Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Prevalence and Prognostic Significance of Thrombotic Microangiopathy in Rheumatologic Patients: Clinical and Immunological Associations.
Aslanidis, Spyros, Pyrpasopoulou, Athina, Douma, Stella, Triantafyllou, Areti, Doumas, Michail, Zamboulis, Chrysanthos
The aim of this study was to assess the prevalence of microangiopathy in rheumatologic patients featuring signs of vasculopathy. As the occurrence of small-vessel occlusions (thrombotic microangiopathy) in the nail fold of patients with antiphospholipid syndrome is well documented, a major target point of this study was to evaluate capillaroscopy in the diagnosis of APS. Capillaroscopic findings and matching autoantibody profiling were subsequently correlated with the incidence of arterial and venous thrombotic events.
738 patients from a Rheumatology Outpatients cohort were consecutively screened with capillaroscopy. Criteria for selection included Raynaud's phenomenon, livedo reticularis, diagnosis of SLE, positive antiphospholipid profile and/or previous thrombotic events, and atypical musculoskeletal symptomatology. Scleroderma patients were excluded. Patients with microhemorrhages were tested for ACL and anti-b2GP1 Abs and data was analyzed with the SPSS 16.0 software.
149 of the screened patients (85.2%[female]/14.8%[male], 49.28±14.31 yrs) exhibited capillary microhemorrhages. Running diagnosis in these patients was MCTD (24.2%), SLE (18.8%), RA (16.1%), APS (12.8%), Sjogren's syndrome (4.7%), B51 (3.4%), and vasculitis (2%). Antiphospholipid profile was tested in the affected individuals, and revealed an additional 14.7% of secondary laboratory APS in 28.6% of the SLE and 22.2% of the MCTD patients. The presence of ACL and anti-b2GP1 Abs was found to both independently significantly correlate with thrombotic events (p<0.001). Subanalysis of the type of anti-b2GP1 Abs indicated that the correlation with thrombotic events was significant for G-type (p<0.001) and M-type (p=0.012), but not A-type Abs (p=0.292, NS). No significant predilection for arterial or venous thromboses was observed in patients with ACL Abs; patients with anti-b2GP1 Abs exhibited a trend for arterial thromboses, p=0.174, NS.
Capillaroscopy is a useful microangiopathy screening tool in rheumatologic patients featuring signs of clinical vasculopathy, and can aid diagnostically to screen for, or verify, APS in patients with a history of thrombotic events. Associations of autoantibody profiling of patients with capillaroscopic microangiopathy with clinically manifested thromboses resulted in similar findings with studies involving patients with clinical APS. The observation that, although IgA-b2GP1 Abs were detected in patients with microangiopathy, they lacked any significant association with thrombotic complications, suggests, that additional factors may be needed for the development of clinical thrombotic events.
To cite this abstract, please use the following information:
Aslanidis, Spyros, Pyrpasopoulou, Athina, Douma, Stella, Triantafyllou, Areti, Doumas, Michail, Zamboulis, Chrysanthos; Prevalence and Prognostic Significance of Thrombotic Microangiopathy in Rheumatologic Patients: Clinical and Immunological Associations. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :11