title: Neuroendocrine manifestations of phospholipid antibody disease identified by long-term follow-up study of patients with phospholipid antibodies.
abstract: Recurrent clinical thrombotic episodes and/or recurrent fetal wastage are the clinical features of phospholipid antibody (aPL) syndrome, which is characterized by a bland thrombosis, but is not inflammatory, as is found in other connective tissue diseases such as systemic lupus erythematosus (SLE). Previous reports have suggested that some patients with primary aPL syndrome may progress to develop other autoimmune diseases, including inflammatory diseases such as SLE. The aim of this study was to determine the long-term outcome of women with aPL antibodies, with regard to progression of their underlying autoimmune disease. To that end, a retrospective study was made of women with aPL and primary aPL syndromes who had been followed at our institution for a minimum of 3 years. Charts were reviewed, patients interviewed, and laboratory tests were performed to determine whether the clinical nature of the disease and/or its autoantibody profile had changed. Thirty patients were enrolled into the study (29 with aPL syndrome, 1 with consistent aPL and no syndrome). Follow-up ranged from 3 to 22 years. Results were as follows: The autoimmune clinical features were unchanged in 27 patients, but 3 patients developed inflammatory disease, presenting with nasal chondritis (2), cutaneous vasculitis (3), and mucosal ulcer (1). In each case, these changes occurred during pregnancy or the immediate postpartum period. One patient fulfilled criteria for SLE as seen by a change in her autoantibody profile. Another incidental finding was that three other patients were diagnosed with papillary thyroid cancer, two being diagnosed during the follow-up period.
  
  
  CONCLUSIONS
  (1) Inflammatory disease may develop in some patients with aPL and appears to be set off by pregnancy, a known trigger for clinical thrombotic events in aPL patients. (2) Thyroid cancer may be associated with aPL, and this association warrants further study with larger number of patients.
authors.affiliation: Department of Medicine, University of Connecticut Health Center, Farmington Avenue, Farmington, CT, USA.
authors.forename: William
authors.initials: W
authors.lastname: Traverse
authors.forename: Beatriz
authors.initials: B
authors.lastname: Tendler
authors.forename: Charles
authors.initials: C
authors.lastname: Galea
authors.forename: Santhanan
authors.initials: S
authors.lastname: Lakshminarayan
authors.forename: Ann
authors.initials: A
authors.lastname: Parke
mesh_terms: D000293:Adolescent; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009490:Neurosecretory Systems / Q000276:immunology*; D013964:Thyroid Neoplasms / Q000150:complications / Q000276:immunology; D013997:Time Factors
chemical_list: D017152:Antibodies, Antiphospholipid