Yu Pei Chock1, Thomas Moulinet2, Virginie Dufrost3, Doruk Erkan4, Denis Wahl3, Stéphane Zuily5. 1. Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA. 2. CHRU de Nancy, Department of Internal Medicine, F-54000 Nancy, France; Université de Lorraine, Inserm UMR_S 1116, F-54000 Nancy, France. 3. Université de Lorraine, Inserm UMR_S 1116, F-54000 Nancy, France; CHRU de Nancy, Vascular Medicine Division And Regional Competence Centre For Rare Vascular And Systemic Autoimmune Diseases, F-54000 Nancy, France. 4. Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA. 5. Université de Lorraine, Inserm UMR_S 1116, F-54000 Nancy, France; CHRU de Nancy, Vascular Medicine Division And Regional Competence Centre For Rare Vascular And Systemic Autoimmune Diseases, F-54000 Nancy, France. Electronic address: s.zuily@chru-nancy.fr.
Abstract
BACKGROUND: According to criteria for the classification of Systemic Lupus Erythematosus (SLE), thrombocytopenia is one of the disease-defining hematologic disorders. Since the recognition of Antiphospholipid Syndrome (APS), thrombocytopenia was frequently reported but several studies yielded contradictory results on the association between aPL-positivity and thrombocytopenia. METHODS: We evaluated the role of antiphospholipid antibodies (aPL) and different aPL profiles on the risk of thrombocytopenia in SLE patients by conducting a systematic review and meta-analysis of available literature from 1987 to 2018. MEDLINE, EMBASE, Cochrane Library, congress abstracts, and reference lists of eligible studies were searched. Studies were selected if they included SLE patients with descriptions of the exposure to aPL and the outcomes (thrombocytopenia). Two reviewers extracted study characteristics and outcome data from published reports. Estimates were pooled using random effects models and sensitivity analyses. We followed the PRISMA guidelines for all stages of the meta-analysis. PROSPERO registration number: CRD42015027378. RESULTS: From 3278 articles identified, 53 studies met inclusion criteria amounting to 9019 SLE patients. Twenty-nine percent of aPL-positive SLE patients had thrombocytopenia compared to 15.1% in aPL-negative SLE patients. The overall pooled Odds Ratio (OR) for thrombocytopenia in aPL positive patients was 2.48 (95% CI; 2.10-2.93). Among aPL subtypes, the risk of thrombocytopenia was highest for lupus anticoagulant (OR = 3.56 [95% CI, 2.57-5.25]), IgM anti-β2-GP1(OR = 2.87 [95% CI; 2.57-5.25]), IgG and IgM anticardiolipin antibodies (OR = 1.87 [95% CI; 1.52-2.31] and OR = 1.73 [95% CI; 1.36-2.19] respectively). CONCLUSIONS: The occurrence of thrombocytopenia was strongly determined by various aPL profiles in SLE patients. While the association between IgM antibodies and other APS manifestations including thrombosis is debated, IgM isotypes are helpful in the risk stratification of thrombocytopenia in SLE.
BACKGROUND: According to criteria for the classification of Systemic Lupus Erythematosus (SLE), thrombocytopenia is one of the disease-defining hematologic disorders. Since the recognition of Antiphospholipid Syndrome (APS), thrombocytopenia was frequently reported but several studies yielded contradictory results on the association between aPL-positivity and thrombocytopenia. METHODS: We evaluated the role of antiphospholipid antibodies (aPL) and different aPL profiles on the risk of thrombocytopenia in SLEpatients by conducting a systematic review and meta-analysis of available literature from 1987 to 2018. MEDLINE, EMBASE, Cochrane Library, congress abstracts, and reference lists of eligible studies were searched. Studies were selected if they included SLEpatients with descriptions of the exposure to aPL and the outcomes (thrombocytopenia). Two reviewers extracted study characteristics and outcome data from published reports. Estimates were pooled using random effects models and sensitivity analyses. We followed the PRISMA guidelines for all stages of the meta-analysis. PROSPERO registration number: CRD42015027378. RESULTS: From 3278 articles identified, 53 studies met inclusion criteria amounting to 9019 SLEpatients. Twenty-nine percent of aPL-positive SLEpatients had thrombocytopenia compared to 15.1% in aPL-negative SLEpatients. The overall pooled Odds Ratio (OR) for thrombocytopenia in aPL positive patients was 2.48 (95% CI; 2.10-2.93). Among aPL subtypes, the risk of thrombocytopenia was highest for lupus anticoagulant (OR = 3.56 [95% CI, 2.57-5.25]), IgM anti-β2-GP1(OR = 2.87 [95% CI; 2.57-5.25]), IgG and IgM anticardiolipin antibodies (OR = 1.87 [95% CI; 1.52-2.31] and OR = 1.73 [95% CI; 1.36-2.19] respectively). CONCLUSIONS: The occurrence of thrombocytopenia was strongly determined by various aPL profiles in SLEpatients. While the association between IgM antibodies and other APS manifestations including thrombosis is debated, IgM isotypes are helpful in the risk stratification of thrombocytopenia in SLE.
Authors: Medha Barbhaiya; Stephane Zuily; Yasaman Ahmadzadeh; Mary-Carmen Amigo; Tadej Avcin; Maria Laura Bertolaccini; D Ware Branch; Guilherme de Jesus; Katrien M J Devreese; Camille Frances; David Garcia; Francis Guillemin; Steven R Levine; Roger A Levy; Michael D Lockshin; Thomas L Ortel; Surya V Seshan; Maria Tektonidou; Denis Wahl; Rohan Willis; Ray Naden; Karen Costenbader; Doruk Erkan Journal: Arthritis Care Res (Hoboken) Date: 2021-09-02 Impact factor: 5.178