Update on anti-phospholipid antibodies in SLE: the Hopkins' Lupus Cohort

Area of Science:

• Immunology
• Rheumatology
• Hematology

Background:

• Anti-phospholipid antibodies (aPLs) are frequently detected in patients with systemic lupus erythematosus (SLE).
• Prevalence rates in the Hopkins' Lupus Cohort include 47% for anti-cardiolipin, 32.5% for anti-beta(2)-glycoprotein I, and 26% for lupus anticoagulant (LA).

Purpose of the Study:

• To investigate the prevalence of various anti-phospholipid antibodies in SLE patients.
• To determine the association between specific aPLs and thrombotic events, including deep venous thrombosis (DVT), pulmonary embolism (PE), arterial thrombosis, and myocardial infarction (MI).

Main Methods:

• Analysis of patient data from the Hopkins' Lupus Cohort.
• Detection of anti-cardiolipin, anti-beta(2)-glycoprotein I, and lupus anticoagulant (using dRVVT confirmatory testing).
• Longitudinal assessment of thrombotic event occurrence over 20 years for patients with LA.

Main Results:

• Lupus anticoagulant is the most prevalent antibody associated with significant thrombotic risk.
• SLE patients with LA have a 50% risk of DVT/PE within 20 years.
• LA is uniquely associated with arterial thrombosis, venous thrombosis, and myocardial infarction, unlike other aPLs.
• Anti-phospholipid antibodies were not found to be associated with atherosclerosis.

Conclusions:

• Anti-phospholipid antibodies, particularly lupus anticoagulant, are significant risk factors for thrombosis in SLE patients.
• Lupus anticoagulant is a strong predictor of major thrombotic events, including arterial and venous thrombosis and myocardial infarction.
• Routine screening for aPLs, especially LA, is crucial for risk stratification and management of thrombotic complications in SLE.