Lupus anticoagulant: a marker for stroke and venous thrombosis in primary Sjögren's syndrome.
Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) have been described in primary Sjögren's syndrome (pSS) with controversial findings regarding aPL prevalence and their association with thrombotic events. We evaluated 100 consecutive pSS patients (American-European criteria) and 89 age-gender-ethnicity-matched healthy controls for IgG/IgM anticardiolipin (aCL), IgG/IgM anti-beta2-glycoprotein-I (aβ2GPI), and lupus anticoagulant (LA) (positivity according to APS Sydney's criteria). Clinical analysis followed standardized interview and physical examination assessing thrombotic and nonthrombotic APS manifestations and thrombosis risk factors. aPLs were detected in 16 % patients and 5.6 % controls (p = 0.035). LA was the most common aPL in patients (9 %), followed by aβ2GPI (5 %) and aCL (4 %). Thrombotic events occurred in five patients [stroke in two, myocardial infarction in one and deep-vein thrombosis (DVT) in four], but in none of controls (p = 0.061). Mean age at time of stroke was 35 years. Three patients with thrombotic events (including the two with stroke) had APS (Sydney's criteria) and were positive exclusively for LA. Comparison of patients with (n = 16) and without (n = 84) aPL revealed similar mean age, female predominance, and ethnicity (p > =0.387). Frequencies of livedo reticularis (25 vs. 4.8 %, p = 0.021), stroke (12.5 vs. 0 %, p = 0.024), and DVT (18.8 vs. 1.2 %, p = 0.013) were significantly higher in APL + patients. Conversely, frequencies of hypertension, dyslipidemia, diabetes, obesity, smoking, sedentarism, and hormonal contraception were similar in patients with or without aPL (p ≥ 0.253). Our study identified LA as an important marker for APS in pSS, particularly for stroke in young patients, warranting routine evaluation of these antibodies and rigorous intervention in modifiable risk factors.
Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. sandrapasoto@yahoo.com.br
Sandra Gofinet
SG
Pasoto
Henrique Pires
HP
Chakkour
Renato Romera
RR
Natalino
Vilma S T
VS
Viana
Cleonice
C
Bueno
Alessandro Cavalcanti
AC
Lianza
José Lázaro
JL
de Andrade
Mauricio Levy
ML
Neto
Ricardo
R
Fuller
Eloisa
E
Bonfa
D000293:Adolescent; D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000737:chemistry; D016736:Antiphospholipid Syndrome / Q000378:metabolism; D002308:Cardiolipins / Q000737:chemistry; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D016682:Lupus Coagulation Inhibitor / Q000097:blood* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000150:complications* / Q000276:immunology*; D020521:Stroke / Q000150:complications / Q000276:immunology*; D013997:Time Factors; D020246:Venous Thrombosis / Q000150:complications / Q000276:immunology*
D017152:Antibodies, Antiphospholipid; D002308:Cardiolipins; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016682:Lupus Coagulation Inhibitor