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Background: Systemic lupus erythematosus (SLE) is the prototype of autoimmune connective tissue diseases. Renal disease is a frequent manifestation of SLE that influences the outcome of the patients. The aim of the current study was to determine and analyze the clinical features and subsequent outcome of 70 patients with LN, followed in our department over the past 5 years, focusing on the impact of cardiovascular risk factors in the renal outcome and mortality. Patients and methods: Our prospective study included 70 patients with SLE and LN and 70 patients with SLE without signs of renal involvement, all patients fulfilled the revised ACR (American College of Rheumatology) criteria for the classification of SLE. Demographical data, risk factors and comorbidities were recorded. Results: Patients with lupus nephritis had a mean age of 37 years (range 15-65, SD 1.8). During the study, we had a rate of drop off of 15 patients with lupus nephritis (21%) and 19 patients without nephritis (26%). Patients with LN had a higher prevalence of positive anti-dsDNA antibodies (85.4% vs 49%, p

Thrombophilia is an inherited or acquired predisposition detected by a set of laboratory tests, which increases the risk for venous thromboembolism or pregnancy complications, as will be discussed. Thrombophilia, as with all other risk factors, should be looked for and modulated according to clinical presentation and risk stratification. Many articles have been written on thrombophilia and pregnancy, but this comprehensive article will focus on the issue from a unique perspective of each thrombophilia separately. This article will elaborate on the main types of thrombophilia and will suggest tools to the treating physician for dealing with thrombophilia during pregnancy. This article is the result of a search of the English literature on PubMed using thrombophilia, pregnancy, complications and thrombosis as keywords.

The antiphospholipid syndrome (APS) is an autoimmune disorder presenting with tissue injury in various organs related to large- or small-vessel thrombosis associated with antiphospholipid and antiprotein/phospholipid complex antibodies. Although the pathophysiology, diagnosis, and clinical scenario may seem clear and straightforward, a more detailed examination reveals a more complex and uncertain picture related to the management of APS. This article reviews the current situation relating to APS therapy by evaluating the different clinical features of the syndrome ranging from thrombosis to pregnancy complications together with new strategies and pharmacological approaches.

An increase in mortality due to accelerated atherosclerosis has been reported in patients affected with Systemic Lupus Erythematosus (SLE). Anti-phospholipid antibodies (aPA) may play a pathogenetic role in the development of atherosclerosis. We measured carotid intima-media thickness (IMT), as a surrogate parameter of atherosclerosis, by B-mode ultrasound examination in 42 patients affected with SLE (11 men and 31 women) and in 42 healthy age- and sex-matched subjects. Lupus Anticoagulant (LA) (APTT sensitive, silica clotting time, DRVVT), Anti-cardiolipin antibodies (ACA) IgG and IgM, anti-β2glycoprotein 1 (anti-β2GP1) IgG and IgM and anti-prothrombin (anti-PT) IgG and IgM in ELISA (Orgentec Bouty) were also detected. IMT was 0.538±0.128 mm (0.310–0.866 mm) in SLE vs 0.473±0.084 mm in healthy subjects (-p 0.003–). IMT correlated with patients’ age (p0.600 mm and 33.3% in those with IMT 0.600 mm and 23.3% in patients with IMT 0.7 mm, 2 had LA positivity (40%) vs 10/37 (27%) of those with minor carotid thickness. In conclusion, IMT, a surrogate parameter of atherosclerosis, was correlated with Patients’ age and CRP and not with presence of aPA, even though, in the group of patients with greater IMT, there was a non-significant higher proportion of positivity for anti-phospholipid antibodies, in particular for Lupus Anticoagulant.

