Background Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in SLE patients.
Objectives To investigate the association between the different aPL and SLE manifestations as well as to elucidate the influence of the load of antibodies.
Methods Patients from the RELESSER-T registry were included. RELESSER-T is a multicenter, hospital-based registry, with retrospective cross-sectional collection of data adult non-selected patients with SLE attending Spanish rheumatology services from the public national health system.
Results Out of a total of 3651 SLE patients, 1368 were positive for aPL (44.9% of patients were positive for anticardiolipin (aCL) antibodies, 27.3% for anti b2glycoprotein I (aB2GPI) and 24% for lupus anticoagulant (LA)). Regarding the load of antibodies, 20.6%, 12.1% and 4.8% were positive for one, two and three antibodies, respectively. The association between the different aPL, the number of positive antibodies and antiphospholipid syndrome related manifestations is showed in Table 1. Overall, all types of aPL were associated with classic APS manifestations, although LA, IgG isotypes, and patients with more than one aPL display a higher risk to develop clinical APS.
Regarding specific lupus manifestations, all aPL types showed a significant negative association with cutaneous manifestations. LA and aCL were associated with an increased risk of cardiac, respiratory and neuropsychiatric manifestations (p<0.001). Furthermore, LA was also associated with an increased risk of renal disease (p<0.001). aCL IgG was associated with a higher risk of specific lupus manifestations compared with aCL IgM. Interestingly, aB2GP IgG were only associated with an increased risk of seizures (p< 0.001). When evaluating the influence of the load of antibodies, we found that the risk of neuropsychiatric manifestations (p<0.001), as well as the cardiac (p=0.003), and pulmonary manifestations (p=0.001), significantly increased with a higher number of positive antibodies. Inversely, the risk of cutaneous symptoms decreased while the number of positive antibodies increased (OR 0.89, 95% CI 0.82-0.96, p=0.003).
Conclusion There is a hierarchy for aPL and the risk of APS and lupus manifestations. aCL, and especially LA, confer a higher risk for major organ involvement in SLE patients. IgG isotypes and the load of aPL antibodies increase the risk for clinical APS and major lupus manifestations.
Disclosure of Interests: Leyre Riancho-Zarrabeitia Grant/research support from: Abbvie, Pfizer, UCB, MSD, GSK, Amgen, Roche travel grants, Victor Martinez Taboada: None declared, Iñigo Rua-Figueroa: None declared, Fernando Sánchez-Alonso: None declared, María Galindo-Izquierdo: None declared, Juan Ovalles: None declared, Alejandro Olivé Grant/research support from: ND, Consultant for: ND, Paid instructor for: ND, Speakers bureau: ND, Antonio Fernandez-Nebro: None declared, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb, Raúl Menor-Almagro: None declared, Eva Tomero Muriel: None declared, Esther Uriarte Isacelaya: None declared, Alina Boteanu: None declared, Mariano Andres: None declared, Mercedes Freire González: None declared, Gregorio Santos Soler: None declared, Esther Ruiz Lucea: None declared, Mónica Ibañez Barceló: None declared, Ivan Castellví Consultant for: I received fees less than 5000USD as a consultant for Kern and Actelion, Paid instructor for: I received fees less than 2000 USD as a instructor for Boehringer -Ingelheim, Novartis and Gebro, Speakers bureau: ND, Carles Galisteo: None declared, Víctor Quevedo Vila: None declared, Enrique Raya: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Lorena Expósito: None declared, José A Hernandez Beriain: None declared, Loreto Horcada: None declared, Jose M Pego-Reigosa: None declared
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