Prevalence of Anticardiolipin Antibodies in Subacute Cutaneous Lupus Erythematosus

Abstract

We examined the prevalence of the antibodies to cardiolipin measured by solid-phase enzyme immunoassay during a prospective study of patients with subacute cutaneous lupus erythematosus (SCLE). Seven of 44 (16%) consecutive patients with SCLE had positive anticardiolipin antibodies; of these only three satisfied the American Rheumatism Association's revised criteria for the classification of systemic lupus erythematosus. Clinical findings probably associated with the positive anticardiolipin antibodies were found in four cases, including clotting abnormalities, thrombocytopenia, hemolytic anemia, livedo reticularis, chilblain lupus erythematosus lesions, migraine, leg venous thrombosis and pulmonary embolism after surgery, and spontaneous abortion. Our data suggest that it is reasonable to screen SCLE patients for these antibodies to confirm the presence of the antiphospholipid syndrome.

Lúpus eritematoso cutâneo subagudo apresentando-se como eritema anular centrífugo

“…4,5,18 O envolvimento sistêmico moderado, sobretudo articular e muscular, a necessidade de terapêutica menos agressiva 19 e o infreqüente achado de antiDNA, anti-SM e antiU1-RNP nos casos de LECSA (menos de 20% da totalidade) colaboram para seu diagnóstico. 20 Em geral, as manifestações renais e neurológicas, quando presentes (20 a 30% dos casos), são moderadas. 2 Entretanto, complicações graves já foram relatadas, como glomerulonefrite proliferativa difusa (GNPD) e óbitos por comprometimento do sistema nervoso central.…”

“…4,5,18 Moderate systemic involvement, above all articular and muscular involvement, the need for less aggressive therapy 19 and infrequent finding of anti-DNA, anti-Sm and antiU1-RNP in cases of SCLE (less that 20% of all cases) collaborate in its diagnosis. 20 In general, kidney and neurological manifestations are moderate when present (20 to 30% of cases). 2 Nevertheless, severe complications have already been reported, with diffuse proliferative glomerulonephritis (DPGN) and death due to central nervous system involvement.…”

Warning: thalidomide-related thrombotic risk potentially concerns patients with lupus

“…However, in these articles, overt SLE seemed to be absent in most patients with both aPL and either DLE or SCLE. [27][28][29]31 To date, APS has rarely been reported to occur in this setting, 28,31,32 but we observed severe arterial forms of the syndrome in some patients with otherwise 'pure' DLE or SCLE. Finally, it cannot be excluded that the potential role of thalidomide in the development of thrombotic events may have been overlooked in the past, given that physicians are rarely inclined to consider drugs as a cause of thrombosis, with few exceptions such as the oestrogencontaining pill, heparin, and more recently cox-2 inhibitors.…”

“…26 The prevalence of aPL has been extensively studied in SLE, but data in DLE and/or SCLE remain rare. In the latter, a positive VDRL has been found in 7-33% of patients, 23 whereas anticardiolipin antibodies (aCL) were present in 10-16% 23,27 and even 54% in a German series. 28 Within DLE, the reported prevalence of aCL ranges widely from 8 to 79% of cases.…”

Cutaneous lupus erythematosus: clinical features, prognosis and laboratory findings

“…Antineutrophil cytoplasmic antibodies (ANCA) and anticyclic citrullinated protein (anti-CCP) antibodies are of secondary importance for LE, whereas, anticardiolipin antibodies indicate possible complications, such as thromboembolia and miscarriage in LE patients [55,103]. This secondary antiphospholipid syndrome should be treated prophylactically with low doses of acetyl salicylic acid and needs careful monitoring.…”