Background/Purpose: An association between anti-phospholipid antibodies (aPL abs) and non-thrombotic neuropsychiatric events has been reported in pediatric and adult patients, including patients who do not have SLE. We reviewed the records of children with aPL abs follow at VCU Health System to assess the prevalence and type of neuropsychiatric events.

Methods: We retrospectively identified all pediatric patients with persistently positive aPLabs (two positive tests 12 weeks apart) followed in the Division of Rheumatology at VCU Health System from 1997 through 2012. Demographic, clinical, and serologic information were collected through chart review including details of clinical presentation, anti-phospholipid antibody testing over time, other autoantibodies, and information about treatment and clinical course. 

Results: Twenty nine pediatric patients with aPL abs were identified. The average age at diagnosis was 13 years and average follow up was 6 years (range 1-12 years). Sixty six percent of the children were African American and 92% were female.  Sixteen children (55%) met criteria for pediatric lupus (pSLE) and 13 (45%) did not. Of the children who did not meet criteria for pSLE, 4 had a positive ANA and 4 had other autoantibodies (3 with SSA, 1 with low positive DSDNA).   Eight patients (28%) met criteria for antiphospholipid antibody syndrome (APS) including 4 (25%) patients with pSLE (1 CVA, 2 with pregnancy loss, 1 thrombotic skin ulcer) and 4 (31%) of those who did not meet criteria for pSLE (1 DVT, 2 with CVA, 1 with catastrophic APS).  Of those children with aPL abs who did not meet criteria for pSLE, presenting symptoms included hemolytic anemia in 3 and thrombocytopenia in 7, with some children presenting with both.

Neurologic problems were common in children with aPL abs. 21 (72%) of children with aPL abs had a neurologic diagnosis and headache was the most common (12, 41%). One child had chorea and 2 had a CVA. Of note, 10 (63%) of children with pSLE and 4 (31%) of those with aPL abs alone had a psychiatric diagnosis, including major depression in 14 (with one suicide attempt), obsessive compulsive disorder (1), oppositional defiance disorder (4), schizophrenia (1), and bipolar disorder (1). Two children were in residential care for behavioral disorders (one with pSLE and one without).  Among the 41 pSLE patients followed at VCUHS who did not have aPL abs, 17% had a major psychiatric disorder (p=0.003 compared to all children with aPL abs).

Conclusion: An association between aPL abs and neuropsychiatric events has previously been reported in adults and children but mood disorders and psychiatric diagnoses have not been consistently found in published series of children with aPL abs. In this cohort followed at VCU, children with both pSLE with aPL abs were more likely to have a psychiatric diagnoses than children with pSLE without aPL abs and children with aPL abs alone also had a high prevalence of psychiatric diagnoses. Although the personal and functional impact of these neuropsychiatric diagnoses is significant, their etiology and responsiveness to treatment is unclear.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/antiphospholipid-antibodies-and-neuropsychiatric-events-in-pediatric-patients/