Clinical Reviews in Allergy & Immunology

, Volume 25, Issue 1, pp 61–77 | Cite as

Unusual manifestations of the antiphospholipid syndrome

  • Ronald A. Asherson
  • Ricard Cervera


The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein “cofactor” b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents—either stroke or transient ischemic attacks—are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these “unusual” manifestations are reviewed.

Index Entries

Antiphospholipid syndrome anticardiolipin antibodies lupus anticoagulant antiphospholipid antibodies 


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  1. 1.
    Asherson, R. A., Cervera, R., Piette, J. C., and Shoenfeld, Y. (2002), in The Antiphospholipid Syndrome II—Autoimmune Thrombosis. Asherson, R. A., Cervera, R., Piette, J. C., and Shoenfeld, Y., eds. Elsevier, Amsterdam, pp. 3–9.Google Scholar
  2. 2.
    Cervera, R., Piette, J. C., Font, J., et al. (2002), Arthritis Rheum. 46, 1019–1027.PubMedGoogle Scholar
  3. 3.
    Alarcón-Segovia, D. and Osmundson, P. J. (1965), Ann. Intern. Med. 62, 907–919.PubMedGoogle Scholar
  4. 4.
    Bird, A. G., Lendrum, R., Asherson, R. A., and Hughes, G. R. V. (1987), Ann. Rheum. Dis. 46, 251–255.PubMedGoogle Scholar
  5. 5.
    Asherson, R. A., Derksen, R. H. W. M., Harris, E. N. et al. (1986), J. Rheumatol. 13, 740–747.PubMedGoogle Scholar
  6. 6.
    Jindal, B. K., Martin, M. F. R., and Gayner, A. (1983), Ann. Rheum. Dis. 42, 347–349.PubMedGoogle Scholar
  7. 7.
    Hall, S., Buettner, H., and Luthra, H. S. (1984), J. Rheumatol. 11, 846–850.PubMedGoogle Scholar
  8. 8.
    Ferrante, F. M., Myerson, G. E., and Goldman, J. A. (1982), Arthritis Rheum. 25, 1501–1504.PubMedGoogle Scholar
  9. 9.
    Asherson, R. A., Harris, E. N., Gharavi, A. E., et al. (1985), Arthritis Rheum. 28, 594–595.PubMedGoogle Scholar
  10. 10.
    Lessof, M. H. and Glynn, L. E. (1959), Lancet i, 799–801.Google Scholar
  11. 11.
    Asherson, R. A., Ridley, M. G., Khamashta, M. A., and Hughes, G. R. V. (1988), Piel 3, 409–412.Google Scholar
  12. 12.
    Drew, P., Asherson, R. A., Zuk, R. J., et al. (1987), Ann. Rheum. Dis. 46, 612–616.PubMedGoogle Scholar
  13. 13.
    Ter Borg, E. J., Van Der Meer, J., De Wolf, J. T. M., et al. (1988), Clin. Rheumatol. 7, 74–79.PubMedGoogle Scholar
  14. 14.
    Sneddon, I. B. (1965), Br. J. Dermatol. 77, 180–185.PubMedGoogle Scholar
  15. 15.
    Rebollo, M., Val, F. J., Garijo, F., et al. (1983), Brain 106, 965–979.PubMedGoogle Scholar
  16. 16.
    Brey, R. L., Escalante, A., Futrell, N., and Asherson, R. A. (1996), in The Antiphospholipid Syndrome. Asherson, R. A., Cervera, R., Piette, J.-C., and Shoenfeld, Y., eds. pp. 133–150.Google Scholar
  17. 17.
    Asherson, R. A., Mayou, S., Black, M., et al. (1987), Arthritis Rheum. 30(Suppl 4), S69.Google Scholar
  18. 18.
    Asherson, R. A. and Cervera, R. (1993), J. Stroke Cerebrovasc. Dis. 3, 121–122.Google Scholar
  19. 19.
    Stockhammer, G., Felber, S. R., Zelger, B., et al. (1993), Stroke 24, 685–690.PubMedGoogle Scholar
  20. 20.
    Briley, D. P., Coull, B. M., and Goodnight, S. H. (1989), Ann. Neurol. 25, 221–227.PubMedGoogle Scholar
  21. 21.
    Levine, S. R., Kieran, S., Puzio, K., Feit, H., Patel, S. C., and Welch, K. Y. A. (1987), Stroke 18, 801–804.PubMedGoogle Scholar
  22. 22.
    Lau, S. O., Bock, G. H., Edson, J. R., and Michael, A. F. (1980), J. Pediatr. 97, 948–950.PubMedGoogle Scholar
  23. 23.
    Averback, P. (1978), Ann. Neurol. 3, 81–86.PubMedGoogle Scholar
  24. 24.
    Provenzale, J. M. and Loganbill, H. A. (1994), J. Comput. Assist. Tomogr. 18, 719–723.PubMedGoogle Scholar
  25. 25.
    Mokri, B., Jack, C. R. J. R., and Petty, G. W. (1993), Stroke 24, 469–472.PubMedGoogle Scholar
  26. 26.
    Khoo, K. B. K., Long, F. L., Tuck, R. R., Allen, R. J., and Tymms, K. E. (1995), Med. J. Austral. 162, 30–32.PubMedGoogle Scholar
  27. 27.
    Jurtz, G. and Muller, N. (1994), Am. J. Psychiatry 151, 1841–1842.Google Scholar
  28. 28.
    Sirota, P., Schild, K., Firer M., et al. (1991), in Abstracts of the First International Congress of the International Society of Neuro-Immune Modulation. Florence, ISNIM, p. 389.Google Scholar
  29. 29.
