The Lupus Connection

Up to 50% of patients with SLE have antibodies to phospholipids ('sticky blood').

SLE patients with Antiphospholipid antibodies: 40% have thrombosis.

SLE without Antiphospholipid antibodies: 12% to 18% of patients.

SLE patients have a higher incidence of cardiac valvular disease, hemolytic anemia, leukopenia and low C4 complement levels.

Hemorrhagic stroke occurs more commonly in active lupus.

Thrombotic stroke, possibly related to the Anti-phospholipid antibody, is more common in quiescent phases-(remissions).

Prevalence Of Antiphospholipid Antibodies:

Presence of antiphospholipid antibodies does not necessarily indicate an increased risk for thrombosis.
The presence of AP-As is considered a risk factor for stroke, but this association may be true only in patients with SLE or other autoimmune disorders.
Many well-controlled studies have found no association between AP-As and stroke in non-SLE patients.

Autoimmune diseases Percentage Relationships to Secondary Anti-Phospholipid Syndrome (APS)

• Juvenile chronic arthritis - 55%
• SLE - 15% to 50%
• Sjogren's syndrome - 42%
• Rheumatoid arthritis - up to 33%
• Idiopathic Thrombotic Purpura - 30%
• Posoriatic arthritis - 28%
• Scleroderma - 25%
• Mixed Connective Tissue Disease - 22%
• Giant cell arteritis - 20%
• Polymyalgia rheumatica - 20%
• Behcet's disease - 0% to 50%

Treatment to prevent Thrombosis

Treatment of patients with APL Antibody is controversial.
The problem seems to be mainly an abnormal hyper-coagulable state that predisposes to thrombosis of arteries rather than true vasculitis.
Asymptomatic patient with Antiphospholipid Antibodies: Reduce risk factors for vascular disease with Warfarin.
Patients with high titers: Avoid oral contraceptive.
Life style change: Maintain ideal weight, cholesterol level and physical activity; control blood pressure and avoid smoking. .