title: Hospital based prospective longitudinal clinical and immunologic study of 179 patients of primary anti-phospholipid syndrome.
abstract: OBJECTIVE
  To study the clinical and immunological features of primary antiphospholipid syndrome (APS), and to analyze the differences between primary APS and APS associated with autoimmune rheumatic disease (ARD/APS).
  
  
  METHODS
  This prospective, longitudinal study, carried out from December 2004 to July 2011 included 179 patients with primary APS and 52 patients of ARD/APS diagnosed as per modified 2006 Sapporo's Criteria.
  
  
  RESULTS
  Out of 179 patients of primary APS, 12 were male and 167 were female. The mean age at the time of study entry was 27 ± 4.33 years. Venous thrombosis was noted in 33 (18.43%) patients. Seventeen patients had deep vein thrombosis and 11 (7.19%) had cortical vein and/or cortical sinus thrombosis. Arterial thrombosis was noted in 19 (10.61%) patients, out of which nine had intracranial arterial thrombosis. Thirty-two (17.85%) had recurrent early fetal losses (< 10 weeks) and 97 (54.18%) had late fetal loss (> 10 weeks). Immunoglobulin G (IgG) and IgM aCLA were present in 141 (78.77%) and 32 (17.87%) patients respectively, whereas lupus anticoagulant was present in 99 (55.3%) patients. In patients with bad obstetric outcome, lupus anticoagulant positivity was significantly more prevalent (P < 0.05) than aCLA positivity. Both venous and arterial thrombosis were significantly more common (P < 0.05) in ARD/APS. However, late fetal loss was significantly more prevalent (P < 0.001) in primary APS.
  
  
  CONCLUSIONS
  Primary APS may lead to a variety of clinical manifestations due to venous and/or arterial thrombosis, which at times may be lethal. It is also an important cause of early and late pregnancy loss(es) and other pregnancy morbidities.
authors.affiliation: Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Vanarasi, U.P., India; Division of Rheumatology, Institute of Medical Sciences, Banaras Hindu University, Vanarasi, U.P., India.
authors.forename: Nand K
authors.initials: NK
authors.lastname: Singh
authors.forename: Dibya R
authors.initials: DR
authors.lastname: Behera
authors.forename: Ankit
authors.initials: A
authors.lastname: Agrawal
authors.forename: Mahendra Narayan
authors.initials: MN
authors.lastname: Singh
authors.forename: Vikash
authors.initials: V
authors.lastname: Kumar
authors.forename: Manoj
authors.initials: M
authors.lastname: Godhra
authors.forename: Anurag
authors.initials: A
authors.lastname: Gupta
authors.forename: Devesh P
authors.initials: DP
authors.lastname: Yadav
authors.forename: Usha
authors.initials: U
authors.lastname: Singh
authors.forename: Lakshmi Kant
authors.initials: LK
authors.lastname: Pandey
authors.forename: Manjari
authors.initials: M
authors.lastname: Matah
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000276:immunology; D000293:Adolescent; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D002648:Child; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007194:India / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D012307:Risk Factors; D013997:Time Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D015415:Biomarkers
keywords: anti-phospholipid syndrome; pregnancy loss; venous and arterial thrombosis