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Immunoglobulin A anti-phospholipid antibodies in Swedish cases of systemic lupus erythematosus: associations with disease phenotypes, vascular events and damage accrual
Linkoping Univ, Div Neuro & Inflammat Sci, Dept Clin & Expt Med, Linkoping, Sweden.
Swedish Med Prod Agcy, SE-75103 Uppsala, Sweden;Karolinska Univ Hosp, Karolinska Inst, Dept Med Solna, Unit Rheumatol, Stockholm, Sweden.
Karolinska Univ Hosp, Karolinska Inst, Dept Med Solna, Unit Rheumatol, Stockholm, Sweden.
Linkoping Univ, Div Neuro & Inflammat Sci, Dept Clin & Expt Med, Linkoping, Sweden.
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2018 (English)In: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 194, no 1, p. 27-38Article in journal (Refereed) Published
Abstract [en]

Immunoglobulin (Ig) G- and IgM-class anti-cardiolipin antibodies (aCL) and lupus anti-coagulant (LA) are included in the 1997 update of the American College of Rheumatology (ACR-97) systemic lupus erythematosus (SLE) criteria. Despite limited evidence, IgA-aCL and IgA anti-(2)-glycoprotein-I (anti-(2)GPI) were included in the 2012 Systemic Lupus International Collaborating Clinics criteria. The present study aimed to evaluate IgG-/IgA-/IgM-aCL and anti-(2)GPI occurrence in relation to disease phenotype, smoking habits, pharmacotherapy, anti-phospholipid syndrome (APS) and organ damage among 526 Swedish SLE patients meeting ACR-97. Patients with rheumatoid arthritis (n=100), primary Sjogren's syndrome (n=50) and blood donors (n=507) served as controls. Anti-phospholipid antibodies (aPL) were analysed by fluoroenzyme-immunoassays detecting aCL/anti-(2)GPI. Seventy-six (14%) SLE cases fulfilled the Sydney APS-criteria, and 1 aCL/anti-(2)GPI isotype (IgG/IgA/IgM) occurred in 138 SLE patients (26%). Forty-five (9%) of the SLE cases had IgA-aCL, 20 of whom (4%) lacked IgG-/IgM-aCL. Seventy-four (14%) tested positive for IgA anti-(2)GPI, 34 (6%) being seronegative regarding IgG/IgM anti-(2)GPI. Six (1%) had APS manifestations but were seropositive regarding IgA-aCL and/or IgA anti-(2)GPI in the absence of IgG/IgM-aPL and LA. Positive LA and IgG-aPL tests were associated with most APS-related events and organ damage. Exclusive IgA anti-(2)GPI occurrence associated inversely with Caucasian ethnicity [odds ratio (OR)=021, 95% confidence interval (CI)=006-072) and photosensitivity (OR=019, 95% CI=005-072). Nephritis, smoking, LA-positivity and statin/corticosteroid-medication associated strongly with organ damage, whereas hydroxychloroquine-medication was protective. In conclusion, IgA-aPL is not rare in SLE (16%) and IgA-aPL analysis may have additional value among SLE cases with suspected APS testing negative for other isotypes of aPL and LA.

Place, publisher, year, edition, pages
WILEY , 2018. Vol. 194, no 1, p. 27-38
Keywords [en]
anti-phospholipid antibodies, anti-phospholipid syndrome, autoantibodies, immunoglobulin A, systemic lupus erythematosus
National Category
Rheumatology and Autoimmunity Immunology in the medical area
Identifiers
URN: urn:nbn:se:uu:diva-363214DOI: 10.1111/cei.13180ISI: 000445601500004PubMedID: 30208508OAI: oai:DiVA.org:uu-363214DiVA, id: diva2:1256587
Funder
Swedish Research CouncilSwedish Society for Medical Research (SSMF)Swedish Society of MedicineSwedish Rheumatism AssociationSwedish Heart Lung FoundationStockholm County CouncilAvailable from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-10-17Bibliographically approved

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