85 patients with at least two high-titer aCL results. In the secondary analysis of patients with at least two abeta2GPI test results, we compared 29 patients with 'aCL 40-79 U and abeta2GPI < 80 U' profiles with 8 patients with 'aCL 40-79U and abeta2GPI >/= 80 U', and also comp...

Oxidative stress and homocysteine metabolism in patients with lupus nephritis.

Lupus — Mon, 23 Nov 2009 00:00:00 +0100

The objective of this study was to compare oxidative status and homocysteinemia in patients with lupus nephritis (LN) and in controls. Total antioxidant capacity (TAC), reactive oxygen species (ROS), homocysteine and related vitamins were measured in 68 patients with LN and in 50 controls. LN patients had lower TAC (p = 0.05) and higher ROS and homocysteinemia (p = 0.01) than controls. TAC, significantly lower in active than in quiescent LN (p = 0.01), was correlated with albuminemia (p = 0.02), inversely with proteinuria (p = 0.01) and anti-DNA antibodies (p = 0.004). ROS values, higher both in active and in inactive LN, correlated with age (p = 0.02), C-reactive protein (CRP) (p = 0.0005) and inversely with prednisone dosage (p = 0.05). At multivariate analysis, CRP (p = 0.04) and age (p...

Heparin and maternal fetal interface: Why should it work to prevent pregnancy complications?

Thrombosis Research — Sun, 22 Nov 2009 14:21:50 +0100

Abstract: Anticoagulant therapy has been used extensively for the prevention of recurrent pregnancy losses, and other placenta mediated complications, including prevention of preeclampsia and fetal growth restriction. While heparin anticoagulation is a standard treatment for antiphospholipid antibody syndrome, it is increasingly being used in the prevention of placenta mediated complications. In this article, we explore the role of heparin at maternal-fetal interface, the molecular mechanism of action for heparin, and ongoing basic and translational work being done to elucidate heparin's principal mechanisms of action. (Source: Thrombosis Research)

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Heparin: Heparin-induced thrombocytopenia and thrombosis syndrome and reversible posterior leukoencephalopathy syndrome in a patient with antiphospholipid syndrome: case report

Reactions — Sun, 22 Nov 2009 14:04:51 +0100

(Source: Reactions)

Primary antiphospholipid syndrome and hepatitis B and C infections

Revista Brasileira de Reumatologia — Fri, 20 Nov 2009 15:20:22 +0100

CONCLUSION: A small percentage of patients with primary APS had positive serology for hepatitis B and C, and all represented cases post-vaccine or serology scar. (Source: Revista Brasileira de Reumatologia)

The geoepidemiology of the antiphospholipid antibody syndrome.

Autoimmunity Reviews — Thu, 19 Nov 2009 00:00:00 +0100

Authors: Biggioggero M, Meroni PL Anti-phospholipid antibodies (aPL) can be detected by functional (lupus anticoagulant) and/or by solid phase assays (anti-cardiolipin and anti-beta2 glycoprotein I). Although detectable in 1-5% of asymptomatic apparently healthy subjects, persistent aPL are significantly associated with recurrent arterial/venous thrombosis and with pregnancy morbidity. Such an association is the formal classification tool for the anti-phospholipid syndrome (APS). The prevalence of the syndrome with no associated systemic connective tissue diseases (primary APS) in the general population is still a matter of debate since there are no sound epidemiological studies in the literature so far. aPL display higher prevalence in systemic lupus erythematosus and rheumatoid arthr...

Role of Tissue Factor in the Maternal Immunological Attack of the Embryo in the Antiphospholipid Syndrome

Clinical Reviews in Allergy and Immunology — Wed, 18 Nov 2009 03:47:20 +0100

Abstract Recurrent fetal loss affects 1–5% of women of childbearing age. Immunological mechanisms may account for 40% of recurrent miscarriages, and in particular, the antiphospholipid syndrome (APS) appears to be implicated in 7–25% of the cases. Because antiphospholipid (aPL) antibodies have thrombogenic properties, fetal loss in patients with APS has been ascribed to thrombosis of placental vessels. However, we have shown that inflammation, specifically activation of complement with generation of the anaphylotoxin C5a, is an essential trigger of fetal injury. Thrombosis and inflammation are linked in many clinical conditions. Tissue factor (TF), the major cellular initiator of the coagulation protease cascade, plays important roles in both thrombosis and inflammatio...

Pharmacokinetics of LJP 993, a tetrameric conjugate of domain 1 of B2-glycoprotein I for antiphospholipid syndrome.

Lupus — Tue, 17 Nov 2009 00:00:00 +0100

Authors: Jia L, Gu Y, Zeng E, Linnik M, Jones DS beta2-glycoprotein I is the best-characterized antigenic target for antiphospholipid autoantibodies. We synthesized a tetrameric conjugate of the domain 1 of beta2-glycoprotein I (LJP 993) aimed at developing the conjugate as a Toleragen to suppress antiphospholipid syndrome. The present studies focused on determining the stability, tissue distribution, plasma concentration-time profile and excretion of the LJP 993 in mice. The stability of LJP 993 in mouse plasma was quantitatively evaluated using strong cation-exchange high performance liquid chromatography. (125)I-labeled LJP 993 was intravenously injected to mice, and levels of (125)I-labeled LJP 993 in plasma, tissues, urine and feces were determined at known intervals. Incubation o...

