Association between antinuclear antibodies and pregnancy prognosis in recurrent pregnancy loss patients.

Study Question: Can antinuclear antibodies (ANA) affect the subsequent live birth rate (LBR) in patients with unexplained recurrent pregnancy loss (RPL) in the absence of antiphospholipid antibodies (aPL)?

Summary Answer: Women with unexplained RPL have a high probability of live birth following a positive pregnancy test (>70%), being similar between those with positive and negative ANA testing, regardless of the cut-off value.

What Is Known Already: The RPL guidelines of the ESHRE state that 'ANA testing can be considered for explanatory purposes'. However, there have been a limited number of studies on this issue and sample sizes have been small, and the impact of ANA on the pregnancy prognosis is unclear.

Immune biomarkers in cases of recurrent pregnancy loss and recurrent implantation failure.

Reproductive failures, such as recurrent pregnancy loss (RPL) and recurrent implantation failures (RIF) are a major challenge for reproductive medicine. The current management of RPL and RIF cases identifies some causes for unsuccessful pregnancy in up to half of patients. Several studies have suggested that immune disorders are responsible for an important portion of unexplained cases of RPL and RIF.

Recurrent pregnancy loss: risk factors and predictive modeling approaches.

Purpose: This review aims to identify and analyze the risk factors associated with recurrent pregnancy loss (RPL) and to evaluate the effectiveness of various predictive models in estimating the risk of RPL. The review also explores recent advancements in machine learning algorithms that can enhance the accuracy of these predictive models. The ultimate goal is to provide a comprehensive understanding of how these tools can aid in the personalized management of women experiencing RPL.

Key Issues at the Forefront of Diagnosis and Testing for Antiphospholipid Syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by antiphospholipid antibodies associated with thrombosis and pregnancy complications. Catastrophic APS is a severe form involving multiple organ systems with a high mortality rate. The pathogenesis involves antiphospholipid antibodies which target phospholipid-binding proteins and damage endothelial cells thus activating coagulation, triggering a pro-thrombotic state.

[Hereditary protein S deficiency in a patient with prominent mesenteric venous thrombosis: A case report].

Hereditary protein S deficiency (PSD) is an autosomal dominant disorder caused by mutations in the 1 gene which can cause venous thrombosis. Individuals with PSD usually present with recurrent deep vein thrombosis and/or pulmonary embolism, but thrombosis may occur at unusual sites, such as the mesenteric and portal veins. Here we report a case of hereditary protein S deficiency patient with predominant mesenteric venous thrombosis.

[Clinical significance of antiphospholipid antibodies in Behcet disease with thrombosis].

Objective: To investigate the distribution and clinical significance of antiphospholipid antibody (aPL) in patients with Behcet disease (BD).

Methods: A total of 222 BD patients admitted to the Department of Rheumatology and Immunology in Peking University People' s Hospital from February 2008 to July 2024 were selected retrospectively. General data of the patients including age and gender were collec-ted.

Increased risk of subsequent antiphospholipid syndrome in patients with endometriosis.

Background: Although autoimmune abnormalities are common in patients with endometriosis, it is unknown whether patients with endometriosis have a higher risk of developing antiphospholipid syndrome (APS).

Methods: We conducted a retrospective cohort study by using the multi-institutional research network TriNetX from 1 January 2012 to 31 December 2021. A total of 13 131 782 women aged 20-60 years from networks within the USA were included.

Trends in nationwide incidence of uveitis in South Korea using the National Health Insurance claims database from 2010 to 2021.

Objectives: To investigate the population-based incidence of uveitis and the differences between anterior and non-anterior uveitis using the comprehensive Korean National Health Insurance Service (NHIS) database.

Methods: We extracted data of patients who visited the clinic and were diagnosed with uveitis (based on Korean Classification of Diseases) from 2010 to 2021. The incidence of uveitis, differences between the demographics, and the underlying co-morbidities of anterior uveitis, non-anterior uveitis, and control groups were investigated.

Insights into the 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria: findings from a cohort of 205 patients with primary APS.

