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Volumn 14, Issue 1, 2008, Pages 94-119

Neurologic manifestations of systemic lupus erythematosus and antiphospholipid antibody syndrome

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ANTICOAGULANT AGENT; CHORIONIC GONADOTROPIN; CORTICOSTEROID; CYCLOPHOSPHAMIDE; FLUORODEOXYGLUCOSE F 18; HEXAMETHYLPROPYLENE AMINE OXIME TECHNETIUM TC 99M; HYDROXYCHLOROQUINE; METHYLPREDNISOLONE; MYCOPHENOLIC ACID 2 MORPHOLINOETHYL ESTER; PHOSPHOLIPID ANTIBODY; RITUXIMAB; WARFARIN;

EID: 40049085918     PISSN: 10802371     EISSN: None     Source Type: Journal    
DOI: 10.1212/01.CON.0000299988.78952.d9     Document Type: Review
Times cited : (5)

References (61)
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    • Appenzeller S, Rondina JM, Li LM, et al. Cerebral and corpus callosum atrophy in systemic lupus erythematosus. Arthritis Rheum 2005;52(9):2783-2789. This study examined 115 patients with SLE and 44 healthy control subjects. In patients with SLE, a reduction in cerebral and corpus callosum volumes is associated with disease duration, a history of CNS involvement, and cognitive impairment. The total corticosteroid dose and the presence of aPLs were not associated with more pronounced atrophy.
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    • This large multicenter study found that the rate of death due to cerebrovascular disease of all types was double for patients with lupus compared to that expected. Cerebral hemorrhages were more common in this group than cerebral infarctions
    • Bernatsky S, Clarke A, Gladman DD, et al. Mortality related to cerebrovascular disease in systemic lupus erythematosus. Lupus 2006;15(12):835-839. This large multicenter study found that the rate of death due to cerebrovascular disease of all types was double for patients with lupus compared to that expected. Cerebral hemorrhages were more common in this group than cerebral infarctions.
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    • Brey RL. Management of the neurological manifestations of APS - what do the trials tell us? Thromb Res 2004;114(5-6):489-499. This evidence-based review concludes that (1) aPLs are a risk factor for incident ischemic stroke (established as useful for the given condition in the specified population); (2) the evidence to support the role of aPLs in recurrent stroke across the age range is conflicting and therefore inconclusive; (3) warfarin at moderate-intensity doses is equally effective in preventing a recurrent thrombotic event as warfarin at high-intensity doses in people with the antiphospholipid syndrome (APS); and (4) no data are available to support the use of any prophylactic therapy for the purposes of preventing an incident stroke in asymptomatic patients with aPLs.
    • Brey RL. Management of the neurological manifestations of APS - what do the trials tell us? Thromb Res 2004;114(5-6):489-499. This evidence-based review concludes that (1) aPLs are a risk factor for incident ischemic stroke (established as useful for the given condition in the specified population); (2) the evidence to support the role of aPLs in recurrent stroke across the age range is conflicting and therefore inconclusive; (3) warfarin at moderate-intensity doses is equally effective in preventing a recurrent thrombotic event as warfarin at high-intensity doses in people with the antiphospholipid syndrome (APS); and (4) no data are available to support the use of any prophylactic therapy for the purposes of preventing an incident stroke in asymptomatic patients with aPLs.
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    • Brey RL. Antiphospholipid antibodies in young adults with stroke. J Thromb Thrombolysis 2005;20(2):105-112. This review concludes that aPLs, in particular the lupus anticoagulant, are an independent risk factor for first and possibly recurrent stroke in young adults. A single best strategy for preventing aPL-associated stroke could not be identified because of lack of data.
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    • Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002;46(4):1019-1027. Over one half of the subjects in this cohort had primary APS, and the remainder had these antibodies in association with another disease, most commonly lupus. Patients with APS and lupus had a higher frequency of arthritis, livedo reticularis, thrombocytopenia, and leukopenia. In 127 patients, APS occurred after the age of 50, and these patients had a higher frequency of angina and stroke.
    • Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002;46(4):1019-1027. Over one half of the subjects in this cohort had primary APS, and the remainder had these antibodies in association with another disease, most commonly lupus. Patients with APS and lupus had a higher frequency of arthritis, livedo reticularis, thrombocytopenia, and leukopenia. In 127 patients, APS occurred after the age of 50, and these patients had a higher frequency of angina and stroke.
