Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Association of Traditional and Novel Antiphospholipid Antibody Assays with Thrombosis in SLE

Akhter1,  Ehtisham, Binder2,  Walter L., Shums2,  Zakera, Magder3,  Laurence, Petri4,  Michelle

Johns Hopkins University, Baltimore, MD,
Inova Diagnostics Inc, San Diego, CA,
University of MD, Baltimore, MD,
Johns Hopkins Univ, Baltimore, MD

Purpose:

The current APS classification criteria recognize the lupus anticoagulant, anticardiolipin (aCL) and anti-beta2 glycoprotein I (anti-beta2). We determined the association of anti-phosphatidylserine-prothrombin (PSPT) and D4/5 IgA (directed against the domain 4/5 fragment of beta2-GPI), as well as anti-beta2 and aCL, with thrombosis in SLE.

Method:

Stored sera from 314 SLE patients in a prospective database were studied. 206 had a history of thrombosis (87% female, 43% African-American, 50% Caucasian) and 108 did not (45% female, 31% African-American, 53% Caucasian). Assays were performed at INOVA Diagnostics, Inc.

Results:

Comparison of those with and without history of any type of thrombosis with respect to the percent positive for each antibody.

AssayThrombosis (n = 206) Number (% positive)No thrombosis (n = 108) Number (% positive)P-valueP-value when age, sex, and race are controlled
anti-beta2 IgA45 (22 %)16 (15%)0.180.23
anti-beta2 IgG24 (12%)3 (3%)0.0100.021
anti-beta2 IgM18 (8%)4 (4%)0.110.12
aCL IgA9 (4 %)1 (1%)0.1710.21
aCL IgG30 (15%)5 (5%)0.0080.016
aCL IgM27 (13%)7 (6%)0.0860.11
anti-PSPT IgG47 (23%)10 (9%)0.0030.001
anti-PSPT IgM43 (21%)8 (7%)0.0020.011
D4/5 IgA36 (18%)16 (15%)0.630.71
Comparison of those with and without a history of venous thrombosis with respect to the percent positive for each antibody.
AssayVenous Thrombosis (n = 123) Number (% positive)No venous thrombosis (n = 191) Number (% positive)P-valueP-value when age, sex, and race are controlled
anti-beta2 IgA29 (24 %)32 (17%)0.140.20
anti-beta2 IgG19 (15%)8 (4%)0.0010.005
anti-beta2 IgM11 (10%)10 (5%)0.170.20
aCL IgA5 (4 %)5 (3%)0.520.53
aCL IgG22 (18%)13 (7%)0.0030.006
aCL IgM15 (12%)19 (10%)0.580.63
anti-PSPT IgG34 (28%)23 (12%)0.0010.001
anti-PSPT IgM27 (22%)24 (13%)0.0410.13
D4/5 IgA20 (16%)32 (17%)1.000.94
No assay was significantly associated with history of arterial thrombosis.

Conclusion:

For any thrombosis, the anti-PSPT assay performed the best after adjustment for age, sex, and race. For venous thrombosis, anti-beta2 GPI, aCL, and anti-PSPT IgG assays performed equivalently. For IgM assays, only the anti-PSPT was significantly associated with thrombosis. This study suggests that anti-PSPT may have value in APS in SLE, and that only IgG assays may be cost-effective.

To cite this abstract, please use the following information:
Akhter, Ehtisham, Binder, Walter L., Shums, Zakera, Magder, Laurence, Petri, Michelle; Association of Traditional and Novel Antiphospholipid Antibody Assays with Thrombosis in SLE [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1215
DOI: 10.1002/art.26289

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