    Maes, M., Meltzer, H., Jacobs, J., et al. (1993), Acta Psychiatr. Scand. 87, 160–166.PubMedGoogle Scholar
  30. 30.
    Calabrese, L. V. and Stern, T. A. (1995), Psychosomatics 36, 344–359.PubMedGoogle Scholar
  31. 31.
    Abel, T., Goldman, D. D., and Urowitz, M. B. (1980), J. Rheumatol. 7, 325–333.PubMedGoogle Scholar
  32. 32.
    Ziporen, L., Eilam, D., Shoenfeld, Y., and Korczyn, A. D. (1996), Neurology 46, A459.Google Scholar
  33. 33.
    Mikdashi, J. A., Chase, C., and Kay, G. G. (1996), Neurology 46, A359.Google Scholar
  34. 34.
    Montalban, J., Arboix, A., Staub, H., et al. (1989), Clin. Exp. Rheumatol. 7, 85–87.PubMedGoogle Scholar
  35. 35.
    Scott, T. F., Hess, D., and Brillman, J. (1994), Arch. Intern. Med. 154, 917–920.PubMedGoogle Scholar
  36. 36.
    Hughes, G. R. V. (1999), Lupus 8, 89.PubMedGoogle Scholar
  37. 37.
    Cervera, R., Asherson, R. A., Font, J., et al. (1997), Medicine (Baltimore) 76, 203–212.Google Scholar
  38. 38.
    Asherson, R. A., Derksen, R. H. W. M., Harris, E. N., et al. (1987), Semin. Arthritis Rheum. 16, 253–259.PubMedGoogle Scholar
  39. 39.
    Bouchez, B., Arnott, G., Hatron, P. Y., Wattel, A., and Devulder, B. (1985), Rev. Neurol. (Paris) 141, 571–574.Google Scholar
  40. 40.
    Khamashta, M. A., Gil, A., Anciones, B., et al. (1988), Ann. Rheum. Dis. 47, 681–683.PubMedGoogle Scholar
  41. 41.
    Hodges, J. R. (1987), J. Neurol. Neurosurg. Psychiatry 50, 368–369.PubMedGoogle Scholar
  42. 42.
    Asherson, R. A., Harris, E. N., Gharavi, A. E., and Hughes, G. R. V. (1986), Arthritis Rheum. 29, 1535–1536.PubMedGoogle Scholar
  43. 43.
    Asherson, R. A., Harris, e. N., Hughes, G. R. V., and Farquharson, R. G. (1988), Arthritis Rheum. 31, 575.PubMedGoogle Scholar
  44. 44.
    Furie, R., Ishikawa, T., Dhawan, V., and Eidelberg, D. (1994), Neurology 44, 2197–2199.PubMedGoogle Scholar
  45. 45.
    Sundén-Cullberg, J., Tedroff, J., and Aquilonius, S.-M. (1998), Movement Disorders 13, 147–149.PubMedGoogle Scholar
  46. 46.
    Tam, L.-S., Cohen, M. G., and Li, E. K. (1995), Lupus 4, 67–69.PubMedGoogle Scholar
  47. 47.
    Singh, P. R., Piasaa, K., Qumar, A., et al. (1988), Ann. Rheum. Dis. 97, 954–956.Google Scholar
  48. 48.
    Propper, D. J. and Bucknall, R. C. (1989), Ann. Rheum. Dis. 48, 512–515.PubMedGoogle Scholar
  49. 49.
    Adrianakos, A. A., Duffy, U. J., Suzuki, M., and Sharp, J. J. (1975), Ann. Intern. Med. 83, 616–624.Google Scholar
  50. 50.
    Harisdangkul, V., Doorenbos, D., and Subramony, S. H. (1995), J. Neurol. 242, 326–331.PubMedGoogle Scholar
  51. 51.
    Lavalle, C., Pizarro, S., Drenkard, C., Sánchez-Guerrero, J., and Alarcón-Segovia, D. (1990), J. Rheumatol. 17, 34–37.PubMedGoogle Scholar
  52. 52.
    Chang, R. and Quismorio, P. Jr. (1990), Arthritis Rheum. 33(Suppl 9), S102.Google Scholar
  53. 53.
    Smyth, A. E., Bruce, I. N., McMillan, S. A., and Bell, A. L. (1996), Ulster Med. J. 645, 91–94.Google Scholar
  54. 54.
    Oppenheimer, S. and Hofbrand, B. I. (1986), Can. J. Neurol. Sci. 13, 129–132.PubMedGoogle Scholar
  55. 55.
    Harris, E. N., Englert, H., Derue, G., Hughes, G. R. V., and Gharavi, A. E. (1983), Lancet ii, 1361–1362.Google Scholar
  56. 56.
    Palosuo, T., Vaarala, O., and Kinnuren, E. (1985), Lancet ii, 839.Google Scholar
  57. 57.
    Frampton, G., Weiner, J. B., Cameron, J. S., and Hughes, R. A. C. (1988), J. Neuro-Immunol. 19, 133–139.Google Scholar
  58. 58.
    Marcusse, H. N., Hahn, J., Tan, W. D., and Breedveld, F. C. (1989), Br. J. Rheumatol. 28, 344–346.Google Scholar
  59. 59.
    Harris, E. N., Gharavi, A. E., Mackworth-Young, C. G., Patel, B. M., Derue, G., and Hughes, G. R. V. (1985), Ann. Rheum. Dis. 44, 281–283.PubMedGoogle Scholar
  60. 60.
    Marullo, S., Clauvel, J.-P., Intrator, L., Danon, F., Brouet, J.-C., and Oksenhendler, E. (1993), J. Rheumatol. 20, 747–749.PubMedGoogle Scholar
  61. 61.
