Background Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are systemic autoimmune diseases that have overlaping irreversible organ damages. Since SLICC/ACR Damage Index (SDI) misses key features of APS, the Damage Index in patients with Thrombotic Antiphospholipid Syndrome (DIAPS) was proposed.
Objectives To assess the differences in indexes available for measuring organ damage in a cohort of patients with SLE and secondary APS.
Methods Clinical records of patients with SLE and secondary APS were reviewed. Data on medical history and clinical manifestations were collected. The two damage indexes, SDI and DIAPS, were applied. Comparison between the two indexes was done for each organ system affected.
Results Sixty five clinical charts were reviewed, 5 had been excluded for incomplete information. SDI and DIAPS was recorded in 60 patients. Patient's mean age was 45.05±14.61 years, with mean disease duration of 9.47±6.96 years. Mean SDI in our cohort was 4,15±2.58 and mean DIAPS – 4.08±3.41. SDI correlated significant to DIAPS (R=0.826, p<0.000). Neuropsyhiatric manifestations were found in 25 patients (41.7%). Their mean SDI value was 4.92±2.73 and DIAPS value of 5.52±3.47. DIAPS value was higher in the subgroup of patients with neuropsyhiatric (p=0.006) and respiratory system damage (p=0.037). This difference was not observed regarding SDI value. DIAPS value correlated significantly to neurological (R=0.397, p=0.002) and pulmonary damage (R=0.364, p=0.004), but not to SDI value. No diferrences were observed between the two scores regarding perypheral vascular manifestation (DIAPS p=0.221, SDI p=0.136) and renal involvement (DIAPS p=0.062, SDI p=0.078).
Conclusions SDI may underestimate APS related damage in patients with SLE and secondary regarding neurological and pulmonary organ involvement. Given the implications for high morbidity and mortality, DIAPS may be the appropriate damage score to be used.
P. Alba et al. Organ Damage and Quality of Life in Antiphospholipid Syndrome. Current Rheumatology Reports. February 2016, 18:7.
Barbhaiya et al. Utility of the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index for Antiphospholipid Antibody (aPL) Positive Patients. [abstract]. Arthritis Rheum 2011;63 Suppl 10:7.
Disclosure of Interest None declared