Korean J Lab Med.  2010 Feb;30(1):38-44. 10.3343/kjlm.2010.30.1.38.

Prevalence and Clinical Associations of Lupus Anticoagulant, Anticardiolipin Antibodies, and Anti-beta2-glycoprotein I Antibodies in Patients with Systemic Lupus Erythematosus

• Woo KS
• Kim KE
• Kim JM
• Han JY
• Chung WT
• Kim KH

• KMID: 1096817
• DOI: http://doi.org/10.3343/kjlm.2010.30.1.38

Abstract

BACKGROUND
The presence of antiphospholipid antibodies (aPLs) is associated with the clinical features of antiphospholipid syndrome (APS), which comprises venous and arterial thrombosis and pregnancy loss, and systemic lupus erythematosus (SLE). The prevalence of aPLs has been reported to be different in patient populations affected by either of these conditions. We performed a retrospective study to evaluate the prevalence and clinical associations of aPLs, including lupus anticoagulant (LAC), anticardiolipin (aCL), and anti-beta2-glycoprotein I antibodies (anti-beta2-GPI) in a cohort of Korean patients with SLE.
METHODS
This study included samples from 88 SLE patients for whom aPL testing had been advised between June 2006 and July 2009 at the Dong-A University Hospital. Serum and plasma samples were tested for LAC, aCL (IgG, IgM), and anti-beta2-GPI (IgG, IgM) antibodies. Clinical data from patients were obtained from a review of medical records.
RESULTS
LAC was the most common (34.1% of total patients, 30/88) antibody, followed by IgM aCL (31.8%, 28/88), IgG aCL (18.2%, 16/88), and IgM and IgG anti-beta2-GPI (both 5.7%, 5/88 each). Positivity for LAC was strongly associated with venous/arterial thrombosis (P=0.002).
CONCLUSIONS
LAC was the most common antibody detected in Korean SLE patients and is shown to have a significant association with the presence of venous/arterial thrombosis. The measurement of LAC may be clinically useful in identifying patients with SLE who are at a high risk for venous/arterial thrombosis.

Keyword

lupus erythematosus; Antiphospholipid antibodies; Antiphospholipid syndrome

MeSH Terms

Adolescent
Adult
Antibodies, Anticardiolipin/*blood
Antibodies, Antiphospholipid/*blood
Cohort Studies
Female
Humans
Immunoglobulin G/blood
Immunoglobulin M/blood
Lupus Coagulation Inhibitor/*blood
Lupus Erythematosus, Systemic/epidemiology/*immunology
Male
Middle Aged
Pregnancy
Prevalence
Retrospective Studies
Risk Factors
Venous Thrombosis/epidemiology/immunology

Reference

1.Sammaritano LR., Gharavi AE., Lockshin MD. Antiphospholipid antibody syndrome: immunologic and clinical aspects. Semin Arthritis Rheum. 1990. 20:81–96.

2.Love PE., Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med. 1990. 112:682–98.

3.Uthman I., Godeau B., Taher A., Khamashta M. The hematologic manifestations of the antiphospholipid syndrome. Blood Rev. 2008. 22:187–94.

4.Miyakis S., Lockshin MD., Atsumi T., Branch DW., Brey RL., Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006. 4:295–306.

5.Galli M., Luciani D., Bertolini G., Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood. 2003. 101:1827–32.

6.Galli M., Barbui T. Antiphospholipid antibodies and pregnancy. Best Pract Res Clin Haematol. 2003. 16:211–25.

7.Somers E., Magder LS., Petri M. Antiphospholipid antibodies and incidence of venous thrombosis in a cohort of patients with systemic lupus erythematosus. J Rheumatol. 2002. 29:2531–6.

8.Tsutsumi A., Matsuura E., Ichikawa K., Fujisaku A., Mukai M., Kobayashi S, et al. Antibodies to beta 2-glycoprotein and clinical manifestations in patients with systemic lupus erythematosus. Arthritis Rheum. 1996. 39:1466–74.

9.Sahin M., Duzgun N., Tunc SE., Tutkak H. Antibodies to beta2-glycoprotein-I: relation of anticardiolipin antibodies with clinical and laboratory parameters in patients with systemic lupus erythematosus. Clin Biochem. 2007. 40:526–30.

10.Mok CC., Tang SS., To CH., Petri M. Incidence and risk factors of thromboembolism in systemic lupus erythematosus: a comparison of three ethnic groups. Arthritis Rheum. 2005. 52:2774–82.

11.Lee SS., Cho ML., Joo YS., Kim WU., Hong YS., Min JK, et al. Isotypes of anti-beta2-glycoprotein I antibodies: association with thrombosis in patients with systemic lupus erythematosus. J Rheumatol. 2001. 28:520–4.

12.Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997. 40:1725.

13.Ghirardello A., Doria A., Ruffatti A., Rigoli AM., Vesco P., Calligaro A, et al. Antiphospholipid antibodies (aPL) in systemic lupus erythematosus. Are they specific tools for the diagnosis of aPL syndrome? Ann Rheum Dis. 1994. 53:140–2.

14.Petri M. Epidemiology of the antiphospholipid antibody syndrome. J Autoimmun. 2000. 15:145–51.

15.Danowski A., Kickler TS., Petri M. Anti-beta2-glycoprotein I: prevalence, clinical correlations, and importance of persistent positivity in patients with antiphospholipid syndrome and systemic lupus erythematosus. J Rheumatol. 2006. 33:1775–9.

16.Mok MY., Chan EY., Fong DY., Leung KF., Wong WS., Lau CS. Antiphospholipid antibody profiles and their clinical associations in Chinese patients with systemic lupus erythematosus. J Rheumatol. 2005. 32:622–8.

17.Lee SG., Cha HS., Yang YS. The association of HLA-DRB1 and DQB1 alleles and a study of anticardiolipin antibody and anti-beta2 glycoprotein I antibody in Korean SLE patients. Immune Netw. 2002. 2:227–32.

18.Swadܚba J., Iwaniec T., Szczeklik A., Musial J. Revised classification criteria for antiphospholipid syndrome and the thrombotic risk in patients with autoimmune diseases. J Thromb Haemost. 2007. 5:1883–9.

19.Scientific and Standardization Committee. Lupus AntiCoagulant/Phospholipid-dependent antibodies. Annual Report. Boston: International Society for Thrombosis and Haemostasis. 2002.

20.Obermoser G., Bitterlich W., Kunz F., Sepp NT. Clinical significance of anticardiolipin and anti-β2-glycoprotein I antibodies. Int Arch Allergy Immunol. 2004. 135:148–53.

21.Nash MJ., Camilleri RS., Kunka S., Mackie IJ., Machin SJ., Cohen H. The anticardiolipin assay is required for sensitive screening for antiphospholipid antibodies. J Thromb Haemost. 2004. 2:1077–81.

22.Martinez-Berriotxoa A., Ruiz-Irastorza G., Egurbide MV., Garmendia M., Gabriel Erdozain J., Villar I, et al. Transiently positive anticardiolipin antibodies and risk of thrombosis in patients with systemic lupus erythematosus. Lupus. 2007. 16:810–6.

23.Arvieux J., Roussel B., Jacob MC., Colomb MG. Measurement of antiphospholipid antibodies by ELISA using β2-glycoprotein I as an antigen. J Immunol Methods. 1991. 143:223–9.

24.Lee EY., Lee CK., Lee TH., Chung SM., Kim SH., Cho YS, et al. Does the anti-beta2-glycoprotein I antibody provide additional information in patients with thrombosis? Thromb Res. 2003. 111:29–32.

25.Ebeling F., Pettersson T., Muukkonen L., Vahtera E., Rasi V. Beta-2-glycoprotein I antibodies in patients with thrombosis. Scand J Clin Lab Invest. 2003. 63:111–8.

26.Stasi R., Stipa E., Masi M., Oliva F., Sciarra A., Perrotti A, et al. Prevalence and clinical significance of elevated antiphospholipid antibodies in patients with idiopathic thrombocytopenic purpura. Blood. 1994. 84:4203–8.

27.Cervera R., Piette JC., Font J., Khamashta MA., Shoenfeld Y., Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum. 2002. 46:1019–27.

28.Kim TM., Kim JS., Han SW., Hong YS., Kim I., Ha J, et al. Clinical predictors of recurrent venous thromboembolism: a single institute experience in Korea. Thromb Res. 2009. 123:436–43.