    Labutta, R. J. (1996), in The Antiphospholipid Syndrome. Asherson, R. A., Cervera, R., Piette, J.-C., and Shoenfeld, Y., eds. CRC Press, Boca Raton, New York, London, Tokyo, pp. 213–218.Google Scholar
  62. 62.
    Jabs, D. A., Fine, S. L., Hochberg, M. C., Newman, S. A., Heiner, G. G., and Stevens, M. B. (1986), Arch. Ophthalmol. 104, 558–563.PubMedGoogle Scholar
  63. 63.
    Asherson, R. A., Merry, P., Acheson, J. F., Harris, E. N., and Hughes, G. R. V. (1989), Ann. Rheum. Dis. 48, 358–361.PubMedGoogle Scholar
  64. 64.
    Montehermoso, A., Cervera, R., Font, J., et al. (1999), Semin. Arthritis Rheum. 28, 326–332.PubMedGoogle Scholar
  65. 65.
    Gerber, S. L. and Cantor, L. B. (1990), Am. J. Ophthalmol. 110, 443–444.PubMedGoogle Scholar
  66. 66.
    Watts, M. T., Greaves, M., Rennie, I. G., and Clearkin, L. B. (1991), Eye 5, 75–79.PubMedGoogle Scholar
  67. 67.
    Reino, S., Muñoz-Rodríguez, F. J., Cervera, R., Espinosa, G., Font, J., and Ingelmo, M. (1997), Clin. Rheumatol. 16, 629–631.PubMedGoogle Scholar
  68. 68.
    Morton, K. E., Gavaghan, T. P., Krilis, S. A., et al. (1986), Lancet ii, 1353–1356.Google Scholar
  69. 69.
    Eber, B., Schumacher, M., Auer-Grumbach, P., Toplak, H., and Klein, W. (1992), Am. J. Cardiol. 69, 1255–1258.PubMedGoogle Scholar
  70. 70.
    Murphy, J. J. and Leach, I. H. (1989), Br. Heart J. 62, 61–64.PubMedGoogle Scholar
  71. 71.
    Brown, J. H., Doherty, C. C., Allen, D. C., and Morton, P. (1988), Br. Med. J. 296, 1505.Google Scholar
  72. 72.
    Nihoyannopoulos, P., Gómez, P. M., Joshi, J., Loizou, S., and Walport, M. J. (1990), Circulation 82, 369–375.PubMedGoogle Scholar
  73. 73.
    Leung, W. H., Wong, K. L., Lau, C. P., Wong, C. K., and Cheng, C. H. (1990), Am. J. Med. 89, 411–419.PubMedGoogle Scholar
  74. 74.
    Hasnie, A. M. A., Stoddard, M. F., Gleason, C. B., et al. (1995), Am. Heart J. 129, 1009–1113.PubMedGoogle Scholar
  75. 75.
    Bruce, D., Bateman, D., and Thomas, R. (1995), Br. Heart J. 74, 202–203.PubMedGoogle Scholar
  76. 76.
    Baum, R. A. and Jundt, J. W. (1996), South Med. J. 87, 928–932.Google Scholar
  77. 77.
    Coppock, M. A., Safford, R. E., and Danielson, G. K. (1988), Br. Heart J. 60, 455–458.PubMedGoogle Scholar
  78. 78.
    O'Neill, D., Magaldi, J., Dobkins, D., and Greco, T. (1995), Arch. Intern. Med. 155, 325–327.PubMedGoogle Scholar
  79. 79.
    O'Hickey, S., Skinner, C., and Beattie, J. (1993), Br. Heart J. 70, 279–281.PubMedGoogle Scholar
  80. 80.
    Gertner, E. and Leatherman, J. W. (1992), J. Rheumatol. 19, 1293–1298.PubMedGoogle Scholar
  81. 81.
    Nickele, G. A., Foster, D. A., and Kenny, D. (1994), Am. Heart J. 128, 1245–1247.PubMedGoogle Scholar
  82. 82.
    Martínez-Levín, M., Fonseca, C., Arugo, M. C., Maya, A., Reyes, P. A., and Ruiz-Argüelles, A. (1995), Clin. Exp. Rheumatol. 13, 489–491.Google Scholar
  83. 83.
    Donaldson, M. C., Weinberg, D., Belkin, M., et al. (1990), J. Vasc. Surg. 11, 825–831.PubMedGoogle Scholar
  84. 84.
    Shortell, C. K., Ouriel, K., Green, R. M., et al. (1992), J. Vasc. Surg. 15, 158–166.PubMedGoogle Scholar
  85. 85.
    Taylor, I. M., Chitwood, R. W., Dalman, R. L., et al. (1994), Ann. Surg. 226, 545–551.Google Scholar
  86. 86.
    Ciocca, R. G., Choi, J., and Graham, A. M. (1995), Ann. J. Surg. 170, 198–200.Google Scholar
  87. 87.
    Luchi, M. E., Asherson, R. A., and Lahita, R. G. (1992), Arthritis Rheum. 35, 700–705.PubMedGoogle Scholar
  88. 88.
    Asherson, R. A. and Oakley, C. N. (1986), J. Rheumatol. 13, 1–5.PubMedGoogle Scholar
  89. 89.
    Gertner, E. and Lie, J. T. (1993), J. Rheumatol. 20, 1224–1228.PubMedGoogle Scholar
  90. 90.
    Brucato, A., Baudo, F., Barberis, M., et al. (1994), J. Rheumatol. 21, 942–944.PubMedGoogle Scholar
  91. 91.
    Ghosh, S., Walters, H. D., Joist, J. H., Osborn, T. G., and Moore, T. L. (1993), J. Rheumatol. 20, 1406–1408.PubMedGoogle Scholar
  92. 92.
    Kerr, J. E., Poe, R., and Kramer, Z. (1997), Chest 112, 1707–1710.PubMedGoogle Scholar
  93. 93.