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    • Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med 2003;349(12):1133- 1138. This is the first randomized study of high- versus moderate-intensity doses of warfarin in patients with APS to prevent recurrent thrombotic events. High-intensity was not superior to moderate-intensity warfarin in this study. The low rate of recurrent thrombotic events in patients in the moderate-intensity group suggests that this approach is appropriate to prevent recurrent thrombosis in patients with APS.
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    • DeGiorgio LA, Konstantinov KN, Lee SC, et al. A subset of lupus anti-DNA antibodies cross-reacts with the NR2 glutamate receptor in systemic lupus erythematosus. Nat Med 2001;7(11):1189-1193. The authors demonstrate that the NR2 receptor is recognized by both murine and human anti-double-stranded DNA antibodies. These cross-reactive antibodies mediate neuronal apoptosis in vitro and in vivo, and the CSF from a patient with these antibodies also mediates neuronal cell death by an apoptotic pathway.
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    • Induction of antiphospholipid antibodies by immunization with synthetic viral and bacterial peptides
    • 2-glycoprotein 1 production. This is consistent with a role for such viral and bacterial proteins in inducing aPL production in humans
    • 2-glycoprotein 1 production. This is consistent with a role for such viral and bacterial proteins in inducing aPL production in humans.
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    • A prospective analysis of cognitive function and anticardiolipin antibodies in systemic lupus erythematosus
    • In this prospective, 5-year study of cognitive function and aPLs in unselected patients with lupus, anticardiolipin immunoglobulin (Ig) G and IgA were associated with long-term subtle deterioration in cognitive function
    • Hanly JG, Hong C, Smith S, Fisk JD. A prospective analysis of cognitive function and anticardiolipin antibodies in systemic lupus erythematosus. Arthritis Rheum 1999;42(4):728-734. In this prospective, 5-year study of cognitive function and aPLs in unselected patients with lupus, anticardiolipin immunoglobulin (Ig) G and IgA were associated with long-term subtle deterioration in cognitive function.
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    • Hanly JG, Urowitz MB, Sanchez-Guerrero J, et al. Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: an international inception cohort study. Arthritis Rheum 2007;56(1):265-273. This international inception cohort study of 572 patients found that 28% of these patients experienced at least one neuropsychiatric lupus manifestation at or around the time of lupus diagnosis. The occurrence of these manifestations was associated with reduced quality of life and increased organ damage.
    • Hanly JG, Urowitz MB, Sanchez-Guerrero J, et al. Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: an international inception cohort study. Arthritis Rheum 2007;56(1):265-273. This international inception cohort study of 572 patients found that 28% of these patients experienced at least one neuropsychiatric lupus manifestation at or around the time of lupus diagnosis. The occurrence of these manifestations was associated with reduced quality of life and increased organ damage.
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    • Harel L, Sandborg C, Lee T, von Scheven E. Neuropsychiatric manifestations in pediatric systemic lupus erythematosus and association with antiphospholipid antibodies. J Rheumatol 2006; 33(9):1873-1877. Neuropsychiatric manifestations occur in about 25% of children with lupus, appear early in the disease course, and are not necessarily associated with a lupus flare. Seizures were the most frequent symptom in this cohort.
    • Harel L, Sandborg C, Lee T, von Scheven E. Neuropsychiatric manifestations in pediatric systemic lupus erythematosus and association with antiphospholipid antibodies. J Rheumatol 2006; 33(9):1873-1877. Neuropsychiatric manifestations occur in about 25% of children with lupus, appear early in the disease course, and are not necessarily associated with a lupus flare. Seizures were the most frequent symptom in this cohort.
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    • Harrison MJ, Ravdin LD, Lockshin MD. Relationship between serum NR2a antibodies and cognitive dysfunction in systemic lupus erythematosus. Arthritis Rheum 2006;54(8):251525-22. No significant cross-sectional association was seen between NR2a antibody positivity and cognitive dysfunction, depressive symptoms, or anxiety in patients with lupus.
    • Harrison MJ, Ravdin LD, Lockshin MD. Relationship between serum NR2a antibodies and cognitive dysfunction in systemic lupus erythematosus. Arthritis Rheum 2006;54(8):251525-22. No significant cross-sectional association was seen between NR2a antibody positivity and cognitive dysfunction, depressive symptoms, or anxiety in patients with lupus.
