Cardiac involvement in primary antiphospholipid syndrome and anticardiolipin positive systemic lupus erythematosus

Since the recognition of antiphospholipid syndrome [APS], many cardiac manifestations have been reported in association with the anti-phospholipid [aPL] antibodies. The APS syndrome can be either primary or secondary to an underlying condition, most commonly systemic lupus erythematosus [SLE]. Echocardiographic studies have disclosed heart valve abnormalities in about a third of patients with APS. The aPL antibodies have been suggested to be a pathogenetic factor in the cardiac abnormalities. To evaluate prospectively the prevalence of cardiac abnormalities in patients with SLE and primary antiphospholipid syndrome [PAPS], and correlate these data with serum level of anticardiolipin [aCL] antibodies. Sixty three patients with SLE [62 females and 1 male] were enrolled and divided into two groups according to the presence [Group III, n=35] or absence of aCL [Group II, n=28]. Ten patients with PAPS [7 females and 3 males] were recruited [Group IV, n=10]. In addition, 23 healthy age and sex matched controls, were included [Group I] The serum levels of IgG and IgM aCL antibodies were measured for all patients and controls by a st and ardized ELISA test. All patients and controls also, underwent st and ard two-dimensional and Doppler echocardiographic examination within a week of serum testing. The aCL IgG antibodies were positive in 30 of 63 [47.6%] patients with SLE, in all 10 [100%] patients with PAPS, and in 1 of 23 [4.5%] control individuals. The aCL IgM antibodies were positive in 12 of 63 [19%] patients with SLE, in 4 of 10 [40%] patients with PAPS, and in none of the control individuals. Both IgG and IgM aCL antibodies were positive in 7 of 63 [11%] patients with SLE and in 4 of 10 [40%] patients with PAPS. Echocardiographic findings showed normal heart in all control subjects [group I], and in 16 [57%] of SLE patients with absence of elevated aCL levels [group II], 10 [28.5%] of SLE patients with elevated aCL levels [group III] and 3 [30%] of patients with PAPS [group IV]. Valvular lesions were detected in 7 patients [25%] in group II, 15 [43%] in group III and 7 [70%] in group IV. Pericardial effusion was SLE: systemic lupus erythematosus, PAPS:primary antiphospholipid syndrome, aPL:anti-phospholipid antibodies, aCL:anticardiolipin antibodies. detected in 3 patients [11%] in group II, 10 [28.5%] in group III, and 1 [10%] in group IV. Myocardial dysfunction was detected in 1 patient [3.5%] in group II, 7 [20%] in group III and 2 [20%] in group IV Left ventricular hypertrophy was detected in 2 patients [7%] in group II, 5 [14%] in group III and 1 [10%] in group IV. Pulmonary hypertension was detected in none [0%] of patients in group II, 4 [11.5%] in group III and 2 [20%] in group IV Diastolic dysfunction was detected in 12 patients [43%] in group II, 14 [40%] in group III and 4 [40%] in group IV. Valvular lesions, myocardial dysfunction and pulmonary hypertension in patients with PAPS and SLE are associated with elevated aCL antibodies. There was no significant difference in the frequency of cardiac involvement between patients with increased aCL antibodies in SLE and those with PAPS. Thus, aCL may play an important role in the pathogenesis of valvular lesions as well as myocardial abnormalities

CD69 to CD3 ratio as a marker of systemic lupus erythematosus activity

Systemic lupus erythematosus [SLE] is a chronic autoimmune disease. Determination of systemic activity is valuable both for clinical research and decision making. In order to investigate whether CD69 to CD3 ratio is correlated with activity, 41 SLE patients were assessed for disease activity using SLE disease activity index [SLEDAI] and were compared to 10 healthy controls. The mean value +/- standard deviation of CD69 to CD3 for SLE patients [46.4 +/- 22.4] and healthy controls [6.9 +/- 6.4] were significantly different, the CD69 to CD3 significantly correlated with SLEDAI, C3, C4 and ESR. In conclusion, CD69 expression is correlated with disease activity and can be used as complimentary activity marker