Even though the association of anti-phospholipid antibodies (aPL) with infertility is debated, infertile women are commonly screened for aPL. To review evidence, a systematic PubMed search was conducted to retrieve papers addressing (i) the association between aPL and infertility, (ii) the positivity rate of criteria and non-criteria aPL in women with infertility, (iii) the association between aPL and assisted reproduction technologies (ART) outcome, (iv) the efficacy of medical treatments on ART outcome, and (v) the effects of ART on thrombotic risk. A total of 46 papers were considered; several limitations emerged: (i) wide heterogeneity in study populations, (ii) non-prospective design in 90% of studies, and (iii) aPL cutoffs not conforming to international guidelines in more than 75% of studies; aPL positivity not confirmed in 89% of studies. Most studies evinced an association between infertility and anti-β2GPI antibodies and almost all non-criteria aPL. The association rate with infertility was below 50% for lupus anti-coagulant, anti-cardiolipin antibodies (aCL), and anti-phosphatidic acid antibodies. According to our estimates, overall positivity rates of criteria and non-criteria aPL tests are 6% and 3% among infertile women, 1% and 2% among controls, respectively. A significant difference in the positivity rate of patients versus controls emerged for aCL only. Five of 18 studies reported a detrimental effect of aPL on ART outcome. Only one of the six studies assessing the effects of treatment on ART outcome among aPL-positive infertile women reported a benefit. All relevant studies reported no increase in the rate of thrombosis among aPL-positive women undergoing ART.

The catastrophic anti-phospholipid syndrome (CAPS) differs from the anti-phospholipid syndrome in its accelerated systemic involvement leading to multi-organic failure. In this study, the occurrence of malignancies in patients with CAPS was evaluated and the clinical findings of CAPS patients with and without malignancies were compared. We investigated the web site-based international registry of patients with CAPS for all cases in which both CAPS and underlying malignancies were present. The clinical characteristics of these cases were subsequently evaluated to establish common characteristics. The CAPS registry included information on a total of 262 cases. Twenty-three (9%) patients suffered from malignancies. In 78% of these patients, the malignancy itself or the treatment modalities instituted for the carcinoma was the precipitating factor of CAPS. Only 39% of CAPS patients with malignancies recovered in comparison to 58% of patients without malignancies (p = 0.07). Treatment modalities, however, did not differ significantly between these patients. Infections were not evident as precipitating factors for any of the malignancy patients. The mean age of patients with malignancies was 9 years older than the average age of other patients with CAPS and the prevalence of SLE was significantly less common than in patients without malignancy. Malignancy may play a pathogenic role in patients with CAPS, whereas infections are more important as triggering factors in patients without malignancies. CAPS patients with malignancies are generally older than CAPS patients without malignancies; they generally have the worst prognosis of the entire CAPS cohort.

Phospholipids are abundantly represented within the nervous system. Aim of our study was to evaluate the presence and fine specificity of anti phospholipid antibodies (aPLAb) among patients with monoclonal gammopathy associated neuropathy. Thirty nine percent of these patients had high titers of aPLAb, mostly associated with low levels of anti beta2 glycoprotein I, which suggests different antibody specificity compared to patients with anti phospholipid syndrome. Further 6/48 patients with dysimmune neuropathy without monoclonal gammopathy had positive aPLAb titers. APLAb strongly cross-reacted with sulfatide. These findings suggest an adjuntive role of aPLAb on nerve damage and may help to better understand the nerve binding properties of anti-sulfatide antibodies.

To determine the prevalence and clinical correlates of anti-phospholipid antibodies (aPL), including anti-cardiolipin antibodies (aCL), lupus anti-coagulant (LA), anti-beta2-glycoprotein 1 (abeta2GP1), and anti-prothrombin (aPT) antibodies, in Black South African patients with systemic lupus erythematosus (SLE).A cross-sectional study of 100 SLE patients in whom clinical characteristics, including features of the anti-phospholipid syndrome (APS), disease activity, and damage were documented, and sera tested for aCL, abeta2GP, and aPT of all isotypes, and LA.Positive aCL, abeta2GPI, aPT, and LA were found in 53, 84, 20, and 2 patients, respectively. Immunoglobulin (Ig)A aCL and IgG abeta2GPI were the commonest aCL (49.1%) and abeta2GPI (47%) isotypes, respectively. IgA abeta2GPI were associated with both a history of thrombosis alone (p0.05) and a history of any clinical feature, thrombosis, and/or spontaneous abortion of the APS (p0.05); IgA aCL were associated with a history of any clinical APS event (p0.05); and abeta2GPI of any isotype were associated with a history of arthritis (p0.001).Our findings provide further evidence that screening for abeta2GPI and IgA aCL isotypes may improve the risk assessment for APS in SLE patients of African extraction. Further prospective studies are warranted to determine the clinical utility of these tests and to elucidate the genetic basis for the increased IgA aPL response in SLE patients of African extraction.