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    • Improvement of coping abilities in patients with systemic lupus erythematosus: A prospective study
    • Patients with lupus enrolled in a psychological intervention to improve coping skills were compared with lupus patients on a wait-list to receive the intervention. This intervention led to a significant and sustained improvement in coping skills and quality of life
    • Haupt M, Millen S, Jänner M, et al. Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis 2005;64(11):1618-1623. Patients with lupus enrolled in a psychological intervention to improve coping skills were compared with lupus patients on a wait-list to receive the intervention. This intervention led to a significant and sustained improvement in coping skills and quality of life.
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    • Anticardiolipin antibodies in patients with multiple sclerosis do not represent a subgroup of patients according to clinical, familial, and biological characteristics
    • In this study, 15% of 285 consecutive patients with multiple sclerosis had positive aPL tests. The clinical characteristics of those with aPL positivity did not differ from those without them
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    • Husebye ES, Sthoeger ZM, Dayan M, et al. Autoantibodies to a NR2A peptide of the glutamate/NMDA receptor in sera of patients with systemic lupus erythematosus. Ann Rheum Dis 2005;64(8):1210-1213. Antibodies to anti-NR2a antibodies were seen in 31% of patients with lupus, 6.1% with myasthenia gravis, 5.3% with primary APS, and 4.6% of healthy controls. There was no correlation between the presence of anti-NR2a antibodies and lupus-related disease activity or clinical manifestations.
    • Husebye ES, Sthoeger ZM, Dayan M, et al. Autoantibodies to a NR2A peptide of the glutamate/NMDA receptor in sera of patients with systemic lupus erythematosus. Ann Rheum Dis 2005;64(8):1210-1213. Antibodies to anti-NR2a antibodies were seen in 31% of patients with lupus, 6.1% with myasthenia gravis, 5.3% with primary APS, and 4.6% of healthy controls. There was no correlation between the presence of anti-NR2a antibodies and lupus-related disease activity or clinical manifestations.
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    • Jacobson MW, Rapport LJ, Keenan PA, et al. Neuropsychological deficits associated with antiphospholipid antibodies. J. Clin Exp Neuropsychol 1999;21(2):251-264. This study evaluated cognitive function in 27 nonelderly asymptomatic patients with aPLs and matched healthy controls. The frequency of impaired cognitive performance was higher in those with aPLs, suggesting that a preclinical phase may exist in patients with these antibodies during which damage occurs that can only be detected by sensitive neuropsychological testing.
    • Jacobson MW, Rapport LJ, Keenan PA, et al. Neuropsychological deficits associated with antiphospholipid antibodies. J. Clin Exp Neuropsychol 1999;21(2):251-264. This study evaluated cognitive function in 27 nonelderly asymptomatic patients with aPLs and matched healthy controls. The frequency of impaired cognitive performance was higher in those with aPLs, suggesting that a preclinical phase may exist in patients with these antibodies during which damage occurs that can only be detected by sensitive neuropsychological testing.
  • 34
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    • Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosis in the antiphospholipid-antibody syndrome. New Eng J Med 1995;332(15):993-997. This uncontrolled study found that the risk of recurrent thrombotic manifestations in patients with APS is high and occurs with the highest frequency in the first 6 months after stopping warfarin therapy. Long-term treatment with high-intensity warfarin is recommended.
    • Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosis in the antiphospholipid-antibody syndrome. New Eng J Med 1995;332(15):993-997. This uncontrolled study found that the risk of recurrent thrombotic manifestations in patients with APS is high and occurs with the highest frequency in the first 6 months after stopping warfarin therapy. Long-term treatment with high-intensity warfarin is recommended.
  • 35
    • 33845893222 scopus 로고    scopus 로고
    • Human lupus autoantibodies against NMDA receptors mediate cognitive impairment
    • This study demonstrates that mice who receive IV injections of anti-NR2a antibodies from human patients with lupus develop neuronal apoptosis only in the presence of blood-brain barrier disruption
    • Kowal C, Degiorgio LA, Lee JY, et al. Human lupus autoantibodies against NMDA receptors mediate cognitive impairment. Proc Natl Acad Sci U S A. 2006;103(52):19854-19859. This study demonstrates that mice who receive IV injections of anti-NR2a antibodies from human patients with lupus develop neuronal apoptosis only in the presence of blood-brain barrier disruption.