    Howe, H. S., Boey, M. L., Fong, K. Y., and Feng, P. H. (1988), Ann. Rheum. Dis. 47, 869–872.PubMedGoogle Scholar
  94. 94.
    Hillerdal, G., Hagg, A., Licke, G., Wegenius, G., and Scheibenflug, L. (1991), Scand. J. Rheumatol. 20, 58–62.PubMedGoogle Scholar
  95. 95.
    Crausman, R. S., Achenbach, G. A., Pluss, W. T., et al. (1995), J. Rheumatol. 22, 554–556.PubMedGoogle Scholar
  96. 96.
    Schwab, E. P., Schumacher, H. R., Freundlich, B., and Callegari, P. E. (1993), Semin. Arthritis Rheum. 23, 8–15.PubMedGoogle Scholar
  97. 97.
    Asherson, R. A., Greenblatt, M., Churg, A., and Goldberg, B. In press.Google Scholar
  98. 98.
    Savin, H., Huberman, M., Koh, E., et al. (1994), Br. J. Rheumatol. 33, 977–980.PubMedGoogle Scholar
  99. 99.
    Kelion, A. D., Cockroft, J. R., and Ritter, J. M. (1994), Postgrad. Med. J. 71, 233–235.Google Scholar
  100. 100.
    Branch, D. W., Kochenour, N. P., Rote, N. S., et al. (1987), Obstet. Gynecol. 69, 460–468.PubMedGoogle Scholar
  101. 101.
    Kupferminc, M. J., Lee, M. J., Green, D., and Pieceman, A. M. (1994), Obstet. Gynecol. 83, 806–807.PubMedGoogle Scholar
  102. 102.
    Asherson, R. A. and Kant, K. S. (1993), J. Rheumatol. 20, 1268–1272.PubMedGoogle Scholar
  103. 103.
    Piette, J.-C., Kleinknecht, D., and Bach, J.-F. (1996), in The Antiphospholipid Syndrome, Asherson, R. A., Cervera, R., Piette, J.-C., and Shoenfeld, Y., eds., CRC Press, Boca Raton, New York, London, Tokyo, pp. 169–181.Google Scholar
  104. 104.
    Cervera, R. and Asherson, R. A. (1994), Hipertensión 11, 79–81.Google Scholar
  105. 105.
    Frampton, G., Hicks, J., and Cameron, J. S. (1991), Kidney Int. 39, 1225–1231.PubMedGoogle Scholar
  106. 106.
    Kant, K. S., Pollack, K. V. E., Weiss, M. A., Glueck, H. I., Miller, A. N., and Hess, E. V. (1981), Medicine (Baltimore) 60, 71–86.Google Scholar
  107. 107.
    Glueck, H. I., Kant, K. S., Weiss, M. A., et al. (1985), Arch. Intern. Med. 145, 1389–1395.PubMedGoogle Scholar
  108. 108.
    Leaker, B., Carrley, K. F., Dowling, J., et al. (1987), Q. J. Med. 238, 163–179.Google Scholar
  109. 109.
    Bhathena, D. B., Sobel, B. J., and Mydal, S. D. (1981), Am. J. Nephrol. 1, 144–159.PubMedGoogle Scholar
  110. 110.
    Churg, J., Goldstein, M. H., and Bernstein, J. (1989), in Renal Pathology with Clinical and Functional Correlates, Tister, C. C. and Brenner, B. M., eds., Vol. 2, Philadelphia, J. B. Lippincott, pp. 1081–1113.Google Scholar
  111. 111.
    Hughson, M. D., Madasdy, T., McCarty, G. A., Stoler, C., Min, K.-W., and Silva, T. (1992), Am. J. Kid. Dis. 20, 150–158.PubMedGoogle Scholar
  112. 112.
    Kinkaid-Smith, P., Fairley, K. F., and Kross, M. (1988), Q. J. Ped. 69, 795–815.Google Scholar
  113. 113.
    Asherson, R. A. (1992), J. Rheumatol. 19, 508–512.PubMedGoogle Scholar
  114. 114.
    Asherson, R. A., Nobel, G. E., and Hughes, G. R. V. (1991), J. Rheumatol. 18, 1413–1415.PubMedGoogle Scholar
  115. 115.
    Asherson, R. A., Hughes, G. R. V., and Derksen, R. H. W. M. (1988), J. Urol. 140, 1028.PubMedGoogle Scholar
  116. 116.
    Poux, J. M., Boudet, R., Lacroix, P., et al. (1996), Am. J. Kid. Dis. 27, 721–725.PubMedGoogle Scholar
  117. 117.
    Asherson, R. A., Lanham, J. G., Hull, R. G., Boey, M. L., Gharavi, A. E., and Hughes, G. R. V. (1984), Clin. Exp. Rheumatol. 2, 75–79.PubMedGoogle Scholar
  118. 118.
    Asherson, R. A., Buchanan, M., Baguley, E., and Hughes, G. R. V. (1993), J. Rheumatol. 20, 874–876.PubMedGoogle Scholar
  119. 119.
    Hage, M. L., Liv, R., Harcheschi, D. G., Bowie, J. D., Allen, N. B., and Macik, B. G. (1994), Prenat. Diagn. 14, 873–877.PubMedGoogle Scholar
  120. 120.
    Liaño, F., Mampaso, F., and Barcia-Martín, F. (1988), Nephrol. Dial. Transplant. 3, 684–689.PubMedGoogle Scholar
  121. 121.
    Gronhagen-Riska, C., Teppo, A. M., Helentera, A., Honkanen, E., and Julkunen, H. (1990), Br. Med. J. 300, 1696–1697.Google Scholar
  122. 122.