Objectives: The 2023 ACR/EULAR antiphospholipid syndrome (APS) classification criteria distinguish between anticardiolipin (aCL) or anti-β2-glycoprotein I (aβ2GPI) IgG vs IgM isotypes, having isolate IgM positivity a low weight, insufficient for APS classification, and define aCL and aβ2GPI thresholds based on fixed cut-off values. We aimed to assess the performance of the 2023 ACR/EULAR criteria in a cohort of primary vascular APS patients (PAPS), previously classified according to the Sydney criteria. Additionally, we evaluated the risk of thrombotic recurrence in patients re-classified or not according to the new criteria.

Catastrophic antiphospholipid syndrome of pregnancy with acute massive cerebral infarction: A case report.

Rationale: Catastrophic antiphospholipid syndrome (CAPS) is the most serious type of antiphospholipid antibody syndrome (APS) and can be easily confused with other disorders, such as hemolytic uremic syndrome, disseminated intravascular coagulation and thrombocytopenia syndromes. Timely diagnosis of CAPS poses considerable challenges due to its rarity and the fact that clinicians often lack knowledge of the disease.

Patient Concerns: A 21-year-old patient was 32 weeks and 5 days pregnant when she presented to the hospital with a 7-hour history of sudden onset of left-sided limb weakness with no apparent cause.

Improving diagnosis in patients with obstetric antiphospholipid syndrome through the evaluation of non-criteria antibodies.

Objectives: Antiphospholipid syndrome (APS) is an autoimmune disease driven by antiphospholipid antibodies (aPL). Currently, APS diagnosis requires a combination of clinical manifestations (thrombosis and/or obstetric morbidity) and the persistent presence of at least one criteria aPL: anti-cardiolipin antibodies (aCL), anti-β2-glycoprotein I antibodies (aβ2GPI) or lupus anticoagulant (LA). Patients with suggestive obstetric symptoms but lacking criteria aPL face diagnostic challenges.

Vitamin D affects antiphospholipid syndrome by regulating T cells (Review).

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by arterial and/or venous thrombosis, pathological pregnancies and persistent antiphospholipid antibodies. The occurrence and development of APS are complex and associated with immune disorders, with its prognosis remaining uncertain. Owing to its pathogenesis, anticoagulation therapy is the primary treatment for patients with APS.

Association Between Novel Antiphospholipid Antibodies and Adverse Pregnancy Outcomes.

Objective: To investigate the value of anti-β2 glycoprotein-I domain 1 (aD1) and antiphosphatidylserine-prothrombin antibodies for predicting adverse pregnancy outcomes in an at-risk population and to describe the relationship among aD1, antiphosphatidylserine-prothrombin, lupus anticoagulant, and other antiphospholipid antibodies (aPL).

Methods: Data were obtained from a prospective cohort of pregnant patients with aPL, with systemic lupus erythematosus (SLE) (n=59) or without SLE (n=106), or SLE without aPL (n=100) (PROMISSE [Predictors of Pregnancy Outcome in Systemic Lupus Erythematosus and Antiphospholipid Syndrome] study; NCT00198068). Levels of aD1 and antiphosphatidylserine-prothrombin were quantified with the QUANTA Flash and QUANTA Lite systems, respectively, in sera collected at less than 18 weeks of gestation.

Incidence and prevalence of antiphospholipid syndrome (APS) in the USA (2016-2019): a retrospective database study.

Objective: Few epidemiological studies are reported in the published literature on the incidence or prevalence of antiphospholipid syndrome (APS), and available results are heterogeneous. This study aimed to estimate the incidence and prevalence of APS in the USA, overall and by APS subtype.

Design: A retrospective analysis of APS disease incidence and a cross-sectional analysis of disease prevalence.

Damage Index for Antiphospholipid Syndrome (DIAPS): An Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) "Damage" working group report on strengths and limitations.

Objectives: To gather the perspectives of APS ACTION members regarding the strengths and limitations of Damage Index for Antiphospholipid Syndrome (DIAPS); and establish recommendations for the improvement of DIAPS.