    • (2006) Proc Natl Acad Sci U S A , vol.103 , Issue.52 , pp. 19854-19859
    • Kowal, C.1    Degiorgio, L.A.2    Lee, J.Y.3
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    • Kozora E, Arciniegas DB, Filley CM, et al. Cognition, MRS neurometabolites, and MRI volumetrics in non-neuropsychiatric systemic lupus erythematosus: preliminary data. Cogn Behav Neurol 2005;18(3):159-162. This is the first study to correlate cognitive impairment with an increase in choline/creatine ratio among patients with lupus. These results suggest changes in cerebral white matter might be important in determining the subtle cognitive impairment that may occur in patients with lupus, even in the absence of overt neuropsychiatric manifestations.
    • Kozora E, Arciniegas DB, Filley CM, et al. Cognition, MRS neurometabolites, and MRI volumetrics in non-neuropsychiatric systemic lupus erythematosus: preliminary data. Cogn Behav Neurol 2005;18(3):159-162. This is the first study to correlate cognitive impairment with an increase in choline/creatine ratio among patients with lupus. These results suggest changes in cerebral white matter might be important in determining the subtle cognitive impairment that may occur in patients with lupus, even in the absence of overt neuropsychiatric manifestations.
  • 37
    • 33747001788 scopus 로고    scopus 로고
    • Anti-N-methyl-D-aspartate receptor antibodies, cognitive dysfunction, and depression in systemic lupus erythematosus
    • This cross-sectional study of 60 patients with lupus found that anti-NR2a antibodies are associated with depression but not cognitive dysfunction
    • Lapteva L, Nowak M, Yarboro CH, et al. Anti-N-methyl-D-aspartate receptor antibodies, cognitive dysfunction, and depression in systemic lupus erythematosus. Arthritis Rheum 2006;54(8):2505-2514. This cross-sectional study of 60 patients with lupus found that anti-NR2a antibodies are associated with depression but not cognitive dysfunction.
    • (2006) Arthritis Rheum , vol.54 , Issue.8 , pp. 2505-2514
    • Lapteva, L.1    Nowak, M.2    Yarboro, C.H.3
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    • Levine SR, Brey RL, Tilley BC, et al. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 2004;291(5):576-584. This study evaluated the role of antiphospholipid positivity at study entry on recurrent thrombotic events in 1770 subjects enrolled in the Warfarin Aspirin Recurrent Stroke Study. The presence of either anticardiolipin antibody or lupus anticoagulant did not predict recurrent events in this study or a differential response to warfarin and aspirin.
    • Levine SR, Brey RL, Tilley BC, et al. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 2004;291(5):576-584. This study evaluated the role of antiphospholipid positivity at study entry on recurrent thrombotic events in 1770 subjects enrolled in the Warfarin Aspirin Recurrent Stroke Study. The presence of either anticardiolipin antibody or lupus anticoagulant did not predict recurrent events in this study or a differential response to warfarin and aspirin.
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    • McLaurin EY, Holliday SL, Williams P, Brey RL. Predictors of cognitive dysfunction in patients with systemic lupus erythematosus. Neurology 2005;64(2):297-303. This study prospectively evaluated the role of a number of factors, including aPLs, as risk factors for cognitive dysfunction in patients with SLE. Persistently positive aPLs were found to be associated with cognitive dysfunction in this population, and aspirin appeared to be important in preventing cognitive dysfunction, particularly in patients with hypertension and diabetes.
    • McLaurin EY, Holliday SL, Williams P, Brey RL. Predictors of cognitive dysfunction in patients with systemic lupus erythematosus. Neurology 2005;64(2):297-303. This study prospectively evaluated the role of a number of factors, including aPLs, as risk factors for cognitive dysfunction in patients with SLE. Persistently positive aPLs were found to be associated with cognitive dysfunction in this population, and aspirin appeared to be important in preventing cognitive dysfunction, particularly in patients with hypertension and diabetes.
  • 40
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    • A longitudinal study of anticardiolipin antibody levels and cognitive functioning in systemic lupus erythematosus
    • Persistently positive anticardiolipin IgG antibody levels over a 2- to 3-year period were associated with significantly poorer performance on cognitive function tests in patients with lupus. Tasks requiring speed of attention and concentration were particularly affected
    • Menon S, Jameson-Shortall E, Newman SP, et al. A longitudinal study of anticardiolipin antibody levels and cognitive functioning in systemic lupus erythematosus. Arthritis Rheum 1999;42(4):735-741. Persistently positive anticardiolipin IgG antibody levels over a 2- to 3-year period were associated with significantly poorer performance on cognitive function tests in patients with lupus. Tasks requiring speed of attention and concentration were particularly affected.