    Prakash, R., Miller, C. C., and Suki, W. M. (1995), Am. J. Kid. Dis. 26, 347–352.PubMedGoogle Scholar
  123. 123.
    Kirschbaum, B., Mullinax, F., Curry, N., and Mallory, J. (1991), J. Am. Soc Nephrol. 2, 332.Google Scholar
  124. 124.
    Brunet, P., Aillava, M.-F., San Marco, M., et al. (1995), Kidney Int. 48, 794–800.PubMedGoogle Scholar
  125. 125.
    Radhakrishnan, J., Williams, G. S., Appel, G. B., and Cohen, D. J. (1994), Am. J. Kid. Dir. 23, 286–289.Google Scholar
  126. 126.
    Mondragón-Ramírez, G., Bochicchio, T., García-Torres, R., et al. (1993), Thromb. Res. 72, 109–117.Google Scholar
  127. 127.
    Huang, J. J., Chen, M.-W., Sung, J.-M., Lan, R.-R., Wang, M.-C., and Chen, F.-F. (1988), Nephrol. Dial. Transplant 13, 182–186.Google Scholar
  128. 128.
    Kniaz, D., Eisenberg, G. H., Elrad, H., Johnson, C. A., Valaitis, J., and Bregman, H. (1992), Am. J. Nephrol. 12, 126–133.PubMedGoogle Scholar
  129. 129.
    Ornstein, M. H. and Rand, J. H. (1994), J. Rheumatol. 21, 1360–1364.PubMedGoogle Scholar
  130. 130.
    Asherson, R. A. and Hughes, G. R. V. (1991), J. Rheumatol. 18, 1–3.PubMedGoogle Scholar
  131. 131.
    Asherson, R. A. (1994), in Advances in Thomas Addison's Diseases. Bhatt, M. R., James, W. M., Besser, G. M., Botazzo, G. F., Keen, C. L., eds., Vol. 1, J. Endocrinol. Ltd., Bristol, pp. 87–101.Google Scholar
  132. 132.
    Arnason, J. A. and Graziano, F. M. (1995), Semin. Arthritis Rheum. 25, 109–116.PubMedGoogle Scholar
  133. 133.
    Pelkonen, P., Simell, O., Rasi, V., et al. (1980), Ann. Intern. Med. 92, 156–159.Google Scholar
  134. 134.
    Grottolo, A., Ferrari, V., Mariarosa, M., et al. (1988), Haematologia 73, 517–519.Google Scholar
  135. 135.
    Asherson, R. A. and Hughes, G. R. V. (1989), J. Rheumatol. 16, 378–380.PubMedGoogle Scholar
  136. 136.
    Carette, S. and Jobin, F. (1989), Ann. Rheum. Dis. 48, 430–431.PubMedGoogle Scholar
  137. 137.
    Rao, R., Vagnucci, A., and Amico, J. (1989), Ann. Intern. Med. 110, 227–235.PubMedGoogle Scholar
  138. 138.
    Marie, I., Levesque, H., Heron, F., Kailleux, N., Borg, J. Y., and Courtois, H. (1997), Ann. Rheum. Dis. 56, 567–568.PubMedGoogle Scholar
  139. 139.
    Argento, A. and Di Benedetto, R. J. (1998), Chest 113, 1136–1138.PubMedGoogle Scholar
  140. 140.
    Guibal, F., Rybojad, M., Cordoliani, F., et al. (1996), Dermatology 192, 75–77.PubMedGoogle Scholar
  141. 141.
    Provenzale, J. M., Ortel, T. L., and Nelson, R. C. (1995), Am. J. Roentgenol. 165, 361–364.Google Scholar
  142. 142.
    Oelkers, W. (1996), N. Engl. J. Med. 335, 1206–1212.PubMedGoogle Scholar
  143. 143.
    Pessayre, D. and Larrey, D. (1991) in Oxford Textbook of Clinical Hepatology, McIntyre, N., Benhamou, J.-P. Bircher, J., Rizetto, M., and Rodés, J., eds., Oxford University Press, pp. 876–902.Google Scholar
  144. 144.
    Valla, D. and Benhamou, J.-P. (1991), in Oxford Textbook of Clinical Hepatology, McIntyre, N., Benhamou, J.-P., Bircher, J., Rizetto, M., and Rodés, J., eds., Oxford University Press, pp. 1004–1011.Google Scholar
  145. 145.
    Pomeroy, C., Knodell, R. G., Swain, W. R., Arneson, P., and Mahowald, M. L. (1984), Gastroenterology 86, 158–161.PubMedGoogle Scholar
  146. 146.
    Shimizu, S., Miyata, M., Kamiike, W., et al. (1993), Vasc. Surg. 27, 501–509.Google Scholar
  147. 147.
    Farrant, J. M., Judge, M., and Thompson, R. D. H. (1989), Clin. Exp. Dermatol. 14, 306–308.PubMedGoogle Scholar
  148. 148.
    Ouwendijk, R. J. T., Koster, J. C., Wilson, J. H. P., et al. (1994), Gut 35, 1004–1006.PubMedGoogle Scholar
  149. 149.
    Mackworth-Young, C. G., Gharavi, A. E., Boey, M. L., and Hughes, G. R. V., (1984), Eur. J. Rheum. Inflam. 7, 71–74.Google Scholar
  150. 150.
    Ordi, J., Vargas, V., Vilardell, M. et al. (1988), Am. J. Med. 84, 566–568.PubMedGoogle Scholar
  151. 151.
    De Clerck L., Michielsen, P. P., Ramael, M. R., et al. (1991), J. Rheumatol. 18, 1919–1921.PubMedGoogle Scholar
  152. 152.
    Takahaski, C., Kumagai, S., Tsubata, R., et al. (1995), Lupus 4, 232–235.PubMedGoogle Scholar
  153. 153.