Acute cytomegalovirus (CMV) infection is associated with thromboembolism. However, cerebrovascular ischemic events have not been reported in relation to acute CMV infection. A patient with a transient ischemic attack and acute CMV infection is described. Transient appearance of anti-phospholipid antibodies suggests a causal relationship between the two. Physicians should be alert to symptoms and signs of acute CMV infection in patients with idiopathic cerebrovascular ischemic events. J. Med. Virol. 84:487–489, 2012. 2012 Wiley Periodicals, Inc.

Resume Le syndrome des antiphospholipides constitue une entite clinicobiologique associant des manifestations cliniques principalement a type de thromboses veineuses et arterielles et de fausses couches repetees a des manifestations biologiques liees a la presence d’anticorps antiphospholipides. Les anticorps antiphospholipides representent une famille tres heterogene d'anticorps. En effet, de nombreux travaux ont montre que ces anticorps n'etaient pas seulement diriges contre les phospholipides anioniques seuls, mais pouvaient aussi reconnaitre des phospholipides fixes a des cofacteurs proteiques plasmatiques ou aux cofacteurs eux-meme. L'heterogeneite des anticorps antiphospholipides et le manque de standardisation des techniques rendent delicate l’interpretation biologique et clinique des resultats. Le but de cet article est de faire le point sur les nouvelles donnees cliniques de ce syndrome et sur les tests biologiques disponibles dans le domaine de la coagulation et des tests immunologiques. L’interet clinique des tests biologiques est egalement discute.

Resume De nombreuses affections auto-immunes peuvent se manifester par des complications justifiant une prise en charge en reanimation. Cette prise en charge urgente necessite que lˈon ait la capacite dˈetablir rapidement un diagnostic etiologique, en particulier grâce a lˈutilisation dˈauto-anticorps qui peuvent etre de pertinents marqueurs diagnostiques et parfois pronostiques. Ces auto-anticorps peuvent etre utiles pour lˈexploration dˈun syndrome thrombotique ou de complications viscerales, surtout pulmonaires et renales, evoquant un syndrome des anti-phospholipides, un lupus, une vascularite, un syndrome de Goodpasture ou plus rarement une autre affection auto-immune. Dans ces differentes situations urgentes, les auto-anticorps susceptibles dˈetre recherches sont les antiphospholipides, les anticytoplasmes des polynucleaires (ANCA), les anticorps antinucleaires et anti-ADN natifs, les antimembranes basales glomerulaires et alveolaires ou plus rarement dˈautres specificites. En routine, ces auto-anticorps sont des outils diagnostiques et parfois pronostiques a condition dˈeviter un certain nombre de pieges lies a lˈexistence dˈauto-anticorps non specifiques. Ces pieges peuvent etre evites par une bonne connaissance de la valeur de ces marqueurs et par une collaboration avec un laboratoire de reference.

