Lupus最新文献

{"title":"Barriers and motivations to exercise participation among women with severe systemic lupus erythematosus who have recently undergone glucocorticoid pulse therapy: A qualitative analysis.","authors":"Juliana M Barboza, Gabriel P Esteves, Willian Jd Ribeiro, Vithor R Fickert, Andre S Franco, Luciana Parente Costa Seguro, Hamilton Roschel, Bruno Gualano, Eimear Dolan","doi":"10.1177/09612033251330116","DOIUrl":"10.1177/09612033251330116","url":null,"abstract":"<p><p>BackgroundPhysical activity is important in the management of systemic lupus erythematosus, yet available evidence indicates that inactivity and poor physical fitness are commonplace. Individuals with SLE, and particularly those whose condition severity warrants aggressive pharmacological treatment such as glucocorticoid pulse therapy, may face substantial barriers to exercise participation. A better understanding of these may be useful to develop targeted and effective exercise recommendations and strategies.PurposeTo explore motivations and barriers for exercise participation in a group of women with SLE who have recently undergone glucocorticoid pulse therapy.MethodsThis is a cross-sectional, exploratory study, whereby participants underwent individually administered semi-structured interviews related to personal motivations and barriers to exercise training. Self-reported well-being and quality of life were assessed using the Systemic Lupus Erythematosus Quality of Life (SLEQOL) and SF-36 questionnaires.ResultsTwenty-three women, with a high median level of disease activity (SLEDAI 8; IQR: 4-12) participated in the study. All participants reported wide-ranging health benefits as a motivation to exercise, but the majority did not exercise. They cited numerous health-related, personal and social barriers to exercise participation. SF-36 results indicated that the group experienced difficulties in participating in work and other regular daily activities.ConclusionAlthough the group recognized the health-related benefits of exercise, this knowledge was insufficient to encourage exercise participation. Exercise professionals must remain cognizant of the wide-ranging health-related, personal and social barriers that may exist for this group, and to consider these when formulating exercise recommendations.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"492-499"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the association between antiphospholipid syndrome and ovarian reserve: A systematic review and meta-analysis of the literature.","authors":"Nooshin Hemmati, Maryam Sahebari, Mona Larki, Vahid Ghavami, Elham Manouchehri","doi":"10.1177/09612033251332051","DOIUrl":"https://doi.org/10.1177/09612033251332051","url":null,"abstract":"<p><p>BackgroundAutoimmune diseases can reduce ovarian reserves. Women in reproductive ages are susceptible to an autoimmune disorder known as antiphospholipid syndrome (APS). The aim of this study is to investigate the association between APS and ovarian reserve (OR).MethodPubMed, Scopus, Web-of-Science, Science Direct, and the Google scholar search engine were searched (22 June 2024) for studies that investigated the effect of APS on OR. Literature screening, data extraction, and assessment of the risk of bias of the included studies were conducted by two reviewers independently. Mean differences were computed using a random effects model. Heterogeneity was assessed by I²%.ResultsFour cross-sectional studies were included in this meta-analysis. None of the studies had a high risk of bias. There was no significant association identified between primary (MD = -0.27, 95% CI, -1.42 to 0.87, <i>p</i> = 0.639) and secondary APS (SMD = -0.38, 95% CI, -2.46 to 1.69, <i>p</i> = 0.717) with antimullerian hormone amounts. The antral follicle count (AFC) was investigated in two studies revealed lower levels of AFC in women with primary APS. Regarding the levels of gonadotropins and estradiol in the participants' serum, the results are contradictory.ConclusionsThe results of this meta-analysis identified there is no relationship between primary and secondary APS with the reduction of ovarian reserves in women with APS. This issue should be considered in the reproductive health of women with APS, who can have children at the right time by consulting a rheumatologist and reproductive health specialist.