    Mantz, F. A. and Craige, E. (1951), Arch. Pathol. 52, 91–97.Google Scholar
  154. 154.
    Nakamura, H., Uehara, H., Okada, T., et al. (1989), Hepato Gastroenterology 36, 393–397.PubMedGoogle Scholar
  155. 155.
    Morio, S., Oh, H., Hirasawa, A., et al. (1991), Bone Marrow Transplant 8, 147–149.PubMedGoogle Scholar
  156. 156.
    Rio, B., Andreu, G., Nicod, A., et al. (1986), Blood 67, 1773–1776.PubMedGoogle Scholar
  157. 157.
    Pérez-Ruiz, F., Orte-Martínez, F. J., Zea-Mendoza, A. C., Ruiz del Arbol, L., and Moreno-Caparrós, A. (1991), Semin. Arthritis Rheum. 21, 47–54.PubMedGoogle Scholar
  158. 158.
    Morlà, R. M., Ramos-Casals, M., García-Carrasco, M., et al. (1999), Lupus 8, 160–163.PubMedGoogle Scholar
  159. 159.
    Mor, T., Beigel, Y., Inbal, A., Goren, M., and Wysenbeek, A. G. (1989), Arthritis Rheum. 32, 491–495.PubMedGoogle Scholar
  160. 160.
    Kinoshita, K. (1993), Am. J. Obstet. Gynecol. 169, 199–202.PubMedGoogle Scholar
  161. 161.
    Young, N. and Wong, K. P. (1991), Aus. Radiol. 35, 83–85.Google Scholar
  162. 162.
    Saeki, R., Kaneko, S., Terasaki, S., et al. (1993), Hepato-gastroenterology 40, 499–501.PubMedGoogle Scholar
  163. 163.
    Beales, I. L. P. (1994), Postgrad. Med. J., 70, 305–308.PubMedGoogle Scholar
  164. 164.
    Kesler, A., Pomeranz, I. S., Huberman, H., Movis, B., and Kott, E. (1996), Postgrad. Med. J. 72, 690–692.PubMedGoogle Scholar
  165. 165.
    Muñoz, R. P., Costago, M. A., Fernández-Nebro, A., et al. in press.Google Scholar
  166. 166.
    Reynolds, T. B., Edmondson, H. A., Peters, R. L., and Redeker, A. (1964), Ann. Intern. Med. 61, 650–655.PubMedGoogle Scholar
  167. 167.
    Prieto, J., Yuste, J. R., Beloqui, O., et al. (1996), Hepatology 23, 199–204.PubMedGoogle Scholar
  168. 168.
    Muñoz-Rodríguez, F. J., Tàssies, D., Font, J., et al. J. Hepatol. 30, 770–773.Google Scholar
  169. 169.
    Biron, C., Andréani, H., Blanc, P., et al. (1998), J. Lab. Clin. Med. 131, 243–250.PubMedGoogle Scholar
  170. 170.
    Alric, L., Oskman, F., Sanmarco, M., et al. (1998), Br. J. Rheumatol. 37, 589–590.PubMedGoogle Scholar
  171. 171.
    Chadid, A., Chadalawada, K. R., and Morgan, T. R. (1994), Hepatology 20, 1465–1471.Google Scholar
  172. 172.
    Talenti, D. A., Falk, G. W., Carey, W. D., and Marchant, K. (1994), Am. J. Gastroenterol. 89, 785–788.PubMedGoogle Scholar
  173. 173.
    Meroni, P. L., Harris, E. N., Brucato, A., et al. (1987), Clin. Exp. Immunol. 67, 484–491.PubMedGoogle Scholar
  174. 174.
    Cowchok, S., Fort, J., Muñoz, S., Norberg, R., and Maddrey, W. (1988), Clin. Exp. Immunol. 73, 289–294.Google Scholar
  175. 175.
    Violi, F., Ferro, D., Basili S., et al. (1994), Br. Med. J. 309, 239.Google Scholar
  176. 176.
    Cappell, M. (1994), Am. J. Gastroenterol. 89, 1241–1245.PubMedGoogle Scholar
  177. 177.
    Kalman, D. R., Khan, A., Romain, P. L., and Nompleggi, D. J. (1996), Am. J. Gastroenterol. 91, 1244–1247.PubMedGoogle Scholar
  178. 178.
    Asherson, R. A., Morgan, S., Harris, E. N., et al. (1986), Clin. Rheumatol. 5, 102–106.PubMedGoogle Scholar
  179. 179.
    Asherson, R. A., Mackworth-Young, C., Harris, E. N., et al. (1985), Rheumatol. Int. 5, 90–93.Google Scholar
  180. 180.
    Sánchez-Guerrero, J., Reyes, E., Alarcón-Segovia, D. (1992), J. Rheumatol. 19, 623–625.PubMedGoogle Scholar
  181. 181.
    Hamilton, M. E. (1991), West J. Med. 155, 174–176.PubMedGoogle Scholar
  182. 182.
    Blanc, P., Barki, J., Fabre, J.-M., Larrey, D., Domergue, J., Michel, M., et al. (1995), J. Lab. Invest. 72, 137.Google Scholar
  183. 183.
    England, R. J. A., Woodcock, B., and Zeiderman, M. R. (1995), Eur. J. Vasc. Endovasc. Surg. 10, 372–373.PubMedGoogle Scholar
  184. 184.
    Vahl, A. C., Gans, R. O. B., Mackaay, A. J. C., Van Der Waal, C., and Mauwerda, J. A. (1997), Surgery 121, 588–590.PubMedGoogle Scholar
  185. 185.
    Cappell, M. S., Mikhail, N., and Gujral, N. (1994), Dig. Dis. Sciences 39, 1359–1364.Google Scholar
  186. 186.
