Ilaria Cavazzana1, Laura Andreoli2,3, Maarteen Limper4,5, Franco Franceschini2, Angela Tincani2,3. 1. Rheumatology and Clinical Immunology, Spedali Civili, piazzale Spedali Civili 1, 25100, Brescia, Italy. ilariacava@virgilio.it. 2. Rheumatology and Clinical Immunology, Spedali Civili, piazzale Spedali Civili 1, 25100, Brescia, Italy. 3. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 4. Division of Rheumatology and Clinical Immunology, Utrecht Medical Center, Utrecht, The Netherlands. 5. Division Internal Medicine and Dermatology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, 3508 GA, Utrecht, the Netherlands.
Abstract
PURPOSE OF REVIEW: This review focuses on new clinical aspects of antiphospholipid syndrome (APS) in the last 5 years. RECENT FINDINGS: The pathogenesis of APS is related to endothelial activation by mechanisms other than autoantibody-mediated massive coagulation. These include Toll-like receptors, the m-TORC pathway, and neutrophil activation, inducing an uncontrolled inflammatory cascade. Given these new pathogenetic hypotheses, the treatment of APS could be directed towards a fine balance between anticoagulation and immunomodulation. A hot topic is how to consider asymptomatic antiphospholipid (aPL) carriers, with or without systemic lupus erythematosus (SLE), during pregnancy, or during their life in general: to treat or not to treat? New findings on long-standing APS, regarding survival, comorbidities, and evolution in other autoimmune conditions, have become available, including new insights into aPL as potential risk factors for damage accrual in SLE and potential implications on neuropsychological involvement of children exposed to maternal aPL in utero. This review summarizes recent findings on the management, treatment, and prevention of patients affected by APS or with aPL.
PURPOSE OF REVIEW: This review focuses on new clinical aspects of antiphospholipid syndrome (APS) in the last 5 years. RECENT FINDINGS: The pathogenesis of APS is related to endothelial activation by mechanisms other than autoantibody-mediated massive coagulation. These include Toll-like receptors, the m-TORC pathway, and neutrophil activation, inducing an uncontrolled inflammatory cascade. Given these new pathogenetic hypotheses, the treatment of APS could be directed towards a fine balance between anticoagulation and immunomodulation. A hot topic is how to consider asymptomatic antiphospholipid (aPL) carriers, with or without systemic lupus erythematosus (SLE), during pregnancy, or during their life in general: to treat or not to treat? New findings on long-standing APS, regarding survival, comorbidities, and evolution in other autoimmune conditions, have become available, including new insights into aPL as potential risk factors for damage accrual in SLE and potential implications on neuropsychological involvement of children exposed to maternal aPL in utero. This review summarizes recent findings on the management, treatment, and prevention of patients affected by APS or with aPL.
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