Do All Antiphospholipid Antibodies Confer the Same Risk for Major Organ Involvement in Systemic Lupus Erythematosus Patients?

Leyre Riancho-Zarrabeitia¹, Víctor M Martinez-Taboada ², Iñigo Rua Figueroa ³, Fernando Alonso ⁴, María Galindo ⁵, Juan Ovalles-Bonilla ⁶, Alejandro Olivé-Marqués ⁷, Antonio Fernández-Nebro ⁸, Jaime Calvo-Alen ⁹, Raul Menor Almagro ¹⁰, Eva Tomero-Muriel ¹¹, Esther Uriarte Isacelaya ¹², Alina Boteanu ¹³, Mariano Andrés ¹⁴, Mercedes Freire González ¹⁵, Gregorio Santos Soler ¹⁶, Esther Ruiz Lucea ¹⁷, Monica Ibañez Barcelo ¹⁸, Ivan Castellvi ¹⁹, Carles Galisteo ²⁰, Víctor Quevedo Vila ²¹, Enrique Raya ²², Javier Narváez ²³, Lorena Expósito ²⁴, José A Hernández-Beriain ²⁵, Loreto Horcada Rubio ²⁶, Elena Aurrecoechea ²⁷ and Jose Maria Pego-Reigosa ²⁸, ¹Hospital Sierrallana, Torrelavega, Spain, ²Hospital Valdecilla, Santander, ³Hospital Doctor Negrin, Las Palmas, ⁴Unidad Investigación SER, Madrid, Spain, ⁵Hospital 12 De Octubre, Madrid, ⁶Hospital Gregorio Marañón, Madrid, Spain, ⁷Hospital German Trias i Pujol, Badalona, Spain, ⁸Hospital Carlos Haya, Malaga, Spain, ⁹Hospital Universitario Araba, Vitoria-Gasteiz, Spain, ¹⁰Hospital Universitario de Jerez, Puerto De Santa María, Spain, ¹¹Hospital Universitario La Princesa, Madrid, Spain, ¹²Hospital Universitario Donosti, San Sebastian, Spain, ¹³Hospital Universitario Ramón y Cajal, Madrid, Spain, ¹⁴Hospital General Universitario de Alicante, Alicante, Spain, ¹⁵Hospital Universitario Juan Canalejo, La Coruña, Spain, ¹⁶Hospital Marina Baixa, Villajoyosa, Spain, ¹⁷Hospital Universitario Basurto, Bilbao, Spain, ¹⁸Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain, ¹⁹Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, ²⁰Hospital Parc Taulí, Barcelona, Catalonia, Spain, ²¹Hospital Comarcal Monforte, Monforteº, Spain, ²²Hospital Universitario Clínico San Cecilio, Granada, Spain, ²³Rheumatology Department, Hospital Universitario de Bellvitge, Barcelona, Spain, Barcelona, Catalonia, Spain, ²⁴Hospital Universitario de Canarias, Las Palmas, Spain, ²⁵Hospital Insular Universitario de Gran Canaria, Las Palmas, Spain, ²⁶Complejo Hospitalario Universitario de Navarra, Pamplona, Spain, ²⁷Rheumatology Department. Hospital Sierrallana, Torrelavega, Spain, ²⁸Complexo Hospitalario Universitario, Vigo, Spain

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: antiphospholipid antibodies and aPL, Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 11, 2019

Title: SLE – Clinical Poster II: Comorbidities

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in SLE patients. Our aim is to investigate the association between the different aPL and SLE manifestations as well as to elucidate the influence of the load of antibodies.

Methods: Patients from the RELESSER-T registry were included. RELESSER-T is a multicenter, hospital-based registry, with retrospective cross-sectional collection of data from a large representative sample of adult non-selected patients with SLE attending Spanish rheumatology services from the public national health system.

Results: Out of a total of 3651 SLE patients, 1368 were aPL positive (24.8 % were positive for IgG anticardiolipin (aCL) antibodies, 20.1% for IgM aCL, 13.5% showed positivity for IgG antib2glycoprotein I (aB2GPI) and 13.8% for IgM aB2GPI. Lupus anticoagulant (LA) was positive in 24% of patients). Regarding the load of antibodies, 20.6%, 12.1% and 4.8% were positive for one, two and three antibodies respectively. The association between the different aPL, the number of positive antibodies and antiphospholipid syndrome related manifestations is showed in Table 1. Overall, all types of aPL were associated with classic APS manifestations, although LA, IgG isotypes, and patients with more than one aPL display a higher risk to develop clinical APS. Regarding specific lupus manifestations, all aPL types showed a negative association with cutaneous manifestations. LA and aCL were associated with an increased risk of haematological, ophthalmological and neuropsychiatric manifestations (p< 0.001). Furthermore, LA was also associated with an increased risk of renal disease (p< 0.001). IgG isotypes were associated with a higher risk of specific lupus manifestations compared with IgM. IgG aCL were associated with an increased risk of cardiac and respiratory manifestations. When evaluating the influence of the load of antibodies, we found that the risk of neuropsychiatric manifestations significantly increased with a higher number of positive antibodies (OR for one antibody was 1.19 and 1.7 for 2 and 3 antibodies). Inversely, the risk of cutaneous symptoms decreased while the number of positive antibodies increased (OR=0.9 for one antibody, OR=0.8 for double positivity and OR=0.7 for triple positivity).

Conclusion: There is a hierarchy for aPL and the risk of APS and SLE manifestations. aCL, and especially LA, confer a higher risk for major organ involvement in SLE patients. IgG isotypes seem to have a more important role. The load of aPL confer a higher risk for APS and certain SLE manifestations

Table 2 ACR

Disclosure: L. Riancho-Zarrabeitia, Abbvie, 8; V. Martinez-Taboada, None; I. Rua Figueroa, None; F. Alonso, None; M. Galindo, None; J. Ovalles-Bonilla, None; A. Olivé-Marqués, ND, 5, 8; A. Fernández-Nebro, None; J. Calvo-Alen, None; R. Menor Almagro, None; E. Tomero-Muriel, None; E. Uriarte Isacelaya, None; A. Boteanu, None; M. Andrés, None; M. Freire González, None; G. Santos Soler, None; E. Ruiz Lucea, None; M. Ibañez Barcelo, None; I. Castellvi, Actelion, 5, Boehringer -Ingelheim, 8, Gebro, 8, Kern, 5, Novartis, 8; C. Galisteo, None; V. Quevedo Vila, None; E. Raya, None; J. Narváez, None; L. Expósito, None; J. Hernández-Beriain, None; L. Horcada Rubio, None; E. Aurrecoechea, None; J. Pego-Reigosa, None.

To cite this abstract in AMA style:

Riancho-Zarrabeitia L, Martinez-Taboada V, Rua Figueroa I, Alonso F, Galindo M, Ovalles-Bonilla J, Olivé-Marqués A, Fernández-Nebro A, Calvo-Alen J, Menor Almagro R, Tomero-Muriel E, Uriarte Isacelaya E, Boteanu A, Andrés M, Freire González M, Santos Soler G, Ruiz Lucea E, Ibañez Barcelo M, Castellvi I, Galisteo C, Quevedo Vila V, Raya E, Narváez J, Expósito L, Hernández-Beriain J, Horcada Rubio L, Aurrecoechea E, Pego-Reigosa J. Do All Antiphospholipid Antibodies Confer the Same Risk for Major Organ Involvement in Systemic Lupus Erythematosus Patients? [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/do-all-antiphospholipid-antibodies-confer-the-same-risk-for-major-organ-involvement-in-systemic-lupus-erythematosus-patients/. Accessed .

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