[Primary antiphospholipid syndrome evolving into systemic lupus erythematosus: may antinucleosome antibodies be predictive?].
OBJECTIVE
It was reported by several groups that patients diagnosed as primary antiphospholipid syndrome (PAPS) had developed a full-blown systemic lupus erythematosus (SLE) even after many years of follow-up. Little is known about clinical and/or serological factors that may help predict such evolution. Antinucleosome antibodies (anti-NCS) were described to appear in early stages of SLE, in particular before anti-dsDNA antibodies. The aim of the study is to evaluate the prevalence of anti-NCS in a large cohort of PAPS patients.


METHODS
IgG and IgM anti-NCS antibodies were detected using a home made assay with H1-stripped chromatin as antigen. Sera from 106 PAPS patients were tested; 52 of them were also tested during the follow-up, at least 2 years apart form the basal sample.


RESULTS
Medium-high titre anti-NCS were found in nearly half of the patients (49/106, 46%), more frequently in those presenting features of "lupus like disease". Most of patients displayed an unchanged pattern of anti-NCS over time. We describe three cases of PAPS patients that developed SLE after many years of follow-up; high titre and low titre anti-NCS were present in two and one of them respectively several years before evolving into SLE.


CONCLUSIONS
A significant proportion of PAPS patients displayed medium-high titre anti-NCS, suggesting that the autoimmune response against chromatin may be a relevant event not only in patients with SLE. Further studies are warranted to explore the predictive value of anti-NCS with respect to the evolution from PAPS to SLE.
Andreoli
L
L
U.O. Reumatologia e Immunologia Clinica, Spedali Civili e Università degli Studi di Brescia. andreoli@bresciareumatologia.it
Pregnolato
F
F
Burlingame
R W
RW
Fanelli
V
V
Allegri
F
F
Radice
A
A
Corace
C
C
Sinico
R A
RA
Tincani
A
A
Meroni
P L
PL
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood* / Q000276:immunology; D000918:Antibody Specificity; D016736:Antiphospholipid Syndrome / Q000276:immunology*; D001324:Autoantigens / Q000276:immunology*; D004247:DNA / Q000276:immunology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000276:immunology*; D008297:Male; D009707:Nucleosomes / Q000276:immunology*; D011379:Prognosis
D000974:Antibodies, Antinuclear; D001324:Autoantigens; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D009707:Nucleosomes; D004247:DNA
L'evoluzione da sindrome da anticorpi antifosfolipidi primaria a lupus eritematoso sistemico: possono gli anticorpi anti-nucleosomi essere predittivi?