Hot topics in the antiphospholipid syndrome

Area of Science:

• Rheumatology
• Immunology

Background:

• Antiphospholipid syndrome (APS) poses challenges in pathogenesis understanding, diagnostic standardization, and treatment optimization.
• The 18th International Congress on Antiphospholipid Antibodies (ICAPA) convened in Kyoto in September 2025.

Purpose of the Study:

• To summarize key advancements and discussions from the 18th ICAPA.
• To highlight progress in APS pathogenesis, diagnostics, serology, biomarkers, therapeutics, obstetric APS, organ-specific manifestations, and disease activity assessment.

Main Methods:

• A narrative review summarizing selected highlights from the 18th ICAPA meeting.
• Discussion of topics including antibody-antigen interactions, diagnostic criteria, non-criteria antibodies, anticoagulation, biologic therapies, obstetric APS classification, and disease activity monitoring.

Main Results:

• Advances in understanding antibody-antigen interactions in APS.
• Discussion on distinguishing classification criteria from clinical diagnosis and the utility of non-criteria antibodies.
• Exploration of anticoagulation strategies, emerging biologic therapies, and the 2023 ACR/EULAR classification for obstetric APS.

Conclusions:

• The congress provided insights into various facets of APS, from basic science to clinical applications.
• Clinical implications of discussed findings are presented, alongside identified future research directions.
• Findings require cautious interpretation alongside established clinical guidelines due to varying levels of evidence.