    • (1999) Arthritis Rheum , vol.42 , Issue.4 , pp. 735-741
    • Menon, S.1    Jameson-Shortall, E.2    Newman, S.P.3
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    • Mikdashi J, Handwerger B. Predictors of neuropsychiatric damage in systemic lupus erythematosus: data from the Maryland lupus cohort. Rheumatology (Oxford) 2004;43(12):1555-1560. In this longitudinal study, patients with lupus who developed neuropsychiatric damage were compared with those who did not to identify predictors of this damage. Independent predictors of significant neuropsychiatric damage included disease activity, white ethnicity, and the presence of antiphospholipid and anti-Ro/SSA antibodies.
    • Mikdashi J, Handwerger B. Predictors of neuropsychiatric damage in systemic lupus erythematosus: data from the Maryland lupus cohort. Rheumatology (Oxford) 2004;43(12):1555-1560. In this longitudinal study, patients with lupus who developed neuropsychiatric damage were compared with those who did not to identify predictors of this damage. Independent predictors of significant neuropsychiatric damage included disease activity, white ethnicity, and the presence of antiphospholipid and anti-Ro/SSA antibodies.
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    • 2-glycoprotein 1 antibodies as part of the laboratory criteria for APS.
    • 2-glycoprotein 1 antibodies as part of the laboratory criteria for APS.
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    • Neuropsychiatric disturbances in SLE are associated with antibodies against NMDA receptors
    • This cross-sectional study found that anti-NR2 antibodies in patients with lupus are associated with both depressive mood and cognitive dysfunction
    • Omdal R, Brokstad K, Waterloo K, et al. Neuropsychiatric disturbances in SLE are associated with antibodies against NMDA receptors. Eur J Neurol 2005;12(5):392-398. This cross-sectional study found that anti-NR2 antibodies in patients with lupus are associated with both depressive mood and cognitive dysfunction.
    • (2005) Eur J Neurol , vol.12 , Issue.5 , pp. 392-398
    • Omdal, R.1    Brokstad, K.2    Waterloo, K.3
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    • Immunotherapy of systemic lupus erythematosus
    • This review focuses on new uses for established therapies and novel agents for the treatment of lupus
    • O'Neill SG, Schrieber L. Immunotherapy of systemic lupus erythematosus. Autoimmun Rev 2005;4(6):395-402. This review focuses on new uses for established therapies and novel agents for the treatment of lupus.
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    • O'Neill, S.G.1    Schrieber, L.2
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    • High-dose cyclophosphamide and stem cell transplantation for refractory systemic lupus erythematosus
    • This editorial describes the success of a high-dose immunoablative cyclophosphamide regimen with stem cell rescue in lupus patients with refractory disease
    • Petri M, Brodsky R. High-dose cyclophosphamide and stem cell transplantation for refractory systemic lupus erythematosus. JAMA 2006;295(5):559-560. This editorial describes the success of a high-dose "immunoablative" cyclophosphamide regimen with stem cell rescue in lupus patients with refractory disease.
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    • Petri, M.1    Brodsky, R.2
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    • Antiphospholipid antibodies in an in vivo thrombosis model in mice
    • This is a classic article describing a model for testing factors contributing to aPL-induced thrombosis and potential treatment modalities
    • Pierangeli SS, Harris EN. Antiphospholipid antibodies in an in vivo thrombosis model in mice. Lupus 1994;3(4):247-251. This is a classic article describing a model for testing factors contributing to aPL-induced thrombosis and potential treatment modalities.
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    • Pierangeli, S.S.1    Harris, E.N.2
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    • Intracellular signaling triggered by antiphospholipid antibodies in platelets and endothelial cells: A pathway to therapies
    • This article describes a potential mechanism by which aPLs can lead to cell activation and thrombosis and suggests novel therapeutic targets to prevent thrombosis from occurring
    • Pierangeli SS, Vega-Ostertag M, Harris EN. Intracellular signaling triggered by antiphospholipid antibodies in platelets and endothelial cells: a pathway to therapies. Thromb Res 2004;114(5-6):467-476. This article describes a potential mechanism by which aPLs can lead to cell activation and thrombosis and suggests novel therapeutic targets to prevent thrombosis from occurring.
