[Corticosteroids in the treatment of secondary antiphospholipid syndrome]

The study of changes in the levels of antiphospholipid antibodies (aPL) and clinical manifestations of antiphospholipid syndrome (APS) in response to corticosteroids in secondary APS in patients with systemic lupus erythematosus (SLE) included 219 patients (28 males and 191 females) with APS observed at least for 3 years. aPL in the blood were measured each half of year. Mean age of the patients was 31.2 +/- 11.1 years, mean duration 8.6 +/- 5.2 years. The patients were divided into 3 groups: 54 patients (persistently positive) of group 1 had IgG-anticardiolipin antibodies (aCL) in the blood for the whole period of the observation, were positive by lupus anticoagulant (LA). 73 patients of group 2 were initially aPL-positive, but aPL levels fluctuated in the observation period from positive to negative and vice versa. 92 patients of group 3 had no aPL. For 3-year follow-up 25% of SLE patients were aPL positive, 42%--negative, aCL levels fluctuated in 33%. No APS symptoms were observed in 9%, 33% of groups 1 and 2, respectively, but APS symptoms appeared in the observation period. 10% of group 3 had some aPL-associated signs. aCL levels did not depend on mean daily dose of corticosteroids in groups 1 and 2 initially and within the follow-up. Frequency of LA, irrespective of corticosteroids dose, was significantly higher initially vs that in the follow-up. In spite of correlation between aPL positivity and SLE activity, depressed activity of the disease during the treatment did not entail a significant lowering of a PL levels in the follow-up. Thus, corticosteroids in APS in SLE patients influence LA more than aCL. SLE activity, corticosteroids therapy in APS are independent factors affecting aPL. Detection of aCL and LA in SLE is not the cause of prescription of high-dose corticosteroids.