Session Information
Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Antiphospholipid Syndrome (APS) is an unusual disease and there are scarce epidemiological data. Our objective was to assess incidence and prevalence rates of APS using data from a tertiary university hospital-based health management organization (HMO) in Latin America.
Methods: Different methods were used to ensure complete APS cases ascertainment: (a) patients with diagnosis of APS, recurrent abortions and/or fetal death in HMO electronic medical records, (b) patients with a Lupus anticoagulant, IgG/IgM anticardiolipin and/or IgG/IgM β2glicoprotein positive test in laboratory database, (c) patients included in the Institutional Registry of Thromboembolic Disease of our hospital. Electronical medical records of all cases retrieved by these ascertainment methods were reviewed and definite APS was diagnosed if 2006 modified Sapporo Criteria were fulfilled. Possible APS was diagnosed if diagnosed by an experienced rheumatologist (in spite of absence of a second antibody determination). Global, age-specific, and sex-specific incidence and prevalence rates were calculated for members of the HMO. For the incidence study members with continuous affiliation ≥ 1 year from January 2000 to January 2015 were followed until he/she voluntarily left the HMO, APS was diagnosed, death, or study finalization. Prevalence was calculated on January 1st 2015.
Results: 53 incident cases of APS were identified during the study period. Patients’ characteristics are shown in table 1. A total of 349,775 persons contributed a total of 2,073,438 person-years. Incidence rates are reported as cases per 100,000 person-years (py): APS overall incidence rate was 2.6 (95% CI 1.9-3.2), 2.9 (95% CI 2.0-3.9) and 2.0 (95% CI 1.1.-3.0) in women and men respectively. In our population, age-specific incidence and prevalence rates in female patients peaked in the third decades of life and in male they peaked in the sixth decades. On January 1st 2015, 55 APS prevalent cases were identified from a denominator population of 135,750 HMO members. Prevalence rate was 40.5 per 100,000 persons (95% CI 29.8-51.2). LA was the most frequent antibody (71.7%); thrombotic events were more frequent than obstetric ones and only 2 women had both (5.6%).
Conclusion: Incidence and prevalence rates were similiar of previous reports. Incidence and prevalence rates in women were higher in the young population, associated with obstetric morbidity.
Table 1. APS Incident cases characteristics
|
APS patients (n=53) |
|
| Female, n (%, 95% CI) | 36 (67.9 ,53.9-79.3) |
| Mean age at diagnosis, years (DS) | 55.9 (17.1) |
| Mean age at first event, years (DS) | 52.6 (17.5) |
| Global Incidence per 100,000 patients-year (%, 95% CI) | 2.6 (1.9-3.2) |
| Definite cases (fullfilment of Sapporo criteria), n (%) | 50 (94.3) |
| Probable cases, n (%) | 3 (5.7) |
| Lupus anticoagulant +, n (%, 95% CI) | 38 (71.7, 57.8-82.4) |
| IgG anticardiolipin +, n (%, 95% CI) | 22 (42.3, 29.4-56.4) |
| IgM anticardiolipin +, n (%, 95% CI) | 23 (44.2, 31.1-58.2) |
| IgG β2glicoprotein +, n (%, 95% CI) | 7 (28.0, 13.3-49.6) |
| IgM β2glicoprotein +, n (%, 95% CI) | 5 (20.0, 8.1-41.5) |
| LA + Anticardiolipin, n (%, 95% CI) | 26 (49.1, 35.6-62.2) |
| Triple positive, n (%, 95% CI) | 7/25 (28.0, 13.3-49.9) |
| Thrombotic event, n (%, 95% CI) | 44 (83.0, 70.0, 91.1) |
| Deep venous thrombosis (DVT), n (%, 95%CI) | 24 (45.3, 32.2-59.1) |
| Pulmonary thromboembolism (PTE), n (%, 95%CI) | 7 (13.2, 6.3-25.7) |
| Stroke, n (%, 95%CI) | 12 (22.6, 13.11-36.2) |
| Stroke + DVT or PTE, n (%,95%CI) | 1 (1.9, 0.2-12.9) |
| Obstetric morbidity, n/females (%, 95% CI) | 11/36 (30.6, 17.4-47.9) |
| > or = 3 abortion 1st trimester, n (%, 95% CI) | 5 (9.4, 3.9-21.2) |
| Fetal loss > 10 weeks, n (%, 95% CI) | 5 (9.6, 3.9-21.6) |
| Premature birth < 34 w, n (%, 95% CI) | 1 (1.9, 0.2-13.3) |
| Thrombotic and obstetric event, n/females (%, 95% CI) | 2/36 (5.6, 1.3-20.7) |
| Primary APS, n (%, 95% CI) | 45 (84.9, 72.2.-92.4) |
| Rheumatic disease associated, n (%, 95% CI) | 8 (15.1, 7.6-27.8) |
| Mortality at 12.7 years, n (%, 95% CI) | 1 (1.9, 0,2-13.3) |
| Follow-up time, median, years (IQR) | 12.7 (9.1-15.3) |
To cite this abstract in AMA style:
Luissi A, Scolnik M, Soriano ER. Incidence and Prevalence of Antiphospholipid Syndrome in a Health Management Organization (HMO): A 15-Year Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/incidence-and-prevalence-of-antiphospholipid-syndrome-in-a-health-management-organization-hmo-a-15-year-study/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-and-prevalence-of-antiphospholipid-syndrome-in-a-health-management-organization-hmo-a-15-year-study/