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    • Pierangeli, S.S.1    Vega-Ostertag, M.2    Harris, E.N.3
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    • Antiphospholipid thrombosis: Clinical course after the first thrombotic event in 70 patients
    • This observational study found that the site of the first thrombotic event in patients with aPLs tended to predict the site of recurrent events. Intermediate- to high-intensity warfarin treatment appeared to be more efficacious in preventing recurrent events than either low-intensity warfarin or aspirin treatment
    • Rosove MH, Brewer PM. Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients. Ann Intern Med 1992;117(4):303-308. This observational study found that the site of the first thrombotic event in patients with aPLs tended to predict the site of recurrent events. Intermediate- to high-intensity warfarin treatment appeared to be more efficacious in preventing recurrent events than either low-intensity warfarin or aspirin treatment.
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    • Rosove, M.H.1    Brewer, P.M.2
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    • Neuropsychiatric manifestations in systemic lupus erythematosus: Prevalence and association with antiphospholipid antibodies
    • Of the 185 lupus patients studied, 57.3% had neuropsychiatric manifestations that were commonly associated with aPLs. Stroke, headache, and seizures were independently associated with these antibodies
    • Sanna G, Bertolaccini ML, Cuadrado MJ, et al. Neuropsychiatric manifestations in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies. J Rheumatol 2003;30(5):985-992. Of the 185 lupus patients studied, 57.3% had neuropsychiatric manifestations that were commonly associated with aPLs. Stroke, headache, and seizures were independently associated with these antibodies.
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    • Sanna, G.1    Bertolaccini, M.L.2    Cuadrado, M.J.3
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    • Anticardiolipin antibodies are not a useful screening tool in a nonselected large group of patients with multiple sclerosis
    • Of the 296 patients with multiple sclerosis who were studied, aPLs were found in only six patients. No clinical differences were found between patients with and without aPLs, and no other symptoms associated with APS were found
    • Sastre-Garriga J, Reverter JC, Font J, et al. Anticardiolipin antibodies are not a useful screening tool in a nonselected large group of patients with multiple sclerosis. Ann Neurol 2001;49(3):408-411. Of the 296 patients with multiple sclerosis who were studied, aPLs were found in only six patients. No clinical differences were found between patients with and without aPLs, and no other symptoms associated with APS were found.
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    • Sastre-Garriga, J.1    Reverter, J.C.2    Font, J.3
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    • Sibbitt WL Jr, Brandt JR, Johnson CR, et al. The incidence and prevalence of neuropsychiatric syndromes in pediatric onset systemic lupus erythematosus. J Rheumatol 2002;29(7):1536-1542. This prospective, longitudinal study evaluated the incidence and prevalence of neuropsychiatric manifestation and glomerulonephritis in pediatric-onset lupus patients. Neuropsychiatric manifestations occurred in 95% and glomerulonephritis in 55% of patients (P<.0001). This suggests that neuropsychiatric manifestations are some of the most common and serious complications of pediatric lupus.
    • Sibbitt WL Jr, Brandt JR, Johnson CR, et al. The incidence and prevalence of neuropsychiatric syndromes in pediatric onset systemic lupus erythematosus. J Rheumatol 2002;29(7):1536-1542. This prospective, longitudinal study evaluated the incidence and prevalence of neuropsychiatric manifestation and glomerulonephritis in pediatric-onset lupus patients. Neuropsychiatric manifestations occurred in 95% and glomerulonephritis in 55% of patients (P<.0001). This suggests that neuropsychiatric manifestations are some of the most common and serious complications of pediatric lupus.
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    • Sibbitt WL Jr, Sibbitt RR, Brooks WM. Neuroimaging in neuropsychiatric systemic lupus erythematosus.[see comment]. Arthritis Rheum 1999;42(10):2026-2038. This comprehensive review evaluates the literature pertaining to all brain imaging modalities in the clinical evaluation and research study of neuropsychiatric lupus.
    • Sibbitt WL Jr, Sibbitt RR, Brooks WM. Neuroimaging in neuropsychiatric systemic lupus erythematosus.[see comment]. Arthritis Rheum 1999;42(10):2026-2038. This comprehensive review evaluates the literature pertaining to all brain imaging modalities in the clinical evaluation and research study of neuropsychiatric lupus.
