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Multiple antiphospholipid tests do not increase the diagnostic yield in antiphospholipid syndrome
M L Bertolaccini1, B Roch, O Amengual
1Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, London.
British Journal of Rheumatology
|December 16, 1998
Summary
Screening with multiple antiphospholipid antibody (aPL) tests, beyond anticardiolipin antibodies (aCL) and lupus anticoagulant (LA), does not improve the diagnosis of antiphospholipid syndrome (APS). This study found no significant diagnostic value in testing for antibodies against phosphatidylserine, phosphatidylinositol, phosphatidic acid, phosphatidylcholine, or phosphatidylethanolamine in SLE patients with suspected APS.
Area of Science:
- Immunology
- Rheumatology
- Clinical Diagnostics
Background:
- Antiphospholipid antibodies (aPL) are autoantibodies targeting phospholipids and associated plasma proteins.
- Anticardiolipin antibodies (aCL) and lupus anticoagulant (LA) are standard screening tests for aPL, linked to thrombotic events in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).
- The diagnostic utility of other aPL, including antibodies against phosphatidylserine (aPS), phosphatidylinositol (aPI), phosphatidic acid (aPA), phosphatidylcholine (aPC), and phosphatidylethanolamine (aPE), remains unclear.
Purpose of the Study:
- To determine if employing multiple aPL tests enhances the diagnostic accuracy for APS.
- To investigate the prevalence and potential diagnostic significance of less common aPL in SLE patients.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) was used to detect IgG/M/A antibodies against aPS, aPI, aPA, aPC, and aPE.
- Patient groups included SLE patients with suspected APS but negative aCL/LA (Group 1), SLE patients without APS features (Group 2), and SLE patients with confirmed APS (Group 3).
- A larger cohort of 207 SLE patients was subsequently tested for aPE to validate initial findings.
Main Results:
- In SLE patients with suspected APS but negative aCL/LA, only one patient tested positive for IgA aPE, with no other aPL detected.
- Prevalence of other aPL in SLE patients without APS features was low, with aPE detected in 12.5% of cases.
- In SLE patients with confirmed APS, a high prevalence of aPS (54%), aPI (46%), aPA (63%), and aPE (29%) was observed, alongside aPC (17%). However, aPE showed no association with clinical APS features in an extended cohort.
Conclusions:
- Screening for aPL beyond standard aCL and LA tests does not significantly increase the diagnostic yield for APS.
- The presence of antibodies like aPE in SLE patients, even those without APS, suggests a need for further research into their specific roles.
- Current diagnostic criteria for APS relying on aCL and LA remain the primary screening tools.