Rheumatologists are increasingly involved in the care of young women who, in the age of biologic therapy, are now gaining control of their rheumatic diseases and attempting pregnancy. With careful planning, most women with rheumatic diseases have successful pregnancies. This article focuses specifically on the highest-risk pregnancies and controversial areas. We discuss the women at risk of complications, the types of maternal and fetal complications, the treatments that can be used in pregnancy (and breastfeeding) and longer-term outcomes that could affect the mother. SLE, RA, ANCA-associated vasculitides, large vessel vasculitis (e.g. Takayasu's) and other CTDs (e.g. scleroderma) are among the conditions covered. The evidence and controversies regarding the recommendations for the use of biologics in pregnancy are discussed. The role of the rheumatologist in pregnancy planning and caring for the pregnant and post-partum woman as part of the multidisciplinary team is discussed.

The present study describes a new phase-specific assay system for the detection of anti-phospholipid antibodies, based on the finding by 3IP NMR analysis that phospholipid can be quantitatively ret...

Anti-phospholipid antibodies (aPL) are one of the most recent examples of autoantibodies that can appear even long time before any clinical manifestation can be associated with them. There is a general agreement that they may represent a strong risk factor for recurrent thrombosis and/or fetal losses. Anti-phospholipid antibodies represent a necessary but not sufficient factor (first hit) for thrombosis, and require additional triggering factors (second hit) to disclose the thrombogenic activity. Several factors may affect the predictive value of aPL, including titre, immunoglobulin isotype, fine antigenic specificity and affinity binding activity. Their careful evaluation is suggested in order to characterize the true predictive value of aPL.

The purpose of this study was to investigate whether visible and near-infrared (Vis-NIR) spectroscopy can be used for diagnoses of anti-phospholipid syndrome (APS). Vis-NIR spectra from 90 plasma samples [anti-phospholipid antibodies (aPLs)-positive group, n=48; aPLs-negative group, n=42] were subjected to principal component analysis (PCA) and soft independent modeling of class analogy (SIMCA) to develop multivariate models to discriminate between aPLs-positive and aPLs-negative. Both PCA and SIMCA models were further assessed by the prediction of 84 masked other determinations. The PCA model predicted successful discrimination of the masked samples with respect to aPLs-positive and aPLs-negative. The SIMCA model predicted 42 of 48 (87.5%) aPLs-positive patients and 33 of 36 (91.7%) aPLs-negative patients of Vis-NIR spectra from masked samples correctly. These results suggest that Vis-NIR spectroscopy combined with multivariate analysis could provide a promising tool to objectively diagnose APS.

We report on 2 cases of chronic relapsing thrombotic thrombocytopenic purpura, in which anti-phospholipid antibodies were also found. The first patient was felt to have the anti-phospholipid antibody syndrome, while the second patient had anti-phospholipid antibodies without clinical manifestations of the anti-phospholipid antibody syndrome. We discuss chronic relapsing thrombotic thrombocytopenic purpura and the anti-phospholipid antibody syndrome. Furthermore, we introduce the possibility of an association between chronic relapsing thrombotic thrombocytopenic purpura and the presence of anti-phospholipid antibodies.

This editorial refers to Low-dose aspirin versus low-dose aspirin plus low-intensity warfarin in thromboprophylaxis: a prospective, multicentre, randomized, open, controlled trial, in patients positive for antiphospholipid antibodies (ALIWAPAS), by Maria J. Cuadrado et al., doi:10.1093/rheumatology/ket313, on pages 275-84.