    Gül, A., Inanc, M., Öcal, L., Konice, M., Aral, O., and Lie, J. T. (1996), Clin. Rheumatol. 15, 207–210.PubMedGoogle Scholar
  187. 187.
    North, J. P. and Wollenman, O. J., Jr. (1952), Surg. Gynaecol. Obstet. 95, 665–667.Google Scholar
  188. 188.
    Vianna, J. L., D'Cruz, D., Khamashta, M. A., Asherson, R. A., and Hughes, G. R. V., (1992), Clin. Exp. Rheumatol. 10, 165–168.PubMedGoogle Scholar
  189. 189.
    Chamouard, P., Grunebaum, L., Wiesel, M. L., et al. (1994), Dig. Dis. Sci. 39, 1501–1504.PubMedGoogle Scholar
  190. 190.
    Chamouard, P., Duclos, B., Baumann, R., et al. (1995), Dig. Dis. Sci. 40, 1525.Google Scholar
  191. 191.
    Souto, J. C., Borrell, M., Fontcuberta, J., and Roca, M. (1995), Dig. Dis. Sci. 40, 1524–1525.PubMedGoogle Scholar
  192. 192.
    Hudson, M., Hutton, R. A., Wakefield, A. J., Sawyer, A. M., and Pounder, R. E. (1992), Blood Coagul. Fibrinolysis 3, 773–778.PubMedGoogle Scholar
  193. 193.
    Webberly, M. J., Hart, M. T., and Melikian, V., (1993), Gut 34, 247–251.Google Scholar
  194. 194.
    Papi, C., Ciaco, A., Acierno, G., et al. (1995), Am. J. Gastroenterol. 80, 1514–1517.Google Scholar
  195. 195.
    Wang, R., Hsieh, C., Leeg, L., Chuang, C.-Wa., and Chen, C.-Y. (1992), J. Rheumatol. 19, 1223–1225.Google Scholar
  196. 196.
    Chang, K.-Y., Kuoy, C., Chiuc, T., et al. (1993), Pancreas 8, 654–657.PubMedGoogle Scholar
  197. 197.
    Date, K., Shirai, Y., and Hatakeyama, K. (1997), Am. J. Gastroenterol. 92, 2127–2128.PubMedGoogle Scholar
  198. 198.
    Arnold, M. H. and Schreiber, L. (1988), Clin. Rheumatol. 7, 406–410.PubMedGoogle Scholar
  199. 199.
    Pettersson, T. and Julkunen, H. (1992), J. Rheumatol. 19, 115.Google Scholar
  200. 200.
    Huong, D. L. T., Weschler, B., Edelman, P., et al. (1993), J. Rheumatol. 20, 1229–1232.Google Scholar
  201. 201.
    Hochfeld, M., Druzin, M. L., Maia, D., et al. (1994), Obstet. Gynecol. 83, 804–805.PubMedGoogle Scholar
  202. 202.
    Ornstein, M. H. and Rand, J. H. (1994), J. Rheumatol. 21, 1360–1364.PubMedGoogle Scholar
  203. 203.
    Lioté, F. and Meyer, O. (1996) in The Antiphospholipid Syndrome. Asherson, R. A., Cervera, R., Piette, J.-C., and Shoenfeld, Y., eds., CRC Press, Boca Raton, pp. 195–200.Google Scholar
  204. 204.
    Klippel, T. M., Stevens, M. B., Zizic, T. M., and Hugerford, D. S. (1976), Medicine (Baltimore) 55, 251–257.Google Scholar
  205. 205.
    Zizic, T. M., Marcor, K., Hungerford, D. S., Dansereau, J. V., and Stevens, M. B. (1987), Lancet i, 902–906.Google Scholar
  206. 206.
    Massando, L., Jacobelli, S., Leissner, M., Gonzalez, M., Villaroel, L., and Rivero, S. (1992), Lupus 2, 401–405.Google Scholar
  207. 207.
    Zizic, T. M., Hungerford, D. S., and Stevens, M. B. (1980), Medicine (Baltimore) 59, 134–142.Google Scholar
  208. 208.
    Asherson, R. A., Jungers, P., Lioté, F., et al. (1983), Proceedings of the XVIth International Congress of Rheumatology, Sydney, Australia, pp. 373.Google Scholar
  209. 209.
    Asherson, R. A., Lioté, F., Page, B., et al. (1993), J. Rheumatol. 20, 284–288.PubMedGoogle Scholar
  210. 210.
    Asherson, R. A., Khamashta, M. A., Ordi-Ros, J., et al. (1989), Medicine (Baltimore) 68, 366–374.Google Scholar
  211. 211.
    Seleznick, M. J., Silveira, L. H., and Espinoza, L. R. (1991), J. Rheumatol. 18, 1416–1417.PubMedGoogle Scholar
  212. 212.
    Alijotas, J., Argemí, M., and Barquinero, J. (1990), Clin. Exp. Rheumatol. 8, 297–298.PubMedGoogle Scholar
  213. 213.
    Alarcón-Segovia, D., Delezé, M., Oria, C. V., et al. (1989), Medicine (Baltimore) 68, 353–365.Google Scholar
  214. 214.
    Picillo, U., Migliaresi, S., Marciolis, M. R., Longobardo, A., La Palombara, F., and Tirri, G. (1992), Scand. J. Rheumatol. 21, 271–276.PubMedGoogle Scholar
  215. 215.
    Petri, M. (1995), Arthritis Care Res. 18, 137–145.Google Scholar
  216. 216.
    Houissau, F. A., N'Zeusseu-Toukap, A., Depresseu, X. G., et al. (1998), Br. J. Rheumatol. 37, 448–453.Google Scholar
  217. 217.