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The antiphospholipid triangle

Journal of Thrombosis and Haemostasis — Fri, 13 Nov 2009 00:00:00 +0100

See also Pengo V, Ruffatti A, Legnani C, Gresele P, Barcellona D, Erba N, Testa S, Marongiu F, Bison E, Denas G, Banzato A, Padayattil Jose S, Iliceto S. Clinical course of high-risk patients diagnosed with antiphospholipid syndrome. This issue, pp 237[ndash]42. (Source: Journal of Thrombosis and Haemostasis)

Low molecular weight heparin to achieve live birth following unexplained pregnancy loss: a systematic review

Journal of Thrombosis and Haemostasis — Fri, 13 Nov 2009 00:00:00 +0100

Conclusion: There is a trend for increased live births when using LWMH for the prevention of recurrent pregnancy loss. Currently, there is insufficient evidence to support the routine use of LWMH to improve pregnancy outcomes in women with a history of pregnancy loss. Not only are additional studies necessary but standardized criteria for trials evaluating the benefit of an intervention in recurrent pregnancy loss should be established. (Source: Journal of Thrombosis and Haemostasis)

Venous Thromboembolism in Young Female While on Oral Contraceptives: High Frequency of Inherited Thrombophilia and Analysis of Thrombotic Events in 400 Czech Women

Clinical and Applied Thrombosis/Hemostasis — Thu, 12 Nov 2009 05:30:03 +0100

Conclusion: The results confirm that venous thromboembolism is a multifactorial disease in which thrombophilia screening is needed in young symptomatic women on the pill with thrombosis. The results also emphasize the value of proper thromboprophylaxis in women while on oral contraceptive in situations of increased risk for venous thromboembolism. (Source: Clinical and Applied Thrombosis/Hemostasis)

2010 ASN Abstracts

Journal of Neuroimaging — Wed, 11 Nov 2009 00:00:00 +0100

Conclusion: VBD can enlarge to significant dimensions, producing compressive symptoms in the brainstem, as well as thrombosis and ischemic strokes. SACE of the dolichoectasia can be effective for the vessel reconstruction, to prevent progression of the dilatation, and other potential clinical events. 3. Three Case Reports of Multiple Carotid and/or Vertebral Artery Dissections in Female Mei Lu, Heather Gornik, Esteban Cheng Ching, Vikram Kashyap, Rishi Gupta Cleveland Clinic Foundation, Cleveland, OH 44195, United States Introduction: Multiple carotid and/or vertebral artery dissections are rare. However, patients with multiple dissections can suffer from severe stroke, leading to significant mobility and mortality. The etiology underlying the bilateral carotid dissection is not clear. The...

Thrombophilia investigation in Malaysian women with recurrent pregnancy loss

Journal of Obstetrics and Gynaecology Research — Mon, 09 Nov 2009 00:00:00 +0100

Conclusions: Thrombophilia was identified in more than one-quarter (26.6% = 107/402) of the RPL subjects. APC-R not caused by FVL mutation was the most common thrombophilia marker in Malaysians, whereas in Caucasians it was the APC-R due to FVL mutation. The identification of FVL and PTG mutations in Malaysian women with RPL disputes prevailing evidences suggesting its non-occurrence in patients with Asian ancestries. (Source: Journal of Obstetrics and Gynaecology Research)

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[Antiphospholipid syndrome - an update on diagnosis and treatment.]

Pneumonologia i Alergologia Polska — Fri, 06 Nov 2009 16:50:04 +0100

Authors: Szturmowicz M Antiphospholipid syndrome (APS) was described by Hughes et al in 1986 and then by Harris et al in 1987. The symptoms of disease are related to the presence of autoantibodies directed against plasma and serum proteins that form complexes with phospholipids of cell membranes. The immunologic process involving vascular endothelium, thrombocytes and coagulation factors is responsible for enhancement of procoagulation mechanisms and as a result - venous and arterial thrombosis. Actual criteria of recognition of APS were published in 2006 as a result of 11(th) International Congress on Antiphospholipid Antibodies which was taking place in 2004 in Sydney. Multiorgan symptoms of disease, criteria of recognition and methods of treatment were discussed in the present paper...

Thrombin Activatable Fibrinolysis Inhibitor and Clot Lysis Time in Pregnant Patients with Antiphospholipid Syndrome: Relationship with Pregnancy Outcome and Thrombosis

American Journal of Reproductive Immunology — Fri, 06 Nov 2009 00:00:00 +0100

Conclusion Patients with APS have impairment in fibrinolysis evidenced by prolonged CLT at baseline. TAFI and CLT do not seem to be useful as markers of obstetric outcome or risk of thrombosis in patients with APS. (Source: American Journal of Reproductive Immunology)

Urgent Termination of Pregnancy in Pre-eclampsia and Panel of Antiphospholipid Antibodies

American Journal of Reproductive Immunology — Fri, 06 Nov 2009 00:00:00 +0100

Conclusion Supposed increase in various antiphospholipid antibodies (aPLs) levels due to the stress during the short time of admission and a need for a quick medical decision to terminate the pregnancy was not unambiguously proven, but our results are evidently influenced by the current urgent life-saving treatment. (Source: American Journal of Reproductive Immunology)

Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome.

Lupus — Fri, 06 Nov 2009 00:00:00 +0100

In conclusion, women with thrombotic APS (Group 3) have higher rates of pregnancy complications than those with obstetric APS (Groups 1 and 2). Treatment with aspirin and LMWH is associated with improved outcomes for women with previous late fetal loss or early delivery due to placental dysfunction (Group 2). PMID: 19897518 [PubMed - as supplied by publisher] (Source: Lupus)

Antiphospholipid antibodies in young Indian patients with stroke

Journal of Postgraduate Medicine — Mon, 02 Nov 2009 15:50:47 +0100

Conclusions : APL, positive family history and smoking were significantly associated with stroke in the young. We advocate screening for APL in all young patients with stroke. (Source: Journal of Postgraduate Medicine)

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Common infectious agents prevalence in antiphospholipid syndrome.

