Closing the Serological Gap in the Antiphospholipid Syndrome: The Value of "Non-criteria" Antiphospholipid Antibodies.

Autor:	Zohoury N; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy. nzohoury@inovadx.com.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics. nzohoury@inovadx.com.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital. nzohoury@inovadx.com., Bertolaccini ML; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital., Rodriguez-Garcia JL; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital., Shums Z; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital., Ateka-Barrutia O; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital., Sorice M; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital., Norman GL; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital., Khamashta M; From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.; Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.; N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital.
Jazyk:	angličtina
Zdroj:	The Journal of rheumatology [J Rheumatol] 2017 Nov; Vol. 44 (11), pp. 1597-1602. Date of Electronic Publication: 2017 Sep 01.
DOI:	10.3899/jrheum.170044
Abstrakt:	Objective: Most clinicians use the 2006 Sydney classification criteria to evaluate patients suspected of having antiphospholipid syndrome (APS). Although sensitive and specific for APS, many patients fulfilling clinical criteria for the syndrome are persistently negative for the specific serological tests ("laboratory criteria"). These "seronegative APS" (SN-APS) patients can go undiagnosed and untreated until they experience serious clinical events. This study's objective was to describe antibody profiles of SN-APS patients using non-criteria markers, assess the clinical utility of these markers separately and in combination, and suggest incorporation into guidelines for patients suspected of APS. Methods: We categorized 175 consecutive patients suspected of APS into 2 subgroups: 107 fulfilling Sydney APS classification for seropositive APS (SP-APS) and 68 with clinical manifestations suggestive of APS but having negative serology, on 2 occasions, for criteria markers (SN-APS). On study inclusion, samples were retested for criteria and 11 non-criteria markers, including antiphosphatidylserine/prothrombin antibodies. Results: Using 4 of 11 non-criteria tests, a cumulative 30.9% of SN-APS patients were detected. Combining results of all 11 non-criteria tests, 25 SN-APS (36.8%) and 89 SP-APS (83.2%) were positive for 1 or more non-criteria antibodies. Conclusion: Failure to diagnose APS can result in severe clinical consequences. Patients displaying clinical features of APS, but negative for conventional criteria markers, should undergo additional testing for non-criteria biomarkers. In our cohort, around one-third of SN-APS patients showed reactivity to 1 or more non-criteria markers. An update to the current classification criteria incorporating new serological markers should be considered to identify and stratify patients with APS for more effective treatment and management.
Databáze:	MEDLINE
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