Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Acute Transverse Myelitis and Antiphospholipid Antibodies in Lupus-No Evidence for Anticoagulation
Katsiari1, Christina G., Giavri1, Irene, Mitsikostas2, Dimos D., Yiannopoulou3, Konstantina G., Sfikakis1, Peter P.
First Department of Propaedeutic and Internal Medicine. Laikon Hospital, Athens University Medical School, Athens, Greece,
Department of Neurology, Athens Naval and Veterans Hospital. Athens, Greece,
Neurology Service Laikon Hospital, Athens, Greece
Current views suggest that the prothrombotic properties of antiphospholipid antibodies (aPL) have a role in the development of acute transverse myelitis (ATM) in patients with systemic lupus erythematosus (SLE). Although, trials assessing the role of aPL in SLE-associated ATM have not been possible to conduct due to the rarity of this condition, empiric anticoagulation is included in these patients' treatment. We performed a systemic review of the literature to explore, 1) the clinical and prognostic value of the presence of aPL antibodies in patients with lupus myelitis and 2) the effectiveness of anticoagulation.
We systematically searched Medline using the terms: myelitis, myelopathy and lupus. Publications presenting cases of lupus myelitis that provided data on aPL antibodies were obtained. Selection of myelitis cases was based on the proposed diagnostic criteria of acute transverse myelitis: we included only cases where magnetic resonance imaging was performed 1) to exclude other pathologies and 2) to confirm myelitis. In cases where MRI was normal, we searched for other evidence of spinal cord inflammation as confirmed by pleocytosis and abnormal IgG index in cerebrospinal fluid (CSF). Demographic data as well as data on presentation, treatment and outcome were extracted from the literature. Neurological impairment was measured using the Expanded Disability Status Scale (EDSS, score range: 0 10). Statistical analysis was performed using the Mann-Whitney and the Fisher's exact tests.
We report on a total of 67 patients (age range:1558 years, 89% women, 66% with continuous involvement of >=3 spinal segments, referred also as longitudinal ATM). Thirty-six patients (54%) were aPL-positive and did not differ in respect to demographic characteristics, clinical and laboratory SLE manifestations from aPL-negative patients. The presence of aPL did not predict the involvement of the thoracic part of the spine, which has been postulated to reflect a predominantly thrombosis-induced injury. The presence of aPL antibodies did not correlate with relapsing ATM, additional lupus CNS manifestations or worse clinical outcome. An unfavourable outcome could be predicted by paralysis and abnormal CSF findings at presentation (p=0.04 and 0.02, respectively), irrespective of the presence of aPL. While all patients received major immunosuppressive regiments, severe neurological impairment (EDSS score >7) was found primarily in aPL-negative patients (p=0.03). Anticoagulation was more frequently applied in aPL-positive patients (p=0.04), but any additional therapeutic effect was not evident.
Detection of circulating aPL appears unreliable to suggest a thrombotic cause and inadequate to support the therapeutic use of anticoagulation. Creation of a registry for ATM in SLE patients is needed to obtain more definite answers on the role of aPL in this condition.
To cite this abstract, please use the following information:
Katsiari, Christina G., Giavri, Irene, Mitsikostas, Dimos D., Yiannopoulou, Konstantina G., Sfikakis, Peter P.; Acute Transverse Myelitis and Antiphospholipid Antibodies in Lupus-No Evidence for Anticoagulation [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1572