Lupus — Sun, 01 Nov 2009 00:00:00 +0100

In this study, 98 patients with antiphospholipid syndrome were screened for antibodies directed to several infectious agents. The main finding in this study is the significantly higher prevalence of IgM antibodies to toxoplasma and rubella. This novel finding suggests that these infections might be associated with antiphospholipid syndrome. As autoimmune diseases and, in particular, antiphospholipid syndrome are associated with infections, mainly the catastrophic type of the syndrome, this finding implies that a current infection with these agents, i.e. toxoplasma and rubella, might either be related to the pathogenesis of antiphospholipid syndrome or alternatively to its manifestations. PMID: 19880561 [PubMed - in process] (Source: Lupus)

Antibody May Raise Heart Attack, Stroke Risks: Lupus anticoagulant said to be ‘a major risk factor for arterial thrombotic disease’ in young women.

Family Practice News — Sun, 01 Nov 2009 00:00:00 +0100

The presence of lupus anticoagulant, an antiphospholipid antibody, increased the risk of stroke by 40-fold and of heart attack by 5-fold in a Dutch study that compared young women who had survived these conditions with a healthy control group. (Source: Family Practice News)

MI, Stroke Risk Soars With Lupus Anticoagulant

Cardiology News — Sun, 01 Nov 2009 00:00:00 +0100

Peginterferon-/ribavirin: Antiphospholipid syndrome and cutaneous sarcoidosis: case report

Reactions — Sat, 31 Oct 2009 14:02:00 +0100

(Source: Reactions)

Combined central retinal artery and vein occlusion in a patient with systemic lupus erythematosus and antiphospholipid syndrome.

Lupus — Fri, 30 Oct 2009 00:00:00 +0100

We report herein a 35-year-old female patient displaying a transient and reversible process. Her best-corrected visual acuity improved from 6/60 to 6/8.6 1 day later, before the initiation of systemic corticosteroid and anti-coagulant treatment. The retina regained a normal appearance with her vision recovering to 6/6 2 weeks after the episode of temporary vision loss. Her rapid recovery suggests that continued anti-coagulation therapy and close follow-up to prevent severe complications and recurrent thrombosis is warranted. PMID: 19880552 [PubMed - as supplied by publisher] (Source: Lupus)

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Clinical course of high-risk patients diagnosed with antiphospholipid syndrome

Journal of Thrombosis and Haemostasis — Fri, 30 Oct 2009 00:00:00 +0100

Conclusions: Patients with APS and triple positivity for aPL are at high risk of developing future thromboembolic events. Recurrence remains frequent despite the use of oral anticoagulants, which significantly reduces the risk of thromboembolism. (Source: Journal of Thrombosis and Haemostasis)

Distinct subtypes of myelitis in systemic lupus erythematosus

Arthritis and Rheumatism — Thu, 29 Oct 2009 00:00:00 +0100

This study was undertaken to determine whether SLE myelitis similarly encapsulates distinct syndromes.We analyzed a cohort of 22 patients with SLE and myelitis. Patients were assessed for neurologic variables related to myelitis and for clinical and serologic features of SLE. Magnetic resonance images of the spine, cerebrospinal fluid profiles, and autoantibody profiles were obtained.Eleven patients presented with signs of gray matter dysfunction (i.e., flaccidity and hyporeflexia), whereas 11 patients presented with signs of white matter dysfunction (i.e., spasticity and hyperreflexia). Patients with gray matter dysfunction were more likely to have irreversible paraplegia (P < 0.01), despite presenting with a monophasic versus polyphasic course (P = 0.01), higher levels of SLE activity (m...

Endothelial dysfunction in Iranian lupus patients

Rheumatology International — Fri, 23 Oct 2009 18:53:00 +0100

Abstract Atherosclerosis has a high prevalence in systemic lupus erythematosus (SLE) patients and vascular endothelial dysfunction is the earliest stage of atherosclerosis. The aim of this study was to evaluate the prevalence of vascular endothelial dysfunction and its risk factors in SLE patients and to identify its correlation with disease activity, duration and concomitant conditions in these patients. A total of 84 female SLE patients and 18 healthy young women were included. The vascular endothelial function was evaluated via ultrasonographic assessment of the brachial artery diameter to determine flow-mediated dilation (FMD) and post-TNG dilation–FMD gap (PFG) indexes. FMD indexes of one standard deviation lower than mean FMD of the control group were considered as...

Val247Leu polymorphism of β2 glycoprotein 1 gene may justify the genesis of anti β2GP1 antibodies and Antiphospholipid Syndrome in Multibacillary Leprosy

Anais Brasileiros de Dermatologia — Fri, 23 Oct 2009 12:59:34 +0100

CONCLUSION: The prevalence of Val/Val homozygosis in leprosy group can partially justify the presence of anti-β2GP1 IgM antibodies in MB leprosy. The description of heterozygosis and Val/Val homozygosis in 7 patients with MB leprosy and thrombosis corroborates the implication of anomalous phenotype expression of β2GP1 and development of anti-β2GP1 antibodies, with consequent thrombosis and APS. (Source: Anais Brasileiros de Dermatologia)

Autoimmune diseases induced by biological agents A double-edged sword?

Autoimmunity Reviews — Thu, 22 Oct 2009 00:00:00 +0100

Authors: Ramos-Casals M, Perez-Alvarez R, Diaz-Lagares C, Cuadrado MJ, Khamashta MA, Biological agents are increasingly used for a rapidly expanding number of rheumatic and systemic autoimmune diseases, with a growing number of reports of the paradoxical induction of autoimmune processes, overwhelmingly associated with anti-TNF agents. In this review, we analyze the clinical characteristics and outcomes of autoimmune diseases developing after biological therapies through a baseline Medline search as one of the objectives of the BIOGEAS project, created by the Spanish Society of Internal Medicine. The latest update of our registry (15 July 2009) included more than 800 cases of autoimmune diseases secondary to biological therapies, including a wide variety of both systemic (lupus, vascu...