    Nagasawa, K., Ishii, Y., Mayumi, T., et al. (1989), Ann. Rheum. Dis. 48, 672–676.PubMedGoogle Scholar
  218. 218.
    Mont, M. A., Glueck, C. J., Pacheco, I. H., Wang, P., Hungerford, D. S., and Petri, M. (1997), J. Rheumatol. 24, 654–662.PubMedGoogle Scholar
  219. 219.
    Kleiner, R. C., Najarian, I. V., Schatten, S., et al. (1989), Ophthalmology 96, 896–904.PubMedGoogle Scholar
  220. 220.
    Francès, C., Tribout, B., Boisnic, S., et al. (1989), Dermatologica 178, 194–201.PubMedGoogle Scholar
  221. 221.
    Dessein, P. H., Lamparelli, R. D., Phillips, S. A., Rubenchik, I. A., and Zwi, S. (1989), J. Rheumatol. 16, 1494–1496.PubMedGoogle Scholar
  222. 222.
    Dodd, H. J., Sarkany, I., and O'Shaughnessy, D. (1985), Clin. Exp. Dermatol. 10, 581–586.PubMedGoogle Scholar
  223. 223.
    Aronoff, D. M. and Callen, J. P. (1997), J. Am. Acad. Dermatol. 37, 300–302.PubMedGoogle Scholar
  224. 224.
    Soweid, M., Hajjar, R. R., Hewan-Low, K. O., and Gonzalez, E. B. (1995), South Med. J. 88, 786–788.PubMedGoogle Scholar
  225. 225.
    Del Castillo, L. F., Soria, C., Schoendorff, C., et al. (1997), J. Am. Acad. Dermatol. 36, 872–875.PubMedGoogle Scholar
  226. 226.
    Amster, M. S., Conway, J., Zeid, M., et al. (1993), J. Am. Acad. Dermatol. 29, 853–857.PubMedGoogle Scholar
  227. 227.
    Wolf, P., Soyer, P., Auer-Grumbach, P., et al. (1991), Arch. Dermatol. 127, 1739–1740.PubMedGoogle Scholar
  228. 228.
    Hill, V. A., Whittaker, S. J., Hunt, B. J., et al. (1994), Br. J. Dermatol. 130, 92–96.PubMedGoogle Scholar
  229. 229.
    Doff, H. J., Sarkany, I., and O'Shaughnessy, D. (1985), Clin. Exp. Dermatol. 10, 581–586.Google Scholar
  230. 230.
    Wattiaux, H.-J., Herve, R., Robert, A., Cabane, J., Housset, B., and Imbert, J.-C. (1994), Arthritis Rheum. 37, 1096–1100.PubMedGoogle Scholar
  231. 231.
    Grobb, J. J. and Bonerandi, J. J. (1986), J. Am. Acad. Dermatol. 15, 211–219.Google Scholar
  232. 232.
    Asherson, R. A., Jacobelli, S., Rosenberg, H., et al. (1992), Clin. Exp. Dermatol. 17, 166–169.Google Scholar
  233. 233.
    Renfro, L., Franks, A. G., Grudberg, M., and Kamino, H. (1992), Arch. Dermat. 128, 847.Google Scholar
  234. 234.
    Asherson, R. A. (1990), Ann. Rheum. Dis. 49, 268.PubMedGoogle Scholar
  235. 235.
    Williams, H., Laurent, R., and Gibson, T. (1980), Clin. Lab. Haematol. 2, 139.PubMedGoogle Scholar
  236. 236.
    Kleiner, R. C., Najarian, I. V., Schatten, S., et al. (1989), Ophthalmology 96, 896–904.PubMedGoogle Scholar
  237. 237.
    Digre, K. B., Durcan, F. J., Branch, D. W., Jacobson, D. M., Varner, M. W., and Baringer, J. R. (1989), Ann. Neurol. 25, 228–232.PubMedGoogle Scholar
  238. 238.
    Francès, C., Piette, J., Saada, V., et al. (1994), Lupus 30, 123–128.Google Scholar
  239. 239.
    Cuny, J. F., Schmutz, J. L., Jeandel, C., et al. (1986), Ann. Dermatol. Venereol. 113, 825.PubMedGoogle Scholar
  240. 240.
    Disdier, P., Harle, J., Andrac, I., et al. (1994), J. Am. Acad. Dermatol. 30, 133–134.PubMedGoogle Scholar
  241. 241.
    Ruffatti, A., Veller-Fornasa, C., Patrassi, G. M., et al. (1995), Clin. Rheumatol. 14, 402–404.PubMedGoogle Scholar
  242. 242.
    Alarcón-Segovia, D., Pérez-Vásquez, M., Villa, A., et al. (1992), Semin. Arthritis Rheum. 21, 275–286.PubMedGoogle Scholar
  243. 243.
    Zouboulis, C. C., Gollnick, H., Weber, S., Peter, H. H., and Orfanos, C. E. (1991), J. Am. Acad. Dermatol. 25, 882–888.PubMedGoogle Scholar
  244. 244.
    Chacek, S., MacGregor-Gooch, J., Halabe-Cherem, J., Mellen-Hummel, H., and Quiñones-Galvas, A. (1998), Angiology 49, 157–160.PubMedGoogle Scholar
  245. 245.
    Schlesinger, I. H. and Farber, G. A. (1995), J. La. State Med. Soc. 147, 357–361.PubMedGoogle Scholar

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© Humana Press Inc 2003

Authors and Affiliations

  1. 1.Rheumatic Diseases Unit, Department of MedicineUniversity of Cape Town School of MedicineCape TownSouth Africa
  2. 2.Department of Autoimmune DiseasesHospital ClínicBarcelona, CataloniaSpain

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