The association of antiphospholipid antibodies with cardiopulmonary manifestations of systemic sclerosis

K. B. Morrisroe, W. Stevens, H. Nandurkar, D. Prior, V. Thakkar, J. Roddy, J. Zochling, J. Sahhar, K. Tymms, A. Sturgess, G. Major, F. Kermeen, C. Hill, J. Walker, P. Nash, E. Gabbay, P. Youssef, S. M. Proudman, M. Nikpour

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Abstract

Objectives: To determine the prevalence and correlates of antiphospholipid antibodies (APLA) in systemic sclerosis (SSc). Methods: Nine hundred and forty SSc patients were tested for APLA using an ELISA assay at recruitment. Clinical manifestations were defined as present, if ever present from SSc diagnosis. Logistic regression analysis was used to determine the associations of APLA. Results: One or more types of APLA were present in 226 (24.0%) patients. Anticardiolipin (ACA) IgG (ACA-IgG) antibodies were associated with right heart catheter-diagnosed pulmonary arterial hypertension (PAH), with higher titres corresponding with a higher likelihood of PAH (moderate titre (20-39 U/ml) ACA-IgG odds ratio [OR] 1.70, 95% CI: 1.01-2.93, p=0.047; high titre (>40 U/ml) ACA-IgG OR 4.60, 95% CI:1.02-20.8, p=0.047). Both ACA-IgM (OR 2.04, 95% CI: 1.4-3.0, p<0.0001) and ACA-IgG (OR 1.84, 95% CI: 1.2–2.8, p=0.005) were associated with interstitial lung disease (ILD). Increasing ACA-IgM and IgG titres were associated with increased likelihood of ILD. ACA-IgG was a marker of coexistent pulmonary hypertension and ILD (ILD-PH) (OR 2.10, 95% CI: 1.1–4.2, p=0.036). We also found an association between ACA-IgG and digital ulcers (OR 1.76, 95% CI: 1.16–2.67, p=0.008) and ACA-IgM and Raynaud’s phenomenon (OR 2.39, 95% CI: 1.08-5.27, p=0.031). There was no association between APLA and SSc disease subtype, peak skin score, presence of other autoantibodies, mortality or other disease manifestations. Conclusion: The association of APLA with PAH, ILD, ILD-PH, Raynaud’s phenomenon and digital ulcers suggests that endothelial abnormalities and small vessel thrombosis may be important in the pathogenesis of these disease features.
Original languageEnglish
Pages (from-to)S-133-S-137
Number of pages5
JournalClinical and Experimental Rheumatology
Volume32
Issue number6
Publication statusPublished - 1 Nov 2014
Externally publishedYes

Keywords

  • systemic sclerosis
  • interstitial lung disease
  • pulmonary arterial hypertension
  • antiphospholipid antibody

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    Morrisroe, K. B., Stevens, W., Nandurkar, H., Prior, D., Thakkar, V., Roddy, J., ... Nikpour, M. (2014). The association of antiphospholipid antibodies with cardiopulmonary manifestations of systemic sclerosis. Clinical and Experimental Rheumatology, 32(6), S-133-S-137.