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Autoimmunity and Recurrent Pregnancy Losses

Clinical Reviews in Allergy and Immunology — Wed, 21 Oct 2009 01:08:06 +0100

Abstract The relationship between autoimmunity and reproduction has long been recognized. This relationship is bidirectional and includes many diverse issues, but in this review article, we focus on which autoimmune disturbances are the basic cause of recurrent pregnancy losses in patients with autoimmune diseases. The antiphospholipid antibodies seem to be clearly associated with recurrent miscarriage. Although there is no agreement on the mechanisms of recurrent pregnancy losses in patients with these antibodies, vasculopathy of the terminal spiral arteries may be implicated and there is a general consensus to routinely screen for antiphospholipid antibodies in patients with recurrent miscarriage. Well-designed diagnostic studies are needed to estimate the true associati...

Mechanisms of antiphospholipid antibody-associated pregnancy complications

Thrombosis Research — Tue, 20 Oct 2009 13:24:05 +0100

Abstract: Women with antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are at high risk for recurrent spontaneous miscarriage and late pregnancy complications, such as preeclampsia and preterm labor. Recent clinical and experimental observations suggest that the pathophysiology of pregnancy failure in patients with APS may involve inflammation at the maternal-fetal interface and disruption of normal trophoblast function and survival, rather than a pro-thrombotic event. While treatment with heparin and aspirin from early pregnancy has been shown to significantly increase the live birth rate in recurrent miscarriage patients with APS, the incidence of severe late pregnancy complications still remains high. This review will discuss what is currently known about the mechani...

Plasma gelsolin facilitates interaction between beta(2) glycoprotein I and alpha5beta1 integrin.

J Cell Mol Med — Thu, 15 Oct 2009 23:00:00 +0100

In this study, we identified plasma gelsolin as a protein associated with beta(2)GPI by using immunoaffinity chromatography and mass spectrometric analysis. An in vivo binding assay showed that endogenous beta(2)GPI interacts with plasma gelsolin, which binds to integrin alpha5beta1 through fibronectin. The tethering of beta(2)GPI to monoclonal anti-beta(2)GPI autoantibody on the cell surface was enhanced in the presence of plasma gelsolin. Immunoblot analysis demonstrated that p38 MAPK protein was phosphorylated by monoclonal anti-beta(2)GPI antibody treatment, and its phosphorylation was attenuated in the presence of anti-integrin alpha5beta1 antibody. Furthermore, focal adhesion kinase (FAK), a downstream molecule of the fibronectin-integrin signaling pathway, was phosphorylated by anti...

Lupoid sclerosis

Rheumatology International — Tue, 13 Oct 2009 21:04:52 +0100

Abstract Lupoid sclerosis (LS) is a controversial entity, comprising features of both systemic lupus erythematosus and multiple sclerosis. Diagnostic criteria are a matter of debate, as well as the role of antinuclear and antiphospholipid antibodies. In this review, clinical and laboratory findings of LS available on Pubmed up to date are discussed. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00296-009-1175-1Authors Briele Keiserman, Sao Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul Department of Rheumatology Av. Ipiranga 6690/220 90610-000 Porto Alegre BrazilLuiz Fernando Garcias da Silva, Sao Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul (PUCRS) Department of Neurology, Faculty of Medicine Porto Alegre RS BrazilMau...

[Reflection and Reaction] Antiphospholipid antibodies: pinning risk on a moving target

Lancet Neurology — Sun, 11 Oct 2009 23:00:00 +0100

Since one of the earliest descriptions of thrombosis associated with antiphospholipid antibodies, researchers have sought to characterise this syndrome of arterial and venous thrombotic manifestations, including miscarriage, combined with moving serological targets—the expanding array of circulating antiphospholipid antibodies (aPL). Urbanus and colleagues address several crucial questions in their multicentre, population-based, case–control investigation of aPL and the risk of myocardial infarction and ischaemic stroke in young women. The study also assessed the synergistic interaction between lupus anticoagulant and the established vascular risk factors cigarette smoking and use of . (Source: Lancet Neurology)

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[Articles] Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study

Lancet Neurology — Sun, 11 Oct 2009 23:00:00 +0100

Arterial thrombosis is a major clinical manifestation of the antiphospholipid syndrome, which is an autoimmune disease found mostly in young women. Although the presence of circulating antiphospholipid antibodies in individuals who have a thrombotic event is a prerequisite for the diagnosis of the antiphospholipid syndrome, the risk of arterial thrombosis associated with antiphospholipid antibodies in the general population is unclear. (Source: Lancet Neurology)

Right atrium myxoma coexisting with antiphospholipid syndrome: a case report

BioMed Central — Sat, 10 Oct 2009 23:00:00 +0100

We describe the unusual findings and diagnostic challenges combined with a review of the literature. (Source: BioMed Central)

Factors influencing polyautoimmunity in systemic lupus erythematosus.

