Background/Purpose: Antiphospholipid antibody syndrome is the main acquired thrombophilia in the rheumatological area. It is characterized by thrombotic events and obstetric morbidity associated with the presence of antiphospholipid antibodies. Thrombotic manifestations confer chronic accumulated damage that can be evaluated using the first version of the Damage Index in patients with thrombotic Antiphospholipid Syndrome (DIAPSv1) [Amigo MC, et al. Lupus. 2015 Aug;24(9):927-34]. Recently, an updated version of the DIAPS (DIAPSv2) was developed with new definitions to more accurately detect lung damage, reweighting of the neurological domain, treatment sequelae, and other adjustments [Abstract poster #POS1462HPR EULAR2024]. The objective of this study was to correlate the scores of the original version of the DIAPS and its new version in patients with APS who attend our rheumatology outpatient clinic.

Methods: We include patients with APS who fulfilled the 2023 ACR/EULAR APS criteria and the APS Sydney criteria. The participants were invited during the waiting time of a rheumatology outpatient clinic of the Ignacio Chávez National Institute of Cardiology from January 5 to May 21, 2024. All of them underwent chart review and the following questionnaires: the original version (DIAPSv1) and the updated version (DIAPSv2) of DIAPS. This protocol was approved by the institute’s ethics committee; all patients gave their informed consent. Kolmogorov-Smirnov’s test, Student’s T test, Mann Whitney U test, chi-square test, or Fisher’s exact test were used, as appropriate. Correlations were performed with the Spearman method. A value of p< 0.05 was considered statistically significant.

Results: Twenty-nine patients with APS were analyzed, 22 patients were female, and the mean age was 18 ± 14 years old; 17 patients had the primary form of the syndrome. The DIAPS score was 3 (2-4) in DIPASv1 and 3 (2-4) in DIPASv2. A positive correlation was found between DIAPSv1 and DIAPASv2 (Rho=0,936, p< 0.0001) in patients with APS. Interestingly, DIAPSv1 correlated with the clinical domain score of the 2023 ACR/EULAR APS criteria (Rho=0.459, p=0.012), and a trend was observed with DIAPSv2 (Rho=0.364, p=0.052).

Conclusion: There is an excellent positive correlation between the score of the original version DIAPSv1 and its updated version DIAPSv2. Interestingly, DIAPSv1 correlates better with the clinical domain scores of the 2023 ACR/EULAR APS criteria and DIAPSv2 only reached a trend. The new items in the updated version may give more weight overall to accumulated chronic damage, unlike the original version where the sequelae of thrombotic manifestations predominate. Bigger studies and weighting of the new items are necessary to confirm these findings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/damage-index-in-patients-with-thrombotic-antiphospholipid-syndrome-diaps-version-2-0-one-single-center-pilot-study/