Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Association of IgG, IgM, and IgA Isotypes of Anticardiolipin Alone or In Combination In Prediction of Thrombosis In Systemic Lupus Erythematosus.
Domingues, Vinicius, Fang, Hong, Petri, Michelle, Hopkins, Johns
Background/Purpose:
The Sydney APS Classification Criteria include medium to high titer anticardiolipin IgG or IgM. We explored the association of all anticardiolipin isotypes, singly or in combination, with thrombosis in SLE.
Methods:
There were 1567 SLE patients (92% female, 55% Caucasian, 37% African-American, mean age at entry 39.6±12.9) who participated. There were 668 total thrombotic events (arteral: total 328, TIA 67, stroke 129, myocardial infarction 58, digital gangrene 31, other arterial 45; venous: total 340, DVT or PE 211, superficial 54, other venous 75). Anticardiolipin IgG, IgM, or IgA were assessed at each visit (Inova Diagnostics Inc, San Diego, CA), with cut-offs of 20 for medium positive and 40 for high positive.
Results:
| Assay | OR | P-value |
|---|---|---|
| Venous Thrombosis | ||
| IgG > 20 ever pos | 2.26 (1.70,3.00) | <0.0001 |
| IgG > 40 ever pos | 2.34 (1.65,3.34) | <0.0001 |
| IgM > 20 ever pos | 1.32 (0.98,1.78) | 0.0688 |
| IgM > 40 ever pos | 1.46 (1.01,2.11) | 0.0432 |
| IgA > 20 ever pos | 2.17 (1.42,3.31) | 0.0006 |
| IgA > 40 ever pos | 2.14 (1.18,3.87) | 0.0176 |
| IgG > 20 OR IgM > 20 ever pos | 1.79 (1.38,2.32) | <0.0001 |
| IgG > 40 OR IgM > 40 ever pos | 1.81 (1.34,2.45) | 0.0002 |
| IgG > 20 OR IgA > 20 ever pos | 2.06 (1.56,2.71) | <0.0001 |
| IgG > 40 OR IgA > 40 ever pos | 2.03 (1.44,2.87) | 0.0001 |
| Arterial Thrombosis | ||
| IgG > 20 ever pos | 1.95 (1.45,2.620 | <0.0001 |
| IgG > 40 ever pos | 2.39 (1.67,3.43) | <0.0001 |
| IgM > 20 ever pos | 1.42 (1.05,1.93) | 0.0264 |
| IgM > 40 ever pos | 1.68 (1.16,2.44) | 0.0081 |
| IgA > 20 ever pos | 1.99 (1.28,3.09) | 0.0036 |
| IgA > 40 ever pos | 2.75 (1.55,4.98) | 0.0013 |
| IgG > 20 OR IgM > 20 ever pos | 1.70 (1.30,2.23) | 0.0002 |
| IgG > 40 OR IgM > 40 ever pos | 1.96 (1.44,2.67) | <0.0001 |
| IgG > 20 OR IgA > 20 ever pos | 1.79 (1.34,2.39) | <0.0001 |
| IgG > 40 OR IgA > 40 ever pos | 2.49 (1.77,3.52) | <0.0001 |
| Stroke | ||
| IgG > 20 ever pos | 1.74 (1.17,2.60) | 0.0087 |
| IgG > 40 ever pos | 2.19 (1.37,3.51) | 0.0025 |
| IgM > 20 ever pos | 1.34 (0.89,2.03) | 0.1787 |
| IgM > 40 ever pos | 1.25 (0.74,2.11) | 0.3910 |
| IgA > 20 ever pos | 1.54 (0.84,2.84) | 0.1528 |
| IgA > 40 ever pos | 2.02 (0.93,4.37) | 0.772 |
| IgG > 20 OR IgM > 20 ever pos | 1.53 (1.06,2.21) | 0.0242 |
| IgG > 40 OR IgM > 40 ever pos | 1.70 (1.12,2.58) | 0.0506 |
| IgG > 20 OR IgA > 20 ever pos | 1.51(1.02,2.24) | 0.0506 |
| IgG > 40 OR IgA > 40 ever pos | 2.00 (1.26,3.17) | 0.0045 |
Conclusion:
Analysis of single isotypes found that IgG or IgA, > 20 or > 40 (but not IgM) were associated with venous thrombosis. For arterial thrombosis, all single isotypes were associated. For stroke, only IgG was associated. Combinations of isotypes surprisingly did not add to the strength of the association nor to the statistical significance. We conclude that: 1) the association depends on whether it is venous thrombosis, arterial thrombosis, or stroke (which is important predictive information for clinicians); 2) IgA anticardiolipin should be added to the classification criteria for APS in SLE, as it performs better than IgM; and 3) combining different isotypes of anticardiolipin does not improve the association.
To cite this abstract, please use the following information:
Domingues, Vinicius, Fang, Hong, Petri, Michelle, Hopkins, Johns; Association of IgG, IgM, and IgA Isotypes of Anticardiolipin Alone or In Combination In Prediction of Thrombosis In Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :3
DOI:
