Advertisement

Clinical Rheumatology

, Volume 38, Issue 2, pp 347–351 | Cite as

Antiphospholipid antibodies in adult IgA vasculitis: observational study

  • Alojzija HočevarEmail author
  • Žiga Rotar
  • Polona Žigon
  • Saša Čučnik
  • Jaka Ostrovršnik
  • Matija Tomšič
Brief Report
Part of the following topical collections:
  1. Rheumatology in Slovenia: Clinical practice and translational research

Abstract

We evaluated the occurrence of antiphospholipid antibodies (aPLs) in acute adult IgA vasculitis (IgAV), and potential correlations with IgAV clinical presentation. We determined lupus anticoagulants (LAs) and IgG, IgM, and IgA isotypes of anticardiolipin antibodies (aCL), antibodies against β2-glycoprotein I (aβ2GPI) and against the phosphatidylserine-prothrombin complex (aPS/PT) in prospectively collected, histologically proven IgAV, diagnosed for the first time between January 2013 and February 2018 at our secondary/tertiary rheumatology center. During the 62 months, we determined aPLs in 125 IgAV patients (56.8% male; median (IQR) age 64.7 (48.6–78.2) years). Sixty-four (51.2%) patients had aPLs. We found LAs, aPS/PT, aβ2GPI, and aCL in 24.8%, 21.6%, 13.6%, and 11.2% of cases, respectively. With 17.6%, the IgA aPS/PT was the most common aPL subtype. aPL-positive and aPL-negative patients did not differ in the clinical presentation of acute IgAV or in the frequency of thrombotic events. aPL-positive IgAV patients had significantly higher erythrocyte sedimentation rate (p < 0.001), and C-reactive protein (p < 0.001). The subset of IgA aPS/PT-positive patients more commonly had renal involvement in acute disease (RR 2.4 (95% CI 1.6–3.7)). aPLs are commonly detected during acute IgAV episodes. Patients with aPLs have similar clinical presentation, but higher markers of inflammation at than those without them. The subset of IgAV patients with IgA aPS/PT more commonly had renal involvement.

Keywords

Antiphospholipid antibodies Henoch-Schönlein purpura IgA vasculitis 

Notes

Funding

The study was funded by the Slovenian national research grant P3-0314.

Compliance with ethical standards

Disclosures

None.

Ethics approval and consent to participate

The informed consent for this study was not required nor obtained. The study was approved by the Slovenian National medical ethics committee.

References

  1. 1.
    Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CGM, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DGI, Specks U, Stone JH, Takahashi K, Watts RA (2013) 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65:1–11.  https://doi.org/10.1002/art.37715 CrossRefGoogle Scholar
  2. 2.
    Hocevar A, Rotar Z, Ostrovrsnik J et al (2014) Incidence of IgA vasculitis in the adult Slovenian population. Br J Dermatol 171:524–527.  https://doi.org/10.1111/bjd.12946 CrossRefGoogle Scholar
  3. 3.
    Hocevar A, Rotar Z, Jurcic V et al (2015) Patient age, gender and extent of purpura may suggest short-term outcomes in adults with IgA vasculitis. Rheumatology (Oxford) 54:1330–1332.  https://doi.org/10.1093/rheumatology/kev122 CrossRefGoogle Scholar
  4. 4.
    Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D (2002) Henoch-Schonlein purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 13:1271–1278CrossRefGoogle Scholar
  5. 5.
    Miyakis S, Lockshin MD, Atsumi T et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306.  https://doi.org/10.1111/j.1538-7836.2006.01753.x CrossRefGoogle Scholar
  6. 6.
    de Groot PG, Urbanus RT (2015) Antiphospholipid syndrome -- not a noninflammatory disease. Semin Thromb Hemost 41:607–614.  https://doi.org/10.1055/s-0035-1556725 CrossRefGoogle Scholar
  7. 7.
    Lally L, Sammaritano LR (2015) Vasculitis in antiphospholipid syndrome. Rheum Dis Clin N Am 41:109–123.  https://doi.org/10.1016/j.rdc.2014.09.009 CrossRefGoogle Scholar
  8. 8.
    Tomasson G, Monach PA, Merkel PA (2009) Thromboembolic disease in vasculitis. Curr Opin Rheumatol 21:41–46.  https://doi.org/10.1097/BOR.0b013e32831de4e7 CrossRefGoogle Scholar
  9. 9.
    Kawakami T, Watabe H, Mizoguchi M, Soma Y (2006) Elevated serum IgA anticardiolipin antibody levels in adult Henoch-Schonlein purpura. Br J Dermatol 155:983–987.  https://doi.org/10.1111/j.1365-2133.2006.07457.x CrossRefGoogle Scholar
  10. 10.
    Kawakami T, Yamazaki M, Mizoguchi M, Soma Y (2008) High titer of serum antiphospholipid antibody levels in adult Henoch-Schonlein purpura and cutaneous leukocytoclastic angiitis. Arthritis Rheum 59:561–567.  https://doi.org/10.1002/art.23528 CrossRefGoogle Scholar
  11. 11.
    Kimura S, Takeuchi S, Soma Y, Kawakami T (2013) Raised serum levels of interleukins 6 and 8 and antiphospholipid antibodies in an adult patient with Henoch-Schonlein purpura. Clin Exp Dermatol 38:730–736.  https://doi.org/10.1111/ced.12089 CrossRefGoogle Scholar
  12. 12.
    Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S, Flossmann O, Hall C, Hollywood J, Jayne D, Jones R, Lanyon P, Muir A, Scott D, Young L, Luqmani RA (2009) Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis 68:1827–1832.  https://doi.org/10.1136/ard.2008.101279 CrossRefGoogle Scholar
  13. 13.
    Božič B, Stegnar M, Kveder T et al (1997) Influence of degraded phosphatidylserine on binding of antiphospholipid antibodies. Int Arch Allergy Immunol 112:19–26.  https://doi.org/10.1159/000237426 CrossRefGoogle Scholar
  14. 14.
    Čučnik S, Ambrožič A, Božič B et al (2000) Anti-beta2-glycoprotein I ELISA: methodology, determination of cut-off values in 434 healthy Caucasians and evaluation of monoclonal antibodies as possible international standards. Clin Chem Lab Med 38:777–783.  https://doi.org/10.1515/CCLM.2000.111 Google Scholar
  15. 15.
    Zigon P, Ambrozic A, Cucnik S et al (2011) Modified phosphatidylserine-dependent antiprothrombin ELISA enables identification of patients negative for other antiphospholipid antibodies and also detects low avidity antibodies. Clin Chem Lab Med 49:1573–1018.  https://doi.org/10.1515/CCLM.2011.162 Google Scholar
  16. 16.
    Petri M (2000) Epidemiology of the antiphospholipid antibody syndrome. J Autoimmun 15:145–151.  https://doi.org/10.1006/jaut.2000.0409 CrossRefGoogle Scholar
  17. 17.
    Stassen PM, Derks RP, Kallenberg CG, Stegeman CA (2008) Venous thromboembolism in ANCA-associated vasculitis--incidence and risk factors. Rheumatology (Oxford) 47:530–534.  https://doi.org/10.1093/rheumatology/ken035 CrossRefGoogle Scholar
  18. 18.
    Kimball AS, Obi AT, Diaz JA, Henke PK (2016) The emerging role of NETs in venous thrombosis and immunothrombosis. Front Immunol 7:236.  https://doi.org/10.3389/fimmu.2016.00236 CrossRefGoogle Scholar
  19. 19.
    Rao AN, Kazzaz NM, Knight JS (2015) Do neutrophil extracellular traps contribute to the heightened risk of thrombosis in inflammatory diseases? World J Cardiol 7:829–842.  https://doi.org/10.4330/wjc.v7.i12.829 CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  1. 1.Department of RheumatologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
  2. 2.Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia

Personalised recommendations