Session Information
Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Antiphospholipid syndrome (APS) mainly affects women who are of child-bearing age. We aimed to describe the clinical and immunological features of APS patients diagnosed after the age of 60.
Methods: The Elderly-Phospholipid study is a national, multicenter, retrospective study involving all APS (2006 revised Sapporo criteria) patients followed in 5 French tertiary university centers including 4 national referral centre for lupus and APS. The clinical and serologic features of patients in whom APS was diagnosed after the age of 60 were analyzed and compared to APS patients included in the Euro-Phospholipid cohort.
Results: Sixty-one patients (40 women (65.6%); 68.2±7 years at diagnosis) were included in the Elderly-Phospholipid study. 70.4% of the patients had primary APS. Stroke was the most common manifestation at diagnosis (36.1%) and during follow up (9.8%). Lupus anticoagulant (LA), aCL and aβ2GPI antibodies were detected in 70.5%, 67.7% and 60.6% of patients, respectively. 37.7% patients were triple-positive for aPL antibodies. All patients were treated with antithrombotic treatment including antiplatelet agents (29.5%) and/or oral anticoagulants (82%). Over a 5.3±3.8 years follow-up, only 5 (8.2%) patients, all receiving oral anticoagulants, developed major bleeding. The mortality rate was 11.5% with a mean age at death of 77.2±6 years. The most common causes of death were infection, haemorrhage and malignancy. As compared to Euro-Phospholipid APS patients who had a mean age of 34±13 years at the onset of the disease, patients in the Elderly-Phospholipid study were more frequently male (p<0.01) and had a higher frequency of primary APS (p<0.01), stroke (p<0.0001) and LA (p<0.05).
Conclusion: Older patients with late APS onset have a distinct disease profile, with a higher frequency of LA antibody and arterial thrombosis.
Clinical features at disease onset in elderly patients with APS
|
|
Elderly-Phospholipid (n=61) |
Euro-Phospholipid* (n=1000) |
P |
|
Stroke, n (%) |
22 (36.1) |
131 (13.1) |
<0.0001 |
|
Pulmonary embolism, n (%) |
17 (27.8) |
90 (9) |
<0.0001 |
|
Thrombocytopenia, n (%) |
13 (21.3) |
219 (21.9) |
ns |
|
Deep vein thrombosis, n (%) |
11 (18) |
317 (31.7) |
<0.05 |
|
Livedo reticularis, n (%) |
7 (11.5) |
204 (20.4) |
ns |
|
Transient ischemic attack; n (%) |
6 (9.8) |
70 (7) |
ns |
|
Epilepsy, n (%) |
5 (8.2) |
34 (3.4) |
ns |
|
Myocardial infarction, n (%) |
4 (6.5) |
28 (2.8) |
ns |
|
Hemolytic anemia, n (%) |
3 (4.9) |
66 (6.6) |
ns |
|
Superficial thrombophlebitis, n (%) |
2 (3.3) |
91 (9.1) |
ns |
|
CAPS, n (%) |
1 (1.6) |
6 (0.6) |
ns |
Immunologic findings in elderly patients with APS
|
|
Elderly-Phospholipid (n=61) |
Euro-Phospholipid** (n=1000) |
P |
|
Anticardiolipin antibodies, n (%) |
41 (67.2) |
879 (87.9) |
<0.0001 |
|
IgG and IgM |
5 (8.2) |
321 (32.1) |
<0.0001 |
|
IgG alone |
25 (41) |
436 (43.6) |
ns |
|
IgM alone |
11 (18) |
122 (12.2) |
ns |
|
AntiB2GP1 antibodies, n (%) |
37 (60.6) |
na |
|
|
IgG and IgM |
6 (9.8) |
na |
|
|
IgG alone |
21 (34.4) |
na |
|
|
IgM alone |
10 (16.4) |
na |
|
|
Lupus anticoagulant, n (%) |
43 (70.5) |
536 (53.6) |
<0.05 |
|
Alone |
14 (22.9) |
121 (12.1) |
<0.05 |
|
With anticardiolipin antibodies |
4 (6.6) |
na |
|
|
With antiB2GP1 antibodies |
2 (3.3) |
na |
|
|
Triple positive aPL |
23 (37.7) |
na |
|
|
Antinuclear antibodies, n (%) |
33 (54) |
597 (59.7) |
ns |
|
Anti–double-stranded DNA, n (%) |
11 (18) |
292 (29.2) |
ns |
|
Anti-Ro/SSA, n (%) |
7 (11.5) |
140 (14) |
ns |
|
Anti-La/SSB, n (%) |
1 (1.6) |
57 (5.7) |
ns |
|
Anti-Sm, n (%) |
0 (0) |
55 (5.5) |
ns |
ns, not significant (p>0.05); na, not available; CAPS, catastrophic antiphospholipid syndrome
* Arthritis Rheumatism, 2002, 46, 1019–1027, Ann Rheum Dis 2015;74:1011–1018
To cite this abstract in AMA style:
Grimaud F, Yelnik C, Pineton de Chambrun M, Amoura Z, Arnaud L, Costedoat-Chalumeau N, Hachulla E, Lambert M, Roriz M, Sibilia J, Papo T, Sacre K. Clinical and Immunological Features of Antiphospholipid Syndrome in the Elderly: A Retrospective National Multicenter Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/clinical-and-immunological-features-of-antiphospholipid-syndrome-in-the-elderly-a-retrospective-national-multicenter-study/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-and-immunological-features-of-antiphospholipid-syndrome-in-the-elderly-a-retrospective-national-multicenter-study/