High titer of serum antiphospholipid antibody levels in adult Henoch‐Schönlein purpura and cutaneous leukocytoclastic angiitis

Kawakami, Tamihiro; Yamazaki, Masahide; Mizoguchi, Masahiro; Soma, Yoshinao

doi:10.1002/art.23528

Cited by 48 publications

(49 citation statements)

References 28 publications

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“…Because the present classification system is based on the CHCC classification, it routinely refers to CLA. 15 Livedo vasculopathy is diagnosed based on such clinical features as livedo appearance, recurrent skin ulcer, atrophie blanche, purpura and partial pigmentation on the lower extremities. 16 Because it can be diagnosed based on cutaneous manifestations, it can be easily diagnosed in a clinical setting.…”

Section: Seven Diseases Based On a New Algorithm For Primary Cutaneoumentioning

confidence: 99%

“…7). 10,15 The algorithm as a clinical diagnosis of primary cutaneous vasculitis artificially divides patients into groups depending on clinical symptoms and histopathological findings based on the skin biopsy specimen. Some patients may have positive findings for more than one element of the algorithm.…”

Section: Diagnostic Algorithm Of Primary Cutaneous Vasculitis (Kawakamentioning

confidence: 99%

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New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Kawakami

2010

The Journal of Dermatology

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Palpable purpura tends to indicate involvement of small vessel vasculitis in the upper dermis. Livedo racemosa, nodular lesion and skin ulceration are indicative of involvement of small to medium-sized vessel vasculitis in the lower dermis to subcutaneous fat. We set out to establish a new algorithm (KAWAKAMI algorithm) for primary cutaneous vasculitis based on the Chapel Hill Consensus Conference classification and our research results, and apply to the diagnosis. The first step is to measure serum antineutrophil cytoplasmic antibodies (ANCA) levels. If myeloperoxidase-ANCA is positive, Churg-Strauss syndrome or microscopic polyangiitis can be suspected, and if the patient is positive for proteinase 3-ANCA, Wegener's granulomatosis is most likely. Next, if cryoglobulin is positive, cryoglobulinemic vasculitis should be suspected. Third, if direct immunofluorescence of the skin biopsy specimen reveals immunoglobulin A deposition within the affected vessels, Henoch-Schö nlein purpura is indicated. Finally, the presence of anti-phosphatidylserine-prothrombin complex antibodies and ⁄ or lupus anticoagulant and histopathological necrotizing vasculitis in the upper to middle dermis (leukocytoclastic vasculitis) indicates cutaneous leukocytoclastic angiitis, whereas if necrotizing vasculitis exists in the lower dermis and ⁄ or is associated with the subcutaneous fat, cutaneous polyarteritis nodosa is indicated. The KAWAKAMI algorithm may allow us to refine our earlier diagnostic strategies and allow for efficacious treatment of primary cutaneous vasculitis. In cutaneous polyarteritis nodosa, warfarin or clopidogrel therapies should be administrated, and in cases that have associated active inflammatory lesions, corticosteroids or mizoribine (mycophenolate mofetil) therapy should be added. We further propose prophylactic treatment of renal complications in patients with Henoch-Schö nlein purpura.

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Section: Seven Diseases Based On a New Algorithm For Primary Cutaneoumentioning

confidence: 99%

Section: Diagnostic Algorithm Of Primary Cutaneous Vasculitis (Kawakamentioning

confidence: 99%

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Kawakami

2010

The Journal of Dermatology

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“…[ [6][7][8] The serum IgG and IgM levels of our patients did not differ from those in the controls, but the serum immunoglobulin D (IgD) levels were not measured. The elevation of acute phase reactants reflected the possible nature of the acute inflammatory process, and the increased serum IgA levels showed the immunological effects of HSP.…”

Section: Discussionmentioning

confidence: 84%

“…[6,7] In two studies performed by Kawakami et al [6,7] serum IgA aCL antibodies were elevated in patients with arthralgia and/or proteinuria versus those without these maladies. They suggested that monitoring serum IgA aCL antibody levels might be useful, especially for predicting renal involvement.…”

Section: Discussionmentioning

confidence: 99%