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"9612033251332051"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic lupus erythematosus with hypothermia and Wallenberg's syndrome as signs of brainstem encephalitis: A grand rounds case.","authors":"Reo Shiratani, Takayuki Shibahara, Mikio Shiba, Haruka Murao, Jeong Hoon Park, Tomomi Tada, Nachi Ishikawa, Jun Fujimoto, Junki Jinno, Makoto Tatsumi, Tomoki Yamada, Yoshiharu Higuchi, Shinji Higa","doi":"10.1177/09612033251324496","DOIUrl":"10.1177/09612033251324496","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is an autoimmune disease that causes inflammation and organ damage. However, brain-stem encephalitis is rare in patients with SLE. We report a rare case of a patient with incipient SLE who simultaneously presented with brainstem encephalitis and cardiomyopathy. An 18-year-old woman was admitted to our hospital with fever, polyarthralgia, and malar rash. Laboratory tests revealed leukopenia, thrombocytopenia, proteinuria, an elevated anti-double-stranded deoxyribonucleic acid antibody titer, and hypocomplementemia. She was diagnosed with SLE and treated with an intermediate dose of prednisolone. Her fever disappeared 2 days later, but high-grade fever reappeared, and a high dose of prednisolone was administered from the eighth day of hospitalization. On the tenth day of hospitalization, she developed a headache, hypothermia, dysphagia, respiratory failure, and myocarditis. Brain magnetic resonance imaging indicated brainstem encephalitis. Under ventilator management, the patient received intravenous methylprednisolone pulse therapy, cyclophosphamide, and plasma exchange. Her general condition improved, however, dysphagia and hoarseness persisted, and Wallenberg's syndrome was diagnosed. Our findings suggest that patients with SLE can present with Wallenberg's syndrome as a sign of brainstem encephalitis and that early aggressive immunotherapy can be effective in patients with brainstem encephalitis and cardiomyopathy associated with SLE.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"525-532"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health journey of Nigerian patients with systemic lupus erythematosus.","authors":"Hakeem Babatunde Olaosebikan, Abubakar Yerima, Gbenga Joshua Odunlami, Courage Ukponmwan Uhunmwangho, Henry Madu Nwankwo, Musa Bello Kofar Na'isa, Mary Agun-Ebreme, Ibrahim Daiyabu, Ilo Azizat Bamisebi, Etseoghena Igebu, Henry Ekpenyong, Hassana Hindatu Aliyu, Olufemi Oladipo Adelowo","doi":"10.1177/09612033251324482","DOIUrl":"10.1177/09612033251324482","url":null,"abstract":"<p><p>BackgroundAlthough there is an increase in prevalence and incidence of lupus worldwide, the journey to diagnosis is unduly delayed. This delay is associated with worse outcomes. Sub-Saharan Africa has witnessed an increase in lupus diagnosis in recent decades with no specific data on the time to diagnosis of lupus.ObjectivesWe measured and documented lupus diagnostic delays, patients' experiences, and factors associated with delayed diagnosis and provided recommendations for early diagnosis.MethodsThis is a three-month cross-sectional study of 245 patients diagnosed with lupus who are members of a Nigerian lupus support group. Included participants fill out patients' administered questionnaire in a Google doc. The questionnaire captured all aspects of the study objectives. Four diagnostic journey intervals were defined. Delayed diagnosis was defined as a time interval from first symptoms to lupus diagnosis greater than or equal to 6 months.ResultsThe majority of participants were under 40 years of age (<i>n</i>-187, 76.3%) and predominantly female (<i>n</i>-226, 92.9%). About 53.9% of participants were diagnosed between 6 months and 2 years after their first symptoms, while 42% visited the first doctor within 6 months of symptom onset. Roughly half of the participants were referred to rheumatologists within 6 months of their visit to the last doctor, while 50.2% of the participants were diagnosed within 4 weeks of the rheumatologist's evaluation. Delayed diagnosis and delayed referral were documented in 80% and 66.9% of participants respectively. Low income (OR-7.4), internal organ manifestations (OR-4.5), and multiple doctors' visits (OR-11.6) were independently associated with delayed diagnosis.ConclusionsDiagnostic delay is observed in the majority of our patients. This delay is associated with multiple hospital visits, low income, and internal organ manifestations. There should be concerted efforts in SSA to improve the rheumatology workforce and incorporate non-specialists in clinical service delivery.