The intra-erythrocytic protozoan Babesia bovis is an economically important pathogen that causes an acute and often fatal infection in adult cattle. Babesiosis limitation depends on the early activation of macrophages, essential cells of the host innate immunity, which can generate an inflammatory response mediated by cytokines and nitric oxide (NO). Herein, we demonstrate in bovine macrophages that lipids from B. bovis attenuated R1A strain (LA) produced a stronger NO release, an early TNFα mRNA induction and 2-fold higher IL-12p35 mRNA levels compared to the lipids of virulent S2P strain (LV). Neither LA nor LV induced anti-inflammatory IL-10. Regarding signalling pathways, we here report that LA induced a significant phosphorylation of p38 and extracellular signal-regulated kinases 1 and 2 (ERK1/2) whereas LV only induced a reduced activation of ERK1/2. Besides, NF-κB was activated by LA and LV, but LA produced an early degradation of the inhibitor IκB. Interestingly, LV and the majority of its lipid fractions, exerted a significant inhibition of concanavalin A-induced peripheral blood mononuclear cell proliferation with respect to LA and its corresponding lipid fractions. In addition, we determined that animals infected with R1A developed a higher increase in IgM anti-phosphatidylcholine than those inoculated with S2P. Collectively, S2P lipids generated a decreased inflammatory response contributing to the evasion of innate immunity. Moreover, since R1A lipids induced a pro-inflammatory profile, we propose these molecules as good candidates for immunoprophylactic strategies against babesiosis. Fil: Gimenez, Guadalupe. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; Argentina Fil: Belaunzarán, María Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; Argentina Fil: Poncini, Carolina Veronica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; Argentina Fil: Blanco, Federico Carlos. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Echaide, Ignacio Eduardo. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Santa Fe. Estación Experimental Agropecuaria Rafaela; Argentina Fil: Zamorano, Patricia Ines. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Lammel, Estela Maria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; Argentina Fil: Gonzalez, Stella Maris. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; Argentina Fil: Durante de Isola, Elvira Luisa. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; Argentina

To evaluate the agreement and performance of two tests for aPLs with regard to association with manifestations of the APS in patients with SLE.We investigated 712 SLE patients and 280 population controls. Cardiolipin and β(2) glycoprotein-I antibodies were measured with routine ELISA and a new automated method. Three positivity cut-offs (99%, 90% of controls and recommended cut-off by manufacturers) were used. Associations with previous thrombotic events, thrombocytopenia and, in a subgroup of patients, obstetric morbidity (n = 296) were evaluated. Results were compared with the LA test, performed in 380 patients.Inter-test agreement was moderate (demonstrated by κ-values 0.16-0.71). Performance of the two tests was similar: at the 99th percentile cut-off, sensitivity for any thrombotic event ranged from 3.7% to 24.8%, while specificity was 84.7-97.7%. Regardless of assay, IgG isotypes were associated with venous thrombosis and ischaemic cerebrovascular disease, whereas aPLs of IgM isotype were weakly associated with ischaemic heart disease. Associations were greatly affected by aPL level. LA performed better than the specific aPL tests. LA was associated with any thrombotic event, odds ratio 5.4 (95% CI 3.1, 9.4), while the specific aPL tests ranged from non-significant to an odds ratio of 1.9 (95% CI 1.03, 3.4) using criteria cut-off. LA was also convincingly associated with other APS manifestations.In relation to thrombotic manifestations, there was moderate agreement but no clear advantages when comparing a routine aPL ELISA with an automated method. APL isotype and titre as well as LA positivity are important for risk assessment in SLE patients.

The specificity of anti-phospholipid auto-antibodies present in the serum of systemic lupus erythematosus patients towards the phospholipids has been studied by two different methods. The antibodies have been characterized either after affinity purification or by inhibition experiments. Our results clearly demonstrate that anti-phospholipid auto-antibodies recognize all phospholipids, whatever their polar head.

The clinical course and laboratory findings of a patient with autoimmune haemolytic anaemia due to anti-phospholipid antibodies and secondary to a systemic lupus erythematosus-like syndrome are described. IgG and IgM with anti-phospholipid activity coexisted in both sera and acid eluates prepared from the patient's red cells, as demonstrated by ELISA using a panel of anionic and neutral phospholipids. The anti-erythrocyte binding activity of eluted autoantibodies, determined by a radioactive antiglobulin technique, was totally inhibited by absorption with phospholipid micelles. The patient's serum also contained an IgM warm haemolysin detectable with enzyme-treated cells only, as well as anti-C, -E and -S alloantibodies.