Autoimmunity Reviews — Wed, 07 Oct 2009 23:00:00 +0100

CONCLUSION: Polyautoimmunity is frequent in SLE, and it is influenced by clinical and immunological features. These findings support that clinically different autoimmune phenotypes might share common susceptibility variants. PMID: 19819350 [PubMed - as supplied by publisher] (Source: Autoimmunity Reviews)

Cerebral venous thrombosis with dural arteriovenous fistulas and antiphospholipid syndrome: a case report

Neurological Sciences — Tue, 06 Oct 2009 12:53:16 +0100

Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s10072-009-0166-zAuthors Yasuo Miki, Aomori Prefectural Central Hospital Department of Neurology Higashi Tsukurimichi 2-1-1 Aomori JapanMasahiko Tomiyama, Aomori Prefectural Central Hospital Department of Neurology Higashi Tsukurimichi 2-1-1 Aomori JapanAkira Arai, Aomori Prefectural Central Hospital Department of Neurology Higashi Tsukurimichi 2-1-1 Aomori JapanTamaki Kimura, Aomori Prefectural Central Hospital Department of Neurology Higashi Tsukurimichi 2-1-1 Aomori JapanChieko Suzuki, Aomori Prefectural Central Hospital Department of Neurology Higashi Tsukurimichi 2-1-1 Aomori JapanJin-ichi Nunomura, Aomori Prefectural Central Hospital Department of Neurology Higashi Tsukurimichi 2-1-1 Aomori JapanHiroshi Midorika...

How Can We Lower Risk for Clot in Patients With Antiphospholipid Antibodies?

Medscape Today Headlines — Mon, 05 Oct 2009 16:08:42 +0100

Other factors may be associated with clotting that can be altered to lower patients' risk. Medscape Rheumatology (Source: Medscape Today Headlines)

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Annexin A2 is involved in antiphospholipid antibody-mediated pathogenic effects in vitro and in vivo

Blood — Thu, 01 Oct 2009 16:03:27 +0100

Antiphospholipid (aPL) antibodies recognize receptor-bound β2 glycoprotein I (β2GPI) on target cells, and induce an intracellular signaling and a procoagulant/proinflammatory phenotype that leads to thrombosis. Evidence indicates that annexin A2 (A2), a receptor for tissue plasminogen activator and plasminogen, binds β2GPI on target cells. However, whether A2 mediates pathogenic effects of aPL antibodies in vivo is unknown. In this work, we studied the effects of human aPL antibodies in A2-deficient (A2–/–) mice. A2–/– and A2+/+ mice were injected with immunoglobulin G (IgG) isolated from either a patient with antiphospholipid syndrome (IgG-APS), a healthy control subject (IgG-normal human serum), a monoclonal anti-β2GPI antibody (4C5), an anti-A...

Stillbirth Classification-Developing an International Consensus for Research: Executive Summary of a National Institute of Child Health and Human Development Workshop.

Obstetrics and Gynecology — Thu, 01 Oct 2009 00:00:00 +0100

Authors: Reddy UM, Goldenberg R, Silver R, Smith GC, Pauli RM, Wapner RJ, Gardosi J, Pinar H, Grafe M, Kupferminc M, Hulthén Varli I, Erwich JJ, Fretts RC, Willinger M Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year. The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop from October 22-24, 2007, to review the pathophysiology of conditions underlying stillbirth to define causes of death. The optimal classification system would identify the pathophysiologic entity initiating the chain of events that irreversibly led to death. Because the integrity of the classification is based on available pathologic, clinical, and diagnostic data, experts emphas...

The Cardiac Manifestations of Antiphospholipid Syndrome and Their Echocardiographic Recognition

Journal of the American Society of Echocardiography — Wed, 30 Sep 2009 23:00:00 +0100

Antiphospholipid syndrome is an autoimmune disorder characterized by the presence of antiphospholipid antibodies, hypercoagulability, vascular thrombosis, and recurrent fetal loss. Cardiac involvement occurs frequently. Leaflet thickening and vegetations are detected quite often echocardiographically, but hemodynamically significant stenotic and/or regurgitant valvular disease is uncommon. Antiphospholipid syndrome can also cause left and right ventricular systolic and diastolic dysfunction as well as pulmonary hypertension. Other findings include spontaneous echo contrast and in situ mural thrombosis. In this review, the author discusses the major cardiac manifestations of antiphospholipid syndrome and highlights the role of echocardiography in their detection. (Source: Journal of the Ame...

CME Test for The Cardiac Manifestations of Antiphospholipid Syndrome and Their Echocardiographic Recognition

Journal of the American Society of Echocardiography — Wed, 30 Sep 2009 23:00:00 +0100

(Source: Journal of the American Society of Echocardiography)

Autoimmune Condition, Especially Combined With Smoking And Oral Contraceptive Use, Massively Increases Risk Of Stroke And Heart Attack In Young Women

Health News from Medical News Today — Tue, 29 Sep 2009 10:00:00 +0100

The autoimmune condition antiphospholipid syndrome mainly affects young women. An Article published Online First and in the November edition of The Lancet Neurology shows that women with a particular subtype of antibody called lupus anticoagulant (LA) have a more than 40-fold increased risk of stroke and 5-fold increased risk of heart attack compared with the general population (of young women). (Source: Health News from Medical News Today)

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Presence of low titre of antiphospholipid antibodies in cancer patients: a prospective study

Internal and Emergency Medicine — Tue, 29 Sep 2009 01:07:08 +0100

In conclusion, a high prevalence of low-titre aPL was found in cancer patients at diagnosis, but no statistical difference in thrombosis-free survival or in overall survival was observed between aPL positive and aPL negative patients. Content Type Journal ArticleCategory IM - OriginalDOI 10.1007/s11739-009-0316-6Authors Mario Bazzan, CMID, Centro Multidisciplinare di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Giovanni Bosco Hospital P.zza Donatori di Sangue 3 10154 Turin ItalyBarbara Montaruli, Laboratory Analysis and Oncology Unit, POEV Turin ItalyAntonella Vaccarino, Cellini Hospital Unit of Haematology and Thrombotic Diseases Turin ItalyGianni Fornari, Laboratory Analysis and Oncology Unit, ...