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"425-434"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between extracellular vesicles (EVs) and thrombosis in antiphospholipid syndrome.","authors":"Bruna Cardoso Jacintho-Robison, Jose Diogo Oliveira, Lucas Matheus Bispo Césped, Cristiane Maria de Souza, Bárbara Gomes Barion, Camila de Oliveira Vaz, Bruna De Moraes Mazetto, Fernanda Andrade Orsi","doi":"10.1177/09612033251330099","DOIUrl":"10.1177/09612033251330099","url":null,"abstract":"<p><p>BackgroundAntiphospholipid syndrome (APS) is characterized by thrombosis or pregnancy complications associated with the presence of antiphospholipid antibodies (aPLs). Although the exact mechanisms are unclear, aPLs can increase the expression of tissue factor on platelets, leukocytes, and endothelial cells, leading to hypercoagulability. Extracellular vesicles (EVs) can also be released during this process and play a key role in immune regulation and thrombosis related to APS.AimsTo evaluate the association between circulating levels of EVs and thrombosis related to APS, as well as inflammatory markers.MethodsCase-control study including patients with thrombotic APS (t-APS) and healthy controls (HC). EVs expressing the following antigens were quantified by flow cytometry: CD41 (platelet integrin alpha IIb), CD162 (P-selectin glycoprotein ligand 1), CD31 (platelet and endothelial cell adhesion molecule 1), CD142 (tissue factor), and CD62 (P-selectin). EV levels were compared between groups and correlated with APS clinical and inflammatory parameters.ResultsA total of 69 t-APS patients and 46 HC were included. CD162+EV, CD31+EV, and CD41+EV levels were higher in t-APS patients compared to controls. CD41+EV levels were associated with venous thrombosis (<i>p</i> = .04) and multiple thrombosis (<i>p</i> = .07). Levels of CD162+EV, CD31+EV, CD142+EV and CD62P + EV were positively correlated with levels of interleukin-1 beta (IL-1β).ConclusionEVs expressing antigens related to platelet and endothelial cell activation and adhesion, as well as platelet-leukocyte interaction, were associated with thrombosis related to APS. The correlation between EV levels and IL-1β levels further underscore the association between EV release and thromboinflammatory responses in APS. Our results demonstrate the involvement of EVs in the interaction between inflammation and thrombosis in APS.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"500-510"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of SARS-CoV-2 pre-delta/delta and omicron variants on clinical outcomes in a systemic lupus erythematosus cohort from Puerto Rico.","authors":"Lilliana Serrano-Arroyo, Ariana González-Meléndez, Rafael Ríos-Rivera, Valeria Rodríguez-González, Luis M Vilá","doi":"10.1177/09612033251325361","DOIUrl":"10.1177/09612033251325361","url":null,"abstract":"<p><p>ObjectiveTo examine the clinical outcomes of systemic lupus erythematosus (SLE) patients with COVID-19 during the Pre-Delta/Delta and Omicron periods.MethodsA retrospective study was conducted in a cohort of adult Puerto Ricans with SLE. Demographic parameters, SLE and COVID-19 manifestations, comorbidities, pharmacologic treatment, SLE exacerbations, hospitalizations, and mortality were determined. SARS CoV-2 infection was confirmed by polymerase chain reaction or antigen tests. Variables were compared between the Pre-delta/Delta and Omicron periods. Also, the proportion of COVID-19 cases and mortality of SLE patients was compared to the general population of Puerto Rico.ResultsOf the entire SLE cohort (<i>n</i> = 347), 169 patients (48.7%) had COVID-19. Twenty-two patients had COVID-19 during the Pre-delta/Delta period and 147 during the Omicron period. The proportion of COVID-19 cases in the SLE cohort was significantly higher when compared to the adult general population of Puerto Rico (25.7%), but no difference in mortality was found. Overall, the clinical outcomes of COVID-19 in the SLE cohort were favorable, with low rates of lupus flares (3.0%), hospitalizations (3.6%), and mortality (0.6%). Patients with COVID-19 during the Pre-delta/Delta period were more likely to have oral ulcers, anti-Smith antibodies, and chronic kidney disease, whereas those during the Omicron period were more likely to have COVID-19 symptoms (rhinorrhea, sore throat, and cough).ConclusionIn summary, is this group of Puerto Ricans with SLE, a high proportion had COVID-19, but disease exacerbation, hospitalization, and mortality rates were low. Few clinical differences were noted in SLE patients when comparing the Pre-delta/Delta and Omicron periods.