Objectives: Our primary objective was to quantify damage burden measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in aPLpositive patients with or without a history of thrombosis in an international cohort (the APS ACTION cohort). Secondly, we aimed to identify clinical and laboratory characteristics associated with damage in aPL-positive patients. Methods: In this cross-sectional study, we analysed the baseline damage in aPL-positive patients with or without APS classification. We excluded patients with other autoimmune diseases. We analysed the demographic, clinical and laboratory characteristics based on two subgroups: (i) thrombotic APS patients with high vs low damage; and (ii) non-thrombotic aPL-positive patients with vs without damage. Results: Of the 826 aPL-positive patients included in the registry as of April 2020, 586 with no other systemic autoimmune diseases were included in the analysis (412 thrombotic and 174 non-thrombotic). In the thrombotic group, hyperlipidaemia (odds ratio [OR] 1.82; 95% CI 1.05, 3.15; adjusted P=0.032), obesity (OR 2.14; 95% CI 1.23, 3.71; adjusted P=0.007), aβ2GPI high titres (OR 2.33; 95% CI 1.36, 4.02; adjusted P=0.002) and corticosteroid use (ever) (OR 3.73; 95% CI 1.80, 7.75; adjusted P<0.001) were independently associated with high damage at baseline. In the non-thrombotic group, hypertension (OR 4.55; 95% CI 1.82, 11.35; adjusted P=0.001) and hyperlipidaemia (OR 4.32; 95% CI 1.37, 13.65; adjusted P=0.013) were independent predictors of damage at baseline; conversely, single aPL positivity was inversely correlated with damage (OR 0.24; 95% CI 0.075, 0.77; adjusted P=0.016). Conclusions: DIAPS indicates substantial damage in aPL-positive patients in the APS ACTION cohort. Selected traditional cardiovascular risk factors, steroids use and specific aPL profiles may help to identify patients more prone to present with a higher damage burden.
Damage measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in antiphospholipid antibody-positive patients included in the APS ACTION registry / G.G.M. Balbi, Y. Ahmadzadeh, M.G. Tektonidou, V. Pengo, S. Sciascia, A. Ugarte, H.M. Belmont, C. Lopez-Pedrera, P.R. Fortin, D. Wahl, M. Gerosa, G.R. De Jesús, L. Ji, T. Atsumi, M. Efthymiou, D.W. Branch, C. Nalli, E. Rodriguez Almaraz, M. Petri, R. Cervera, J.S. Knight, B. Artim-Esen, R. Willis, M.L. Bertolaccini, H. Cohen, R. Roubey, D. Erkan, D.C.O. De Andrade, J. Vega, G. Pons-Estel, B. Giannakopoulos, S. Krilis, G. De Jesus, R. Levy, F. Signorelli, D. Andrade, G. Balbi, A.E. Clarke, L. Skeith, P.R. Fortin, L. Ji, Z. Zhang, C. Yang, H. Shi, S. Zuily, D. Wahl, M.G. Tektonidou, C. Nalli, L. Andreoli, A. Tincani, C.B. Chighizola, P. Meroni, V. Pengo, C. Cheng, G. Pazzola, S. Sciascia, S. Foddai, M. Radin, S. Davis, O. Amengual, T. Atsumi, I. Uthman, M. Limper, P. De Groot, G. Ruiz - Irastorza, A. Ugarte, I. Rodriguez-Pinto, R. Cervera, J. Pardos-Gea, E. Rodriguez Almaraz, M.A.A. Zamorano, C. Lopez-Pedrera, B. Artim-Esen, M.L. Bertolaccini, H. Cohen, M. Efthymiou, I. Mackie, G. Sanna, J. Knight, Y. Zuo, M. Petri, R.K. Leaf, R. Roubey, T. Ortel, R. Willis, N. Kello, M. Belmont, S. Levine, J. Rand, M. Barbhaiya, D. Erkan, J. Salmon, M. Lockshin, A.A. Duarte Garcia, B. Ware. - In: RHEUMATOLOGY. - ISSN 1462-0324. - 63:3(2024 Mar), pp. 772-779. [10.1093/rheumatology/kead292]
Damage measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in antiphospholipid antibody-positive patients included in the APS ACTION registry
M. Gerosa;C.B. Chighizola;P. Meroni;
2024
Abstract
Objectives: Our primary objective was to quantify damage burden measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in aPLpositive patients with or without a history of thrombosis in an international cohort (the APS ACTION cohort). Secondly, we aimed to identify clinical and laboratory characteristics associated with damage in aPL-positive patients. Methods: In this cross-sectional study, we analysed the baseline damage in aPL-positive patients with or without APS classification. We excluded patients with other autoimmune diseases. We analysed the demographic, clinical and laboratory characteristics based on two subgroups: (i) thrombotic APS patients with high vs low damage; and (ii) non-thrombotic aPL-positive patients with vs without damage. Results: Of the 826 aPL-positive patients included in the registry as of April 2020, 586 with no other systemic autoimmune diseases were included in the analysis (412 thrombotic and 174 non-thrombotic). In the thrombotic group, hyperlipidaemia (odds ratio [OR] 1.82; 95% CI 1.05, 3.15; adjusted P=0.032), obesity (OR 2.14; 95% CI 1.23, 3.71; adjusted P=0.007), aβ2GPI high titres (OR 2.33; 95% CI 1.36, 4.02; adjusted P=0.002) and corticosteroid use (ever) (OR 3.73; 95% CI 1.80, 7.75; adjusted P<0.001) were independently associated with high damage at baseline. In the non-thrombotic group, hypertension (OR 4.55; 95% CI 1.82, 11.35; adjusted P=0.001) and hyperlipidaemia (OR 4.32; 95% CI 1.37, 13.65; adjusted P=0.013) were independent predictors of damage at baseline; conversely, single aPL positivity was inversely correlated with damage (OR 0.24; 95% CI 0.075, 0.77; adjusted P=0.016). Conclusions: DIAPS indicates substantial damage in aPL-positive patients in the APS ACTION cohort. Selected traditional cardiovascular risk factors, steroids use and specific aPL profiles may help to identify patients more prone to present with a higher damage burden.
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