Antiphospholipid syndrome plus rheumatic fever: a higher risk factor for stroke?

Abstract

To compare clinical and laboratory findings between patients with primary antiphospholipid syndrome (PAPS) versus secondary APS due to rheumatic fever (APS-RF) (according to Jones criteria). Seventy-three APS patients (Sapporo criteria) were enrolled, and demographic, clinical, and laboratory data were collected. Exclusion criteria were heart congenital abnormalities and previous infectious endocarditis. Patients were divided into two groups: PAPS (n = 68) and APS-RF (n = 5). The mean current age, disease duration, frequencies of female gender, and Caucasian race were similar in APS-RF and PAPS patients (P > 0.05). Remarkably, the frequency of stroke was significantly higher in APS-RF compared to PAPS patients (80% vs. 25%, P = 0.02). Of note, echocardiogram of these patients did not show intracardiac thrombus. No significant differences were found in peripheral thromboembolic events (P = 1.0), pulmonary thromboembolism (P = 1.0), miscarriage (P = 0.16), thrombocytopenia (P = 0.36), arterial events (P = 0.58), and thrombosis of small vessels (P = 1.0). There were no differences in the frequencies of comorbidities such as diabetes mellitus, hypertension, smoking, and hyperlipidemia in both groups (P > 0.05). The frequencies of lupus anticoagulant, IgG, and IgM anticardiolipin were similar in two groups. APS patients associated with rheumatic fever without infective endocarditis may imply a high stroke risk as compared with PAPS, and future studies are needed to confirm this finding.

IgG/IgM antiphospholipid antibodies present in the classification criteria for the antiphospholipid syndrome: a critical review of their association with thrombosis

“…The main reasons for exclusion included: no correlation of serologic results with thrombosis; measurement of only IgG or only IgM antibodies; no discrimination between IgG and IgM antibodies; presentation of combined antibody results; only LA/non‐criteria antibodies being measured; and the inclusion of overlapping patient populations. Thus, 177 studies were included in this systematic review . Those studies were grouped according to their analysis method: those containing ORs for thrombosis or allowing their calculation, and those for which, owing to a lack of information, only the percentage of positive patients in the thrombotic population can be shown.…”

Lack of antiphospolipid antibodies in long-term cardiac rheumatic fever

“…Rheumatic fever (RF) has been linked with the presence of antiphospholipid syndrome [1], especially with antiphospholipid antibodies, represented by anticardiolipin in 40% of the patients [2] and anti-2-glicoprotein I antibodies in 24% of them [3]. However, there is no study in which all routine antiphospholipid antibodies were performed simultaneously in RF patients.…”

Clinical diagnosis in patients with positive antiphospholipid antibodies

“…En nuestro trabajo, el aFL más frecuentemente observado en el aCL IgM, seguido de AL y de aCL IgG. Este resultado es congruente resultados de trabajos anteriores (4)(5)(6)(7)(8)(9)(10)(11).…”