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"415-424"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of low-grade proteinuria with changes of lupus nephritis in kidney biopsy in SLE patients.","authors":"Homa Timlin, Abbal Koirala, Matthew Gross, Duvuru Geetha, Ihab Kamel, Mohamed G Atta","doi":"10.1177/09612033251321655","DOIUrl":"10.1177/09612033251321655","url":null,"abstract":"<p><p>BackgroundA kidney biopsy is essential for definitive histopathological diagnosis in lupus nephritis, informing therapeutic strategies. Current guidelines (ACR and EULAR/ERA-EDTA) do not include a kidney biopsy for patients with isolated proteinuria of less than 500 mg/g. We explored the histopathologic findings in patients with SLE with proteinuria ≤500 mg/g.MethodsWe conducted a retrospective review of 27 biopsies of lupus patients with proteinuria ≤500 mg/g who underwent a kidney biopsy at Johns Hopkins. Clinical and laboratory data were obtained from a review of the medical records. The study was approved by the Office of Human Subjects Research and Institutional Review Board.ResultsMost individuals were females (93%) and African American (56%), with a mean age of 42.1 (12.4) years at the time of biopsy. Twelve individuals had no prior history of lupus nephritis. The average creatinine at the biopsy was 1.05 mg/dl, and UPCR was 0.27 grams/gram. Most patients (100%) were on hydroxychloroquine, 41% were on prednisone, and 33% were on mycophenolate mofetil. Kidney biopsies were most commonly performed based on extra-renal disease activity, new-onset or worsening proteinuria (88.9%) and worsening dsdNA levels (55.6%). At the time of biopsy, 55.6% of patients presented with extrarenal lupus, most commonly arthritis or arthralgias and mucosal ulcers. Of the 27 patients, 23 patients had evidence of lupus nephritis (85.1%), including class III (33%), V (30%), III/V (7%), class II (4%) and class I (11%). Nine patients had a UPCR of 200 mg/g or lower. Among these patients, 22% did not show signs of lupus nephritis in the kidney biopsy, 44% had class V LN, and 11% had class I and III LN. Kidney biopsy was well tolerated, with the majority (93%) not developing post-biopsy complications.ConclusionsWe identified patients with proteinuria ≤500 mg/g who had lupus nephritis, with the majority ranging from Class III to V with only one class II. This study supports that normal or low UPCR <500 mg/g lacks the sensitivity to detect early lupus nephritis. Better biomarkers for the cutoff of biopsy are needed to improve kidney outcomes and trial design.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"331-336"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long COVID in patients with systemic lupus erythematosus: A case-control study.","authors":"Chris Ching Lam Cheung, Chi Chiu Mok","doi":"10.1177/09612033251326987","DOIUrl":"10.1177/09612033251326987","url":null,"abstract":"<p><p>BackgroundLong COVID was defined by the WHO as continuation or development of new symptoms 3 months after the initial SARS-CoV2 infection, with these symptoms lasting for ≥2 months without alternative explanations.ObjectivesTo compare the incidence of long COVID in patients with SLE with matched controls after a SARS-CoV2 infection.MethodsConsecutive patients (≥18 years) who fulfilled the ACR or SLICC criteria for SLE between July to November 2023 were recruited. Those with SARS-CoV2 infection (positive rapid antigen test [RAT] or PCR) were identified by a self-reported questionnaire, which also captured the duration and severity of a number of pre-defined symptoms of long COVID. An equal number of healthy subjects, matched for gender and age, who had SARS-CoV2 infection in the same period were recruited for the same survey. The incidence and presentation of long COVID was compared between patients and controls, and risk factors for long COVID in SLE patients were studied.ResultsA total of 211 SLE patients (97.6% women, age 44.2 ± 11.9 years) and 211 healthy controls (97.6% women, age 44.2 ± 11.9 years) were studied. In all patients, the most common long COVID symptoms were fatigue (30.1%), worsening of memory (29.1%), difficulty to concentrate (26.3%), cough (23.2%) and insomnia (18.9%). Compared with controls, the incidence of long COVID was significantly higher in SLE patients (54.5% vs 34.6%; OR 2.27 [1.53-3.35]). Symptoms of worsening of memory (OR 2.77 [1.78-4.31]), chest pain (OR 4.18 [1.16-15.0]), palpitation (OR 3.43 [1.58-7.47]) and arthralgia (OR 2.67 [1.29-5.53]) were significantly more common in SLE patients than controls. However, no clinical and serological factors were significantly associated with the occurrence of long COVID in SLE patients except the ever use of hydroxychloroquine (OR 2.03 [1.04-3.96]).ConclusionsLong COVID is more common in SLE patients than matched controls after a SARS-CoV2 infection. The development of long COVID symptoms in SLE is largely unpredictable.