The Clinical Impact of Antiphospholipid Antibodies on Lupus

Description

The presentation by Doruk Erkan provides an overview of antiphospholipid syndrome (APS) under the umbrella of antiphospholipid (APL) antibodies, particularly as it relates to systemic lupus erythematosus (SLE) patients. Erkan highlights the limited attention given to APL positive lupus patients in research and emphasizes new updates to the 2023 ACR/EULAR classification criteria, which aim to enhance APS research quality. He contrasts two identical lupus patients, pointing out that one with positive aPL is likely to experience a more severe clinical phenotype and worse prognosis.



Erkan discusses the prevalence of aPL in lupus patients, indicating that 20-40% is a common statistic, though clinically relevant profiles may show higher frequencies, such as persistent aCL antibodies or LA. He presents various meta-analyses showing increased risks of complications such as thrombosis, cognitive dysfunction, and adverse pregnancy outcomes in aPL positive patients. Through cluster analyses, he indicates how serological profiles correlate with clinical outcomes like thrombosis and neurological manifestations.



The talk continues by addressing management questions in lupus patients with APL positivity, specifically regarding primary thrombosis prevention. Erkan outlines risk factors and the importance of distinguishing between types of aPL antibodies. He expounds on the conflicting evidence regarding the effectiveness of aspirin for primary prevention and suggests risk stratification and patient counseling as critical elements in managing these patients. He urges caution in applying treatment guidelines since research is still evolving. The session concludes with an invitation for further discussion and questions, underlining the need for continued research in this specialized area of autoimmune disease management.

Specialties