Young women with circulating antiphospholipid antibodies have increased risk of MI and stroke

NeLM - News — Mon, 28 Sep 2009 23:00:00 +0100

Source: Lancet Neurology Area: News Analysis of data from a large case-control study indicates that women who have some sub-types of circulating antiphospholipid antibodies are at significantly increased risk of myocardial infarction (MI) and stroke, especially those taking combined oral contraceptives (COC) and smokers. The antiphospholipid syndrome is an autoimmune disease found mostly in young women, and is associated with an increased risk of arterial thrombosis. However, the risk of arterial thrombosis associated with antiphospholipid antibodies in the general population is not clear: RATIO (Risk of Arterial Thrombosis In relation to Oral contraceptives) is a multicentre case-control study intended to clarify this risk. Cases were women aged under 50 who were admitted to a...

Plasmin immunization preferentially induces potentially prothrombotic IgG anticardiolipin antibodies in MRL/MpJ mice

Arthritis and Rheumatism — Mon, 28 Sep 2009 23:00:00 +0100

To test the hypothesis, utilizing 2 experimental mouse models, that plasmin is an important autoantigen that drives the production of certain IgG anticardiolipin (aCL) antibodies in patients with the antiphospholipid syndrome.BALB/cJ and MRL/MpJ mice were immunized with Freund's complete adjuvant in the presence or absence of human plasmin. The mouse sera were analyzed for production of IgG antiplasmin, IgG aCL, and IgG anti-[beta]2-glycoprotein I (anti-[beta]2GPI) antibodies. IgG monoclonal antibodies (mAb) were generated from the plasmin-immunized MRL/MpJ mice with high titers of aCL, and these 10 mAb were studied for their binding properties and functional activity in vitro.Plasmin-immunized BALB/cJ mice produced high titers of IgG antiplasmin only, while plasmin-immunized MRL/MpJ mice ...

Lupus anticoagulant ‘a major risk factor for arterial thrombosis’

MedWire News - Stroke — Mon, 28 Sep 2009 17:00:55 +0100

Women with a certain form of the autoimmune condition antiphospholipid syndrome face a more than 40-fold increased risk for stroke and a five-fold increased risk fold myocardial infarction compared with the general population, study findings show. (Source: MedWire News - Stroke)

Lupus anticoagulant ‘a major risk factor for arterial thrombosis’

MedWire News - Cardiology — Mon, 28 Sep 2009 00:00:00 +0100

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Smoking, Oral Contraceptive Use Linked to Increased Cardiovascular Risks in Women with Antiphospholipid Syndrome

Physician's First Watch current issue — Sun, 27 Sep 2009 23:00:00 +0100

(Source: Physician's First Watch current issue)

Extensive Nonbacterial Thrombotic Endocarditis Isolated to the Tricuspid Valve in Primary Antiphospholipid Syndrome

Journal of the American Society of Echocardiography — Tue, 22 Sep 2009 00:00:00 +0100

Nonbacterial thrombotic endocarditis is a condition characterized by noninfectious valvular vegetations and is associated with numerous conditions, including the antiphospholipid syndrome. Although vegetations most frequently affect the left-sided valves, isolated involvement of the right-sided valves rarely occurs. Ideal management of the lesions, from both medical and surgical perspectives, is not well defined. The authors report the case of a patient who presented with clinically symptomatic isolated tricuspid valve and right atrial nonbacterial thrombotic endocarditis due to primary antiphospholipid syndrome, who was subsequently managed with diuretics and anticoagulation and has remained clinically stable. (Source: Journal of the American Society of Echocardiography)

Newer antiphospholipid antibodies predict adverse outcomes in patients with acute coronary syndrome.

American Journal of Clinical Pathology — Mon, 21 Sep 2009 05:12:07 +0100

Authors: Greco TP, Conti-Kelly AM, Greco T, Doyle R, Matsuura E, Anthony JR, Lopez LR Antiphospholipid antibodies (aPLs) have been implicated in atherogenesis. We studied 344 patients with acute coronary syndromes; approximately 40% were aPL+ in 1 or more tests and 60% aPL-. In 215 patients, coronary artery disease (CAD) was angiographically documented, with 43.7% positive for aPL vs 34.9% of patients without CAD positive for aPLs. Anti-beta(2)-glycoprotein I (beta2GPI; 54%) and anti-oxidized low-density lipoprotein (oxLDL)/beta2GPI (48%) were most frequent, accounting for 87% of all aPL+ CAD cases. aPLs correlated with severity of CAD (P = .012). Adverse events occurred in 16.7% of patients with CAD, more frequently in patients who were aPL+ (P = .0006; relative risk, 2.9; 95% confide...

Isolated elevation of IgA anti-{beta}2glycoprotein I antibodies with manifestations of antiphospholipid syndrome: a case series of five patients.

Lupus — Sat, 19 Sep 2009 13:34:03 +0100

We report four cases of exclusive IgA anti-beta(2)GPI antibody sero-positivity with concomitant clinical manifestations associated with APS. Four of the five patients were LA negative. 1) Thirty-eight-year-old African-American female with SLE presented with resolving digital ulcers. Serum IgA anti-beta(2)GPI antibody titres were 118.5 SAU (normal range: 0-20 SAU). 2) Twenty-seven-year-old African-American woman with SLE was evaluated for recent onset of severe headaches, unresponsive to analgesics and anti-migraine medications. MRI of the brain revealed hyper-intensities in the white matter in the frontal lobes. Serum IgA anti-beta(2)GPI antibody titres were 29.1 Standard A Units (SAU). 3) Thirty-two-year-old Hispanic female with history of two unexplained miscarriages and negative serolog...