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"452-459"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of the modified National Institute of health activity and chronicity scoring system in predicting end-stage kidney disease in Latin American lupus nephritis patients.","authors":"Joaquín Roberto Rodelo-Ceballos, Lina Aguirre, Luis Alonso González","doi":"10.1177/09612033251325315","DOIUrl":"10.1177/09612033251325315","url":null,"abstract":"<p><p>ObjectiveTo assess the effectiveness of the modified National Institute of Health (mNIH) activity and chronicity scoring system in predicting the progression to end-stage kidney disease (ESKD) in Latin American lupus nephritis (LN) patients.MethodsWe retrospectively analyzed 412 patients with biopsy-proven LN. ESKD was defined as an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m² for ≥3 months, dialysis for >3 months, or kidney transplant. Univariable and multivariable Cox proportional hazards regression analyses were performed to evaluate the predictive value of the mNIH activity and chronicity indices for ESKD.Results84 patients (20.4%) progressed to ESKD at a median of 3.0 months after biopsy. The mNIH activity and chronicity indices were significantly higher in patients who progressed to ESKD compared to those who did not [7 (5-10) versus 4 (1-7), <i>p</i> < .001; and 3 (1-5) versus 0 (0-2), <i>p</i> < .001, respectively]. Multivariable Cox regression analysis revealed that the mNIH activity index (HR 1.17, 95% CI 1.05-1.29), and the mNIH chronicity index (HR 1.21, 95% CI 1.05-1.40) were independently associated with a higher risk of ESKD, adjusting for age, sex, ethnicity, and eGFR. Furthermore, fibrinoid necrosis (HR 4.09, 95% CI 1.54-10.86) and fibrous crescents (HR 2.36; 95% CI 1.06-5.27), components of the activity and chronicity indices, respectively, were also associated with a shorter time to ESKD.ConclusionsIn Latin American LN patients, the mNIH activity and chronicity indices are associated with an increased risk of ESKD. Among the components of these indices, shorter time to ESKD was mainly driven by fibrinoid necrosis and fibrous crescents.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"381-394"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for bleeding in patients with thrombotic antiphospholipid syndrome during antithrombotic therapy.","authors":"Pedro Gaspar, Prabal Mittal, Hannah Cohen, David A Isenberg","doi":"10.1177/09612033251322927","DOIUrl":"10.1177/09612033251322927","url":null,"abstract":"<p><p>ObjectivesWe aimed to explore the prevalence and risk factors for bleeding in patients with thrombotic antiphospholipid syndrome (tAPS) on antithrombotic therapy.MethodsSingle-centre retrospective analysis of patients with tAPS (Sydney criteria). Bleeding events were classified according to the International Society on Thrombosis and Haemostasis as (a) major bleeding and (b) any bleeding. Risk factors for any bleeding and for major bleeding were explored using logistic regression.ResultsWe identified 197 patients (female, 71.1%; primary APS, 65.9%; presenting with arterial thrombosis, 44.2%; median disease duration, 10 years), all of whom had been exposed to antithrombotic therapy: anticoagulation, 98.5% (90.2% warfarin), and combined antithrombotic therapy, 24.9%. Eighty patients (40.6%) experienced 167 bleedings (22.8% major bleedings). Recurrent thrombosis during treatment occurred in 26.9% of patients (58.5% arterial thrombosis), and 41.9% of patients received high-intensity anticoagulation schemes (all warfarin target INR >3). Thrombocytopenia (<150 × 10⁹ platelets/L) affected 12.7% of patients. Secondary APS was associated with major bleeding, whereas recurrent thrombosis and high-intensity anticoagulation were associated with any bleeding. Combined antithrombotic therapy and thrombocytopenia increased the risk for any bleeding and major bleeding, with thrombocytopenia associated with both outcomes (OR = 5.58, 95% CI, 1.93-16.13; OR = 2.82, 95% CI, 1.06-7.51, respectively) after multivariate analysis.ConclusionPatients with secondary APS, those experiencing recurrent thrombosis and exposed to combined antithrombotic treatment, are particularly at risk for bleeding. Patients with thrombocytopenia warrant the most attention as it is both an independent and the strongest risk factor for bleeding that we identified.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"405-411"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}