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Anticardiolipin antibodies in pediatric systemic lupus erythematosus
A Ravelli1, R Caporali, G Di Fuccia
1Pediatric Clinic, Istituto di Ricovero e Cura a Carattere Scientifico S Matteo, Italy.
Insights
Anticardiolipin antibodies (ACLs) are common in children with systemic lupus erythematosus (SLE). High IgG ACL levels are linked to central nervous system issues, but ACLs have low predictive value for thrombosis.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Autoimmune Diseases
Background:
- Systemic lupus erythematosus (SLE) is a complex autoimmune disease affecting children.
- Antiphospholipid antibodies, including anticardiolipin antibodies (ACLs), are associated with autoimmune conditions.
- Understanding the role of ACLs in pediatric SLE is crucial for risk stratification and management.
Purpose of the Study:
- To determine the prevalence of anticardiolipin antibodies (ACLs) in children diagnosed with SLE.
- To investigate the clinical significance and associations of ACLs with disease activity and specific manifestations in pediatric SLE patients.
Main Methods:
- A study involving 30 children diagnosed with SLE, aged 4.9 to 16.5 years.
- Utilized a cross-sectional and longitudinal design to assess ACL prevalence and changes over time.
- Measured IgG and IgM ACL levels and correlated them with clinical and laboratory markers of SLE activity and complications.
Main Results:
- A high prevalence of ACLs was observed, with 87% of patients testing positive for IgG or IgM ACLs.
- Elevated IgG ACL levels showed a trend towards association with autoimmune cytopenia and inverse association with renal disease.
- High IgG ACL levels correlated with certain SLE activity markers and were frequently observed in patients with neuropsychiatric manifestations and autoimmune cytopenia.
Conclusions:
- Anticardiolipin antibodies (ACLs) are frequently detected in children with pediatric SLE.
- High levels of IgG ACLs are significantly associated with central nervous system involvement in this cohort.
- The predictive value of ACLs for the development of vascular thrombosis in pediatric SLE appears to be low.
Objective:
To investigate the prevalence and the clinical significance of anticardiolipin antibodies (ACLs) in a group of children with systemic lupus erythematosus (SLE).
Design:
Cross-sectional and longitudinal study.
Setting:
Pediatric Clinic, University of Pavia, Italy.
Participants:
Thirty children (aged 4.9 to 16.5 years) with SLE.
Measurements And Main Results:
Twenty-six (87%) of the 30 patients were initially positive for either IgG or IgM ACLs; 24 (80%) of 30 had IgG ACLs, and 15 (50%) of 30 had IgM ACLs. The cross-sectional analysis showed a trend for IgG ACLs to be positively associated with autoimmune cytopenia and negatively associated with renal disease. The levels of ACLs, particularly of the IgG isotype, tended to correlate with SLE activity as expressed by the complement fraction C3, the erythrocyte sedimentation rate, or the SLE Activity Measure, but not by the SLE Disease Activity Index or the anti-DNA antibodies. Serial determinations of ACL levels in 20 patients revealed frequent fluctuations. High levels of IgG ACLs (> 50 arbitrary units) were observed in nine patients; all nine had active disease and eight had one or more clinical features that have been previously associated with antiphospholipid antibodies: neuropsychiatric manifestations in six patients, autoimmune cytopenia in two patients, and avascular necrosis of bone in one patient. Only one patient experienced an overt episode of vascular thrombosis; IgG ACLs were positive at a medium level 6 months before the thrombotic event, but their level was unchanged when the thrombosis was discovered; the lupus anticoagulant test was positive at time of the thrombosis.
Conclusions:
Our results show that in pediatric SLE, ACLs are frequently found, high levels of IgG ACLs are often associated with central nervous system involvement, and ACLs have a low predictive value in the development of vascular thrombosis.