Digital vasculitis in systemic lupus erythematosus: a minor manifestation of disease activity?

Lupus — Sat, 19 Sep 2009 13:34:03 +0100

In conclusion, DV in patients with SLE identifies a subgroup of a mild disease. The high 'weighted' index attributed to this alteration in the SLEDAI score should therefore be revised. PMID: 19762400 [PubMed - in process] (Source: Lupus)

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Catastrophic antiphospholipid syndrome in a patient with Down syndrome.

Lupus — Sat, 19 Sep 2009 13:34:03 +0100

We report a patient with Down syndrome, under treatment with carbamazepine, levopromazine and clonazepam. After urinary infection he developed glans necrosis requiring excision of prepuce. Six hours post surgery he presented right-hand ischemia followed by arterial and venous thrombosis of the right thoracic extremity. Later, he progressed to a compartment syndrome and presented ischemia of toes. All the clinical manifestations developed over a week. Anticardiolipin (aCL) antibodies, lupus anticoagulant and perinuclear antineutrophil antibodies were positive. Anticoagulant and immunosuppressive treatment were initiated. Owing to the failure of both treatments, the patient underwent amputation of right hand and a toe. Histopathology revealed recent and old thrombosis of medium- and small-si...

Antithyroid antibodies in antiphospholipid syndrome: prevalence and clinical associations.

Lupus — Sat, 19 Sep 2009 13:34:03 +0100

We present novel associations between thyroid autoimmunity and ischemic CNS clinical manifestations in the setting of APS. PMID: 19762385 [PubMed - in process] (Source: Lupus)

The Rationale for Comparative Studies of Accelerated Atherosclerosis in Rheumatic Diseases.

Atherosclerosis — Fri, 18 Sep 2009 20:58:09 +0100

Authors: Gasparyan AY, Stavropoulos-Kalinoglou A, Mikhailidis DP, Toms TE, Douglas KM, Kitas GD The inflammatory pathogenesis of atherosclerosis is now well-established, owing to in vitro and in vivo studies and the application of high sensitivity assays for C-reactive protein (CRP) in the general population and specific groups at risk for cardiovascular disease (CVD). In view of the complexity of inflammation-induced atherosclerosis, the rationale for comparative studies of atherogenesis in rheumatic diseases with diverse inflammatory pathogenesis seems obvious; they are human in vivo models to study inflammatory mechanisms involved in atherosclerosis and the impact of treatment. Factors implicated in atherogenesis in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), fami...

Antiphospholipid syndrome may be associated with dysfunctional HDL

MedWire News - Lipidology — Fri, 18 Sep 2009 18:01:11 +0100

Women with antiphospholipid syndrome have lower paraoxonase activity and greater functional and structural arterial abnormalities than healthy controls, report researchers. (Source: MedWire News - Lipidology)

PRELIMINARY COMMUNICATION: Vascular Abnormalities, Paraoxonase Activity, and Dysfunctional HDL in Primary Antiphospholipid Syndrome

JAMA — Mon, 14 Sep 2009 23:00:00 +0100

Conclusions Compared with controls, women with aPL had greater functional and structural arterial abnormalities, which were associated with lower activity of paraoxonase. In patients with aPL, HDL reduced nitric oxide bioavailability and had impaired anti-inflammatory and antioxidant properties. (Source: JAMA)

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Do etiologies of premature ovarian aging (POA) mimic those of premature ovarian failure (POF)?

Human Reproduction — Sun, 13 Sep 2009 23:00:00 +0100

CONCLUSIONS Presumed underlying etiologies with POA follow a similar distribution pattern as reported for POF. POA and POF may, therefore, represent a continuum in phenotypical expression of different etiologies of premature ovarian senescence. Like POF, POA should be considered reason to investigate underlying etiologies. (Source: Human Reproduction)

Autoantibodies against phosphatidylserine, prothrombin and phosphatidylserine-prothrombin complex: Identical or distinct diagnostic tools for antiphospholipid syndrome?

International Journal of Clinical Chemistry — Thu, 10 Sep 2009 23:00:00 +0100

CONCLUSIONS: Our data shows lack of association between aPS/PT antibodies and LA in APS patients with recurrent pregnancy loss. In the evaluation of these patients, there may be redundancy in testing all three markers as the aPT and aPS assays formed part of the aPS/PT antibody repertoire. PMID: 19751711 [PubMed - as supplied by publisher] (Source: International Journal of Clinical Chemistry)

Antiphospholipid Syndrome and Systemic Lupus Erythematosus: Are They Separate Entities or Just Clinical Presentations on the Same Scale?

Medscape Allergy Headlines — Thu, 10 Sep 2009 17:49:46 +0100

The authors discuss recent findings on antiphospholipid syndrome and systemic lupus erythematosus, and how they are related to one another. Current Opinion in Rheumatology (Source: Medscape Allergy Headlines)

Lupus anticoagulant and leg ulcers in sickle cell anemia

Indian Journal of Dermatology — Thu, 10 Sep 2009 16:21:51 +0100

Conclusions:</b> We conclude that SCA patients with CLU may be more likely to develop LA, and this may be related to the degree of hemolysis. Further studies are required to find out if CLU and LA are a result of hemolysis or if LA is responsible for the higher incidence of hemolysis and CLU found among these patients. (Source: Indian Journal of Dermatology)

Catastrophic antiphospholipid syndrome presenting as ischemic pancreatitis in systemic lupus erythematosus.

JOP — Wed, 09 Sep 2009 21:44:05 +0100

CONCLUSION: Awareness of this rare, rapidly fatal medical condition prompts vital, early intervention to improve patients' survival. This case report aims to add to the limited therapeutic data available as well as suggest a possible approach to treating this rare syndrome with very high morbidity and mortality. PMID: 19734640 [PubMed - in process] (Source: JOP)

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Annexin A2 mediates anti-beta2GPI/beta2GPI-induced tissue factor expression on monocytes.

International Journal of Molecular Medicine — Thu, 03 Sep 2009 16:40:14 +0100

In conclusion, these results indicate that ANX2 on cell surface functions as a mediator boosting TF expression on monocytes induced by anti-beta2GPI/beta2GPI complex, which is contributed to the thrombotic events in APS. PMID: 19724897 [PubMed - in process] (Source: International Journal of Molecular Medicine)

How I treat the antiphospholipid syndrome

Blood — Wed, 02 Sep 2009 23:00:00 +0100

This article discusses how we approach medical decision making in the treatment of the various facets of the antiphospholipid syndrome (APS), including secondary prophylaxis in the setting of venous and arterial thrombosis, as well as treatment for the prevention of recurrent miscarriages and fetal death. The role of primary thromboprophylaxis is also discussed in depth. Great emphasis is given to incorporating the most up-to-date and relevant evidence base both from the APS literature, and from large, recent, randomized controlled trials (RCTs) of primary and secondary thrombotic prophylaxis in the general population setting (ie, the population that has not been specifically investigated for APS). (Source: Blood)

Prothrombotic factors and the risk of acute onset non-cardioembolic stroke in young Asian Indians

Thrombosis Research — Mon, 31 Aug 2009 23:00:00 +0100

Abstract: Introduction: Several prothrombotic factors – both hereditary and acquired – are known to cause stroke. Commonly investigated causes are activated protein C resistance, factor V Leiden mutation, factor VIII levels, prothrombin 20210 G-to-A mutation, coagulation inhibitors such as proteins C and S, and antiphospholipid antibodies such as β2-glycoprotein.Objective: The literature on the prevalence of hematological defects pertaining to these variables in the Asian Indian stroke population is limited to a few isolated reports. In the current study we investigate the above-mentioned variables in 120 stroke patients (non-cardioembolic acute-onset stroke) and compare their status with the hematological profile of an equal number of healthy age- and sex-matched controls.Material an...

LETTERS: Antiphospholipid Syndrome, Microalbuminuria, and Risk of Venous Thromboembolism

JAMA — Mon, 31 Aug 2009 23:00:00 +0100

(Source: JAMA)

LETTERS: Antiphospholipid Syndrome, Microalbuminuria, and Risk of Venous Thromboembolism--Reply

JAMA — Mon, 31 Aug 2009 23:00:00 +0100

(Source: JAMA)

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Accuracy of the First Fully Automated Method for Anti-cardiolipin and Anti-β2 Glycoprotein I Antibody Detection for the Diagnosis of Antiphospholipid Syndrome

Annals of the New York Academy of Sciences — Mon, 31 Aug 2009 23:00:00 +0100

In conclusion, newly developed EliA methods for antiphospholipid antibody detection perform similarly to other ELISA assays and represent a useful tool for APS laboratory diagnosis in daily practice. (Source: Annals of the New York Academy of Sciences)

Anti-C1q Autoantibodies in Lupus Nephritis

Annals of the New York Academy of Sciences — Mon, 31 Aug 2009 23:00:00 +0100

Anti-C1q antibodies are found in a variety of diseases, in addition to systemic lupus erythematosus (SLE), and in 3[ndash]5% of normal individuals. In particular, anti-C1q antibodies are detected at a high titer in 100% of patients with hypocomplementemic urticarial vasculitis and in 30[ndash]48% of SLE patients. Their titer correlates with active renal disease with a sensitivity of 44[ndash]100% and a specificity of 70[ndash]92%. An increase in anti-C1q antibody titer has been suggested to be able to predict renal flares in lupus nephritis so that monitoring anti-C1q might be valuable for the clinical management of SLE patients as a noninvasive biological marker. Recently our group studied 228 patients affected by lupus nephritis and found that the association of anti-C1q, C3, and C4, in ...

Seronegative Autoimmune Diseases

Annals of the New York Academy of Sciences — Mon, 31 Aug 2009 23:00:00 +0100

A close relationship exists between autoimmunity and autoantibodies; despite this, some patients are persistently negative for disease-specific autoantibodies. These conditions have been defined as seronegative autoimmune diseases. Although the prevalence of seronegative autoimmune diseases is low, they may represent a practical problem because they are often difficult cases. There are also situations in which autoantibodies are positive in healthy subjects. In particular, three different conditions can be described: latent autoimmunity, preclinical autoimmunity, and postclinical autoimmunity. Here, we analyze briefly the meaning of autoantibody negativity in the seronegative autoimmune diseases, focusing in particular on the specificities associated with systemic lupus erythematosus, anti...

Possible Involvement of Chemokine-induced Platelet Activation in Thrombophilic Diathesis of Antiphospholipid Syndrome

Annals of the New York Academy of Sciences — Mon, 31 Aug 2009 23:00:00 +0100

Among the heterogeneous antiphospholipid antibodies, many studies suggest that those directed to [beta]2-glycoprotein I ([beta]2GPI) are the major pathogenic antibodies in antiphospholipid syndrome (APS). They have been shown to activate the coagulation pathway via several mechanisms, activate platelets via thrombin formation, and suppress fibrinolysis. Additionally, we propose another possible mechanism that involves certain chemokines and results in platelet activation. This hypothesis is based on the observations that anti-[beta]2GPI antibodies stimulated monocytes to secrete inflammatory cytokines such as IL-1[beta] and TNF-[alpha], which in turn stimulated vascular endothelial cells to express chemokines such as CX3CL1 and CCL5. CX3CL1 increased the ability of normal platelets to adhe...