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.

Development and Initial Validation of a Chronic Damage Index in Patients with Antiphospholipid Syndrome.

Amigo1,  Mary-Carmen, Barile2,  Leonor A., Barragan3,  Alberto, Espinosa-Cuervo4,  Gisela, Goycochea5,  Mavis, Martinez-Martinez6,  Laura Aline, Medina7,  Gabriela

ABC Medical Ctr, Mexico City, Mexico
Hospital Especialidades CMN, Mexico City, Mexico,
México, Mexico
Research Unit, Mexican College of Rheumatology, Mexico, Mexico
Instituto Mexicano del Seguro Social and Research Unit, Mexican College of Rheumatology, Mexico City, Mexico
Intituto Nacional de Cardiologia, Mexico, Mexico
Seris/Zachila s/n La Raza, Mexico City, Mexico
Instituto Nac de Cardiologia, Mexico City, Mexico
Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico


The antiphospholipid syndrome (APS) is defined by the presence of venous or arterial thrombosis or recurrent pregnancy complications in association with antiphospholipid antibodies. Certain key manifestations are associated with a worse prognosis and permanent organ damage; but, at this time, there is not a comprehensive assessment of accumulative damage APS


To describe the development and initial content, criterion and construct validity of a disease specific cumulative Damage Index in APS (DIAPS)


Phase 1 included generation for index content through an expert panel agreement, a list of items considered to reflect the damage in APS was generated in three rounds. An initial list of 60 manifestations linked with potential irreversible damage were identified by experts, then by an operative definition to report each manifestations was established; finally after independent revision by 3 clinicians experts in methodology and 3 APS experts a consensus round selected 47 items. A second phase was a cross-sectional study conducted in patients with APS diagnosis included in a multicentre electronic registry The output rating was determined by the physician if each manifestation was absent (0), present but without sequel (1), or present with sequel (2). The final score was made adding the output rating reflecting the damage for domains and global index. Quality of life related to health status was evaluated with Euroqol for construct validation, considering that this analysis could reflect a good agreement among the physicians on the assessment damage in the patients; a Cronbach and correlation with Euroqol scale were calculated with SPSS 18.0, (p<0.05)


DIAPS was evaluated in 139 cases, female 76.4% (113), the mean of the age at diagnosis 35.5 ± 12.4 years; primary APS diagnosis in 72.6% (119), APS plus SLE in 22% (36) and APS plus Sjögren in 1.8% (3). The most common comorbidities were obesity 24.3% (36), depression 18.2% (27) and dyslipidemia 14.2% (21). The most frequent manifestations conditioning sequels were: deep venous thrombosis 26.6% (37) and ischemic stroke 11.5% (16). Blindness 5.8% (8); retinal occlusive vessel disease 4.3% (6); myocardial infarction 2.9% (4); Cardiac valve requiring replacement 1.4% (2); sequel of mesenteric thrombosis (including liver, spleen and intestine) 3.6% (5) and renal insufficiency 1.4% (2); The index has a high homogeneity (a Cronbach 0.954). Questionnaire DIAPS showed correlation with Euroqol as follow: pain (r 0.479, p 0.000), mobility (r 0.425, p 0.000), personal care (r 0.344, p 0.000), daily activities (r 0.329, p 0.000), current health status (r 0.249, p 0.003) and anxiety/depression (r 0.192, p 0.025).


The preliminary validation study demonstrated content, criterion and construct validity of a new physician-reported instrument of APS damage. DIAPS has a good correlation with Euroqol. Further studies have to be conducted to examine reliability and psychometric properties in extended populations. DIAPS could be a useful clinical tool and a good instrument in epidemiological and economic evaluations to measure the real impact of this severe disease.

To cite this abstract, please use the following information:
Amigo, Mary-Carmen, Barile, Leonor A., Barragan, Alberto, Espinosa-Cuervo, Gisela, Goycochea, Mavis, Martinez-Martinez, Laura Aline, et al; Development and Initial Validation of a Chronic Damage Index in Patients with Antiphospholipid Syndrome. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :8

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