High Impact of Antiphospholipid Syndrome on Irreversible Organ Damage and Survival of Patients With Systemic Lupus Erythematosus

[Guest guest]

High Impact of Antiphospholipid Syndrome on Irreversible Organ Damage and

Survival of Patients With Systemic Lupus Erythematosus

Guillermo Ruiz-Irastorza, MD, PhD; - Egurbide, MD; Jon Ugalde,

MD; Ciriaco Aguirre, MD, PhD

Arch Intern Med. 2004;164:77-82.

Background Thrombosis is a frequent cause of morbidity and death in

patients with systemic lupus erythematosus (SLE). Whether antiphospholipid

syndrome (APS) is the cause of increased irreversible organ damage and

mortality in lupus patients is not well established.

Methods Prospective inception cohort of 202 patients with SLE (American

College of Rheumatology criteria). Antiphospholipid syndrome was defined

according to the Sapporo criteria. Irreversible damage was measured using

the Systemic Lupus International Collaborating Clinics­American College of

Rheumatology damage index (SDI) at 6 months and 1, 3, 5, 10, 15, 20, and 25

years after the diagnosis of SLE. All deaths were documented.

Results A total of 88% of patients were women. Twenty-eight patients met

criteria for definite APS. Mean (SD) follow-up was 9.7 (6.0) years. Nine

patients could not be contacted for follow-up. All patients with APS

experienced thrombosis, most of them in the arterial bed. Damage was more

severe in patients with APS than in those without APS (median SDI score, 2

vs 0 at 5 years; P<.001; 4 vs 1 at 15 years; P<.001). Cumulative survival at

15 years was lower in patients with APS than in those without APS (65% vs

90%, P = .03). Older age at diagnosis, lupus nephritis, and APS were

independent predictors of mortality.

Conclusions Antiphospholipid syndrome with thrombotic manifestations is a

major predictor of irreversible organ damage and death in patients with SLE.

From the Servicio de Medicina Interna, Hospital de Cruces, Universidad del

Pais Vasco/Euskal Herriko Unibertsitatea, Bizkaia, Spain. The authors have

no relevant financial interest in this article.