Forty-three laboratories in 13 countries participated in a workshop to determine the degree of agreement between laboratories performing anticardiolipin tests. Each laboratory received freezedried aliquots of three samples labeled Gl (107 GPL units), G2 (20 GPL units), and G3 (6 GPL units) to be used as reference standards in the IgG assay, and three samples labeled Ml (106 MPL units), M2 (21 MPL units), and M3 (5 MPL units) as references for the IgM assay. Participating laboratories were divided into 8 groups and serum samples were exchanged between laboratories in each group. For IgG anticardiolipin, results were reported as: high, IgG positive for samples with optical absorbance readings exceeding Gl; medium, IgG positive for samples with readings between Gl and G2; low, IgG positive between G2 and G3, and negative, if less than G3. In like manner, samples were defined as high-, medium-, or Iow-IgM positive, with reference to standards Ml, M2, and M3. An index of agreement was computed to determine the degree of agreement between laboratories in each group. Interlaboratory agreement was excellent in each category assessed. For high positive and negative IgG and IgM results, the index of agreement exceeded 90%, and for medium and low positive results, agreement exceeded 75%. The overall index of agreement between laboratories exceeded 90%. The researchers conclude that the use of these six standards to obtain a semiquantitative measure of anticardiolipin positivity will enable good interlaboratory agreement in reporting anticardiolipin results.

Background The laboratory arm of the diagnostic process of the anti-phospholipid antibodies (aPL) syndrome is facing a crucial moment of renewal thanks to the availability both of new serological biomarkers and of new analytical methods. Objectives To compare the analytical performance of immunoenzymatic (ELISA) and chemiluminescence (CLIA) aPL tests during twelve months of observation. Methods We collected data on aCL (anti-cardiolipin), aB2GPI (anti-B2-glycoprotein I) IgG and IgM antibodies of 2628 patients, referred to our diagnostic Laboratory from October 2013 to October 2014. From October 2013 to may 2014 anti-phospholipid (aPL) antibodies were analysed by ELISA (Orgentec, Idk; cut-off aCL IgG >10 U/ml, aCL IgM >8 U/ml, aB2GPI IgG/IgM >8 U/ml) while from june 2014 to October 2014 they were analysed by CLIA (Zenit RA, Menarini Diagnostics; cut-off IgG >20 U/ml, IgM >10 U/ml). Lupus anticoagulant (LAC) assays were done in all cases following standardized methods. Results By ELISA we found 61/1625 (3.8%) aCL IgG+ patients, among which 36 (59%) were also aB2GPI IgG+, and 108/1625 (6.6%) aCL IgM+ patients, among which 89 (82.4%) also B2GPI IgM+. On the other hand, among the overall 57/1625 (3.5%) aB2GPI IgG+ patients, 36 (63.2%) were also aCL IgG+ and among the overall 106/1625 (6.5%) aB2GPI IgM+ patients, 89 (83.9%) were also aCL IgM+. However, when considering aB2GPI IgG or IgM >40 U/ml, 100% of positive aB2GPI samples were also aCL positive. By CLIA, we found 38/1003 (3.8%) aCL IgG+ patients, among which 37 (97.4%) also aB2GPI IgG+ and 125/1003 (12.5%) aCL IgM+ patients, among which 100% were also aB2GPI IgM+. Furthermore, among the overall 42/1003 (4.2%) aB2GPI IgG+ patients, 40 (95.2%) were also aCL IgG+, while among the overall 163/1003 (16.3%) aB2GPI IgM+ patients, 127 (77.9%) were also aCL IgM+. Again, when considering only high IgG+ or IgM+ aB2GPI titres (>40 U/ml) all samples were also aCL IgG+ or IgM+. The percentage of aB2GPI IgG+ and/or IgM+ positive cases within the LAC positive patients increased from 43/154 (27.9%) by ELISA to 42/92 (45.7%) by CLIA (p=0.0056; 95%CI: 1.26-3.72, OR 2.17). Conclusions The CLIA method showed comparable sensitivity to ELISA for high titres samples, while improved significantly the overall aB2GPI specificity of the aCL tests and, more importantly, the correlation with LAC activity. Low positive aB2GPI IgM samples increased, probably due to the intrinsic high sensitivity of the CLIA method, suggesting a possible reformulation of the cut-off. Disclosure of Interest None declared

Systemic lupus erythematosus (SLE) patients are often at high risk of thromboembolism, associated with the presence of anti‐phospholipid antibodies (APAs). They are also prone to various infections...