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    • Spronk PE, Bootsma H, Huitema MG, et al. Levels of soluble VCAM-1, soluble ICAM-1, and soluble E-selectin during disease exacerbations in patients with systemic lupus erythematosus (SLE); a long term prospective study. Clin Exp Immunol 1994;97(3):439-444. Serial evaluations were performed over a 6-month period preceding 22 lupus exacerbations for soluble adhesion molecule levels. In contrast to soluble intracellular adhesion molecule and e-selectin levels, soluble vascular adhesion molecule-1 levels are increased and rise in parallel to disease activity during exacerbations and are also associated with falling complement levels.
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    • 99mTc-HMPAO) brain SPECT were studied before and after 1 month of treatment with anticoagulant therapy. After anticoagulant therapy, 11 patients showed complete recovery of brain hypometabolism and five showed partial recovery on follow-up images.
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    • The review discusses the literature on cardiac manifestations in patients with the APS. Valve disease is the most important and most common cardiac manifestation
    • Tenedios F, Erkan D, Lockshin MS. Cardiac manifestations in the antiphospholipid syndrome. Rheum Dis Clin North Am 2006;32(3):491-507. The review discusses the literature on cardiac manifestations in patients with the APS. Valve disease is the most important and most common cardiac manifestation.
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    • Tenedios, F.1    Erkan, D.2    Lockshin, M.S.3
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    • Role of anticardiolipin antibodies in young persons with migraine and transient focal neurologic events: A prospective study
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    • Tietjen GE, Day M, Norris L, et al. Role of anticardiolipin antibodies in young persons with migraine and transient focal neurologic events: a prospective study. Neurology 1998;50(5):1433-1440. This prospective, longitudinal study evaluated 645 young patients every 6 months for 3 years for the role of aPLs in migraine and transient focal neurologic deficits. APLs were not associated with either in this cohort.
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    • Tietjen, G.E.1    Day, M.2    Norris, L.3
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    • Toubi E, Khamashta MA, Panarra A, Hughes GR. Association of antiphospholipid antibodies with central nervous system disease in systemic lupus erythematosus. Am J Med 1995;99(4):397-401. This study evaluated the relationship between aPLs and clinical and brain MRI evidence of nervous system manifestations in patients with lupus. aPLs were highly associated with CNS disease and brain MRI abnormalities.
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    • Toubi, E.1    Khamashta, M.A.2    Panarra, A.3    Hughes, G.R.4
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    • Patients with multiple sclerosis with other autoimmune features such as low titer antinuclear antibodies and/or aPLs are not different clinically than those with them
    • Tourbah A, Clapin A, Gout O, et al. Systemic autoimmune features and multiple sclerosis: a 5-year follow-up study. Arch Neurol 1998;55(4):517-521. Patients with multiple sclerosis with other autoimmune features such as low titer antinuclear antibodies and/or aPLs are not different clinically than those with them.
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    • Yu HH, Lee JH, Wang LC, et al. Neuropsychiatric manifestations in pediatric systemic lupus erythematosus: a 20-year study. Lupus 2006;15(10):651-657. This is a retrospective study conducted between 1985 and 2005 evaluating pediatric patients with lupus for NPSLE manifestations. NPSLE manifestations developed in 34.6% of patients with the most frequent being seizure disorder, ischemic stroke, and psychosis. In the last 10 years of the study, the leading cause of death was NPSLE manifestations.
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    • Zaccagni H, Fried J, Cornell J, et al. Soluble adhesion molecule levels, neuropsychiatric lupus and lupus-related damage. Front Biosci 2004;9:1654-1659. Persistently positive levels of soluble intracellular adhesion molecule-1 and vascular cellular adhesion molecule-1, but not e-selectin, were associated with increased lupus-related damage. Elevated levels of all soluble adhesion molecule levels were correlated with high levels of aPLs.
    • Zaccagni H, Fried J, Cornell J, et al. Soluble adhesion molecule levels, neuropsychiatric lupus and lupus-related damage. Front Biosci 2004;9:1654-1659. Persistently positive levels of soluble intracellular adhesion molecule-1 and vascular cellular adhesion molecule-1, but not e-selectin, were associated with increased lupus-related damage. Elevated levels of all soluble adhesion molecule levels were correlated with high levels of aPLs.


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