Increased Risk of Livedo Reticularis Associated with Antiphospholipid Antibodies in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Ersilia M. DeFilippis¹, Denis Wahl² and Stephane Zuily², ¹Department of Medicine, Brigham and Women's Hospital, Boston, MA, ²CHU de Nancy, Vascular Medicine Division and Regional Competence Center For Rare Vascular And Systemic Autoimmune Diseases, Nancy, F-54000, France; Inserm, UMR_S 1116, Nancy, F-54000, France; Université de Lorraine, Nancy, F-54000, France, Nancy, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Antiphospholipid antibodies, livedo reticularis, meta-analysis and systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 10, 2015

Title: Antiphospholipid Syndrome: Clinical

Session Type: ACR Poster Session C

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

Background/Purpose : Livedo reticularis (LR)
is present in patients with systemic lupus erythematosus (SLE), and the role of
antiphospholipid antibodies (aPL) is controversial. Therefore our objective was
to estimate the risk of LR associated with aPL in patients with SLE.

Methods : Studies were selected if they
investigated the association between aPL and LR in SLE patients and if
aPL-negative patients were included for comparison. Data sources were Pubmed,
Embase, Cochrane Library, hand search, congress abstracts, and reference lists
of studies, without language restrictions. Risk estimates were independently
extracted by 2 investigators. Pooled effect estimates were obtained by using
the Mantel-Haenszel method (random effects).

Results: Of 919 identified abstracts,
28 primary studies (4 cohorts, 5 case-control, 19 cross-sectional) met
inclusion criteria, including 3413 SLE patients according to ACR criteria and 564
cases of LR. Prevalence of LR in aPL-positive vs. aPL-negative SLE patients was
26.5% (n=320/1207) vs. 11.1% (n=244/2206), respectively. Compared with SLE
patients without LR, the overall pooled odds ratios (OR) for LR in aPL-positive
SLE patients was 3.36 (95% confidence interval [CI], 2.49-4.55) (Figure 1). The
risk of LR was the highest for lupus anticoagulant (LA) (5 studies, OR=4.65 [95%
CI, 2.35-9.20]), anti-β₂-glycoprotein I antibodies (3 studies, OR=3.40
[95% CI, 1.53-7.52] and IgG anticardiolipin antibodies (aCL) (7 studies, OR=3.26
[95% CI, 2.18-4.88]) while IgM aCL (3 studies, OR = 1.66 [95% CI, 0.97-2.85]),
anti-β₂-glycoprotein I IgM antibodies (1 study, OR 2.12 [95%
CI, 0.65,6.94]) and anti-β₂-glycoprotein I IgG antibodies (2
studies, OR 2.90 [95% CI, 0.65,12.92]) did not reach statistical significance.

Conclusion : In SLE patients,
aPL-positivity is associated with a significant 3- to 4-fold increased risk for
livedo reticularis. These findings a) confirm that an aPL-related small vessel
involvement can contribute to LR in SLE patients and b) suggest that LR could
be associated with aPL in SLE patients.

Figure 1

Disclosure: E. M. DeFilippis, None; D. Wahl, None; S. Zuily, None.

To cite this abstract in AMA style:

M. DeFilippis E, Wahl D, Zuily S. Increased Risk of Livedo Reticularis Associated with Antiphospholipid Antibodies in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/increased-risk-of-livedo-reticularis-associated-with-antiphospholipid-antibodies-in-patients-with-systemic-lupus-erythematosus-a-systematic-review-and-meta-analysis/. Accessed .

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