Background Previous studies have postulated a connection between human parvovirus B19 (B19) infection and anti-phospholipid antibodies (aPL). Recently, the phospholipase domain of B19 has been linked to B19-VP1 unique region (VP1u). To elucidate the roles of VP1u in B19 infection and aPL production, the major reactivity of anti-B19-VP1u, anti-cardiolipin antibody (aCL), and anti-beta2-glycoprotein I (β2GPI) antibody was evaluated. Methods Sera from 102 clinically suspected cases of B19 infection were analyzed by nested PCR and ELISA. Humoral responses of anti-B19-VP1u and anti-B19-VP1uD175A IgM/IgG antibodies, aCL and the anti-β2GPI antibody were assessed by Western blot and ELISA. Absorption experiments were also performed to determine the binding specificity of immunoglobulins to B19-VP1u, CL and β2GPI. Results Sera from patients with the diagnostic pattern DNA+/IgM+/IgG+ had a high frequency (57%) for recognition of CL and β2GPI. Furthermore, adsorption experiments were performed by adding purified B19-VP1u, which partially suppressed the reactivity of anti-B19VP1u to CL and β2GPI. Conclusions Serum from patients with acute B19 infection has a high frequency in recognition of CL and β2GPI, and the phospholipase domain observed in the B19-VP1u may have contributed to the production of aPL. These findings may provide a clue for understanding the roles of B19-VP1u in B19 infection and aPL production.

The development of factor V inhibitor is very rare, especially in combination with raised antiphospholipid (aPL) antibodies.

Summary We report the course of a pregnancy of a 21-year-old primipara and primigravida with systemic lupus erythematosus (SLE) and anti-U1RNP, anti-PCNA/cyclin, anti-dsDNA and anti-phospholipid autoantibodies. The pregnancy was normal and a healthy child was born at term. The risks associated with the HLA phenotype of of the mother and with these autoantibodies were previously unknown. We present a model for risk assessment in patients with rare laboratory features of SLE.

In October, 1998, in the brisk, clear air of Sapporo, Japan, the world’s experts on the Hughes syndrome summarized present knowledge about antiphospholipid antibody. This book presents an updated review of this syndrome. The intent of the current chapter is to outline our future needs.

A young woman aged 23 experienced binocular partial amaurosis fugax attacks for at least one year with crescendo frequency. Clinical and laboratory evaluations were normal except for the demonstrat...

A 12-year-old African American boy with mental retardation and Asperger's disorder presented with acute psychosis. Antiphospholipid antibody testing with enzyme-linked immunosorbent assay showed increased levels of immunoglobulin G anticardiolipin antibodies in the cerebrospinal fluid, but not in the serum. Although antiphospholipid antibodies have been reported in the serum of patients with thrombotic and neurologic disorders, there are only a few reports of these antibodies in cerebrospinal fluid. This finding is consistent with a recent report of antiphospholipid antibodies found in the cerebrospinal fluid of adults with acute psychosis.

Anti-phospholipid syndrome includes a variety of clinical manifestations, among which is recurrent pregnancy loss. Recently, it was suggested that anti-phospholipid antibodies might also have a role in infertility, mainly in unexplained infertility. Most of the studies report about an increased prevalence of these antibodies in infertile women; however, data regarding the implication of these antibodies on treatment outcome (mainly in in-vitro fertilization) and if there is a beneficial effect of treating these patients with aspirin, heparin and prednisone--remains still controversial. In this communication we review the literature reports of association of anti-phospholipid antibodies and infertility, and deal with the question whether they have a pathogenic role in these cases.