Methods: APS ACTION members were invited to answer a survey regarding their satisfaction with DIAPS scoring system and individual items. The level of agreement (LoA) among members with the inclusion of individual items in DIAPS was calculated (LoA of <75% was considered disagreement).

Impact of the 2023 ACR/EULAR Classification Criteria on START2 Antiphospholipid Registry.

Introduction: The recently published ACR/EULAR classification criteria score (3 points or more) both clinical and laboratory criteria to define the presence of antiphospholipid syndrome (APS). The clinical criteria have been better defined while laboratory criteria remain the same [lupus anticoagulant (LA), anticardiolipin (aCL) and anti ß2-Glycoprotein I (aß2GPI) antibodies] but with different impact (points) on the classification of patients. APS is excluded if more than 3 years separate positive test for antiphospholipid antibodies (aPL) and clinical manifestation.

Contraceptives or Hormone Replacement Therapy and Associations with Autoimmune Conditions: Exploring Effects of Estrogen Analog Supplementation.

Objective: The aim of this study was to investigate the impact of estrogen and progesterone analog supplementation on the development of autoimmune conditions.

Methods: This retrospective observational study used data from the TriNetX network, which comprised over 100 million patients from 89 health care organizations. We compared patients exposed to estrogen and progesterone analogs to those exposed to progesterone-only therapy, using 1:1 propensity score matching based on age, ethnicity, and additional criteria.

Direct oral anticoagulants versus vitamin K antagonists in patients with thrombotic antiphospholipid syndrome: A prospective observational analysis.

Background: The role of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in the treatment of venous thromboembolism (VTE) in patients with antiphospholipid syndrome remains uncertain.

Methods: We conducted a prospective observational study on APS patients with VTE treated with VKAs or DOACs in a tertiary hospital from 2010 to 2023. Clinical characteristics, recurrent arterial or VTE events, and hemorrhagic complications were analyzed over a one-year follow-up.

Efficacy of combining aspirin with hydroxychloroquine in pregnancies at high risk for pre-eclampsia: a prospective, multicentre, open-label, single-arm clinical trial, investigator-initiated study (HUGS study).

Introduction: The use of hydroxychloroquine (HCQ) during pregnancies complicated by systemic lupus erythematosus or refractory antiphospholipid antibody syndrome has demonstrated a significant ability to prevent pre-eclampsia (PE). As such, the potential for the administration of HCQ to prevent PE in other high-risk pregnancies is an important clinical research agenda among maternal and fetal medicine specialists. Mechanistically, the anti-inflammatory and immunomodulatory effects of HCQ can offer vascular protection and inhibit the placental dysfunction-associated thrombotic changes underlying the pathophysiology of PE, fetal growth restriction (FGR) and fetal death in utero (FDIU).

Neurovascular complications of antiphospholipid syndrome: a narrative review.

Background:  Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombosis, pregnancy complications, and other nonthrombotic manifestations in the presence of antiphospholipid antibodies. Neurovascular complications, including ischemic stroke, cerebral venous thrombosis and cognitive impairment, pose significant challenges in management.

Objective:  To comprehensively review relevant and updated clinical aspects of neurovascular manifestations of APS.

Impact of Thrombophilia Testing on Clinical Management: A Retrospective Cohort Study.

Thrombophilia management is based on the personal and family history of thrombosis. Current guidelines recommend performing thrombophilia testing only when the results will change clinical management. To investigate to what extent treatment recommendations changed following thrombophilia testing, clinical and laboratory data of 255 patients with and without venous thromboembolism who underwent thrombophilia screening were assessed retrospectively.

Case report: Antiphospholipid syndrome revealed by multiple ischemic cerebral strokes in the context of preeclampsia.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombotic events and pregnancy complications, including preeclampsia. This case report presents a rare manifestation of APS revealed by multiple ischemic cerebral strokes in a patient with severe preeclampsia. A comprehensive review of the literature is included to highlight the clinical presentation, diagnosis, management, and prognosis of APS in the context of preeclampsia.