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Antibodies to domain I of β-2-glycoprotein I and IgA antiphospholipid antibodies in patients with ‘seronegative’ antiphospholipid syndrome
  1. Laura Cousins1,
  2. Charis Pericleous1,
  3. Munther Khamashta2,
  4. Maria Laura Bertolaccini2,
  5. Yiannis Ioannou1,3,
  6. Ian Giles1,
  7. Anisur Rahman1
  1. 1 Centre for Rheumatology Research, University College London, London, UK
  2. 2 Lupus Research Unit, The Rayne Institute, King's College London School of Medicine, London UK
  3. 3 Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
  1. Correspondence to Professor Anisur Rahman, Centre for Rheumatology Research, Division of Medicine, Fourth Floor Rayne Institute, 5 University Street, London WC1E 6JF, UK; anisur.rahman{at}

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The standard serological tests included in the classification criteria1 for antiphospholipid syndrome (APS) are those to detect immunoglobulin G (IgG) and IgM antibodies to cardiolipin (aCL) or β-2-glycoprotein I (anti-β2GPI) and the lupus anticoagulant. It is increasingly recognised, however, that some patients have typical thrombotic and non-thrombotic features of APS but test repeatedly negative in these routinely used assays. It has been suggested that these patients have the so-called seronegative APS (SN-APS).2 In a retrospective study, there were no significant differences in clinical manifestations between 87 patients with seropositive APS and 67 with SN-APS.3 Several authors have suggested that in these ‘seronegative’ patients, clinically relevant antibodies can be detected by looking for different isotypes, particularly IgA2 and/or different antigen specificity4 or by using different techniques4 ,5 than those of the routine assays. In a recent …

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