Livedo reticularis en pacientes con Lupus Eritematoso Sistémico y su asociación con anticuerpos anticardiolipina / Livedo reticularis in patients with systemic lupus erythematosis and its association with anticardiolipin antibodies

RESUMO

With the purpose of determining whether a relationship exists between Livedo Reticularis (LR) and anticardiolipine antibodies (ACA) in patients with Systemic Lupus Erithemathosus (SLE), a clinical prospective and descriptive study was carried out on 17 female lupus patients with LR, aged 15-46, from the Immunology and Dermatology outpatient clinic of the Enrique Tejera Hospital Compound in Valencia, Venezuela, during 1998. A complete clinical evaluation of each patient was done, from which a diagnosis of LR was made. This was categorized as mild, moderate or severe (Weinstein and col. criteria), depending on the severity of the lesions. Immunoenzymatic techniques were used to determine ACA Ig or IgM. The study followed the Guidelines of Good Practices in Clinical Research, and a signed informed consent was obtained from each patient. The average age of the studied patients was 28.5 +/- 10.9 years; 52.9 of them presented serum levels of ACA IgG above normal. In all cases, levels of ACA IgM were within normal limits (4.41 +/- 2.63 U/mL. Range 0.51-9.53). All patients with mild LR had normal levels of ACA IgG, and 83.3 and 80 of those in the Moderate and Severe categories, respectively, had high levels of ACA IgG (> or = 10 U/mL), and there was a statistically significant association between each of the three categories and their respective ACA levels (p < 0.05). 82.4 of the patients had severe manifestations of the disease which included CNS involvement, lower limb vasculitis, renal insult, pericarditis, thrombocytopenia, and recurrent miscarriages. No statistically significant association was found between each of these manifestations and the severity of LR (p > 0.05), probably due to the small number of patients studied in each group; nor between the medium serum levels of ACA IgG and each of the manifestations, except for lower limb vasculitis (ACA IgG'values-presence or absence Fisher p < 0.05) However, a statistically significant association (p < 0.05) was observed when the number of severe manifestations of the disease of each patient was related to the levels of ACA IgG, and the severity of LR.