Clinical importance of persistence of anticardiolipin antibodies in systemic lupus erythematosus

Article Abstract:

Rheumatic diseases are associated with autoimmunity, where the immune system makes antibodies against an individual's own tissues. Antibodies against phospholipids, which are important fats contained in the membrane which surround every body cell, are thought to be associated with some of the medical problems resulting from systemic lupus erythematosus (SLE). Antibodies against cardiolipins (a small group of phospholipids) have been proposed as a characteristic of a subgroup of SLE patients, but the relation of these antibodies to clinical symptoms is not understood. In a study of 155 patients with SLE, 80 were in the active stage and 75 in the stable stage; all but 10 were female. Anti-cardiolipin antibodies (anti-CL) were detected in 45 percent of patients. Of the 69 with anti-CL, 43 were in active and 26 were in stable phases. In the remaining 86 patients, 37 were in active and 49 were in stable phases. Patients were studied for over two years, and were divided into two groups according to anti-CL status. Group A (39 patients) had anti-CL during both active and stable phases, while group B (29 patients) had anti-CL only during active phases. Immunosuppressants were used significantly more often by those in group B. Certain clinical features such as low levels of blood cells (leukocytes, platelets), brain dysfunction, and hypertension, did not differ in prevalence between groups. Group A had kidney disease rarely, but thromboses (clots) and associated strokes were much more frequent in group A. Spontaneous abortions occurred more frequently in group A, and another antibody, lupus anticoagulant, was more prevalent in this group. Group A had a significantly lower live birth rate, 65 percent compared with 94 percent in group B. The term ''anticardiolipin syndrome'' is proposed for the condition affecting group A, which in summary has mild SLE disease activity but frequent thromboses and obstetric disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis

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Prevalence of anticardiolipin antibodies in juvenile chronic arthritis

Article Abstract:

Many of the rheumatic diseases have an autoimmune basis, in which the body inappropriately makes antibodies against its own molecules. Among these autoantibodies are antinuclear antibodies, directed against structures normally found in the cell nucleus, and antiphospholipid antibodies, which are directed against certain fats commonly found in the membranes surrounding cells. Currently, antinuclear antibodies are thought to be the most useful in the classification and treatment of children with juvenile chronic arthritis (JCA), a disorder characterized by diverse symptoms. Anticardiolipin antibodies are directed against cardiolipin, a phospholipid found in membranes of particular tissues, and these occur in patients with systemic lupus erythematosus and other autoimmune disorders. The occurrence of anticardiolipin antibodies in 70 patients (44 female) with JCA was assessed. Results were compared with those from 42 healthy control children, 25 adult patients with rheumatoid arthritis, and 40 healthy control adults. Two types of antibody (immunoglobulin, Ig) subclasses were assessed: IgG and IgM. Twenty-four percent of children with JCA had IgG anticardiolipin antibodies, 10 percent had IgM, and 19 percent had both types of anticardiolipin antibodies. Twenty-eight percent of adults with rheumatoid arthritis had IgG or IgM antibodies, while 5 percent of control children and 10 percent of control adults had IgM anticardiolipin antibodies. Of the JCA patients with IgG antibodies, 27 percent had high blood levels of the antibodies and also had high erythrocyte sedimentation rates (a non-specific laboratory test associated with the presence of a systemic or inflammatory disease). Otherwise, the presence of anticardiolipin antibodies did not correlate with any aspect of JCA symptoms or disease process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rheumatoid arthritis in children, Juvenile rheumatoid arthritis

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Inhibitory effects of anticardiolipin antibodies on lymphocyte proliferation and neutrophil phagocytosis

Article Abstract:

In autoimmune diseases such as systemic lupus erythematosus (SLE), inappropriate antibodies to the body's own molecules are produced. Among these autoantibodies are those directed against phospholipids, a type of fat found in the membranes surrounding cells. In particular, anticardiolipin antibodies are common in SLE and other autoimmune disorders, and are associated with complications such as thrombosis (clot formation), neurological problems, and recurrent miscarriage. These antibodies may act by binding to cells involved in the cascade of reactions leading to coagulation (blood clotting). Activation of immune cells and other blood cells may render them sensitive to anticardiolipin antibodies. The effect of these antibodies on lymphocytes (immune cells important for fighting infection) and phagocytes, blood cells that invest foreign cells and particles, was evaluated. The antibodies suppressed lymphocyte and phagocyte functions such as proliferation following activation, and this effect increased with greater doses of antibody. The effect on lymphocytes was specific to the anticardiolipin antibodies and was not replicated by other antibodies that share similar stem structures with the autoantibodies. In addition, the autoantibody exerted nonspecific effects in decreasing levels of particular proteins on the surfaces of lymphocytes and in suppressing phagocytic activity of a type of white blood cell. These newly recognized, nonspecific inhibitory activities of the anticardiolipin antibodies may be significant in immune function changes in SLE. (Consumer Summary produced by Reliance Medical Information, Inc.)

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