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Pattern of disease expression in SLE patients with antiphospholipid antibodies: data from Indian Systemic Lupus Erythematosus Inception cohort (INSPIRE)

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Abstract

Antiphospholipid antibodies (APLA) are present in one-third of systemic lupus erythematosus (SLE) patients, and they are associated with both criteria and non-criteria manifestations. We studied the prevalence, clinical associations, and impact on mortality of APLA in SLE patients from India. Among the Indian SLE inception cohort (INSPIRE), patients who had data on all five routinely performed APLAs [lupus anticoagulant (LA), IgG and IgM anticardiolipin antibody (aCL) and anti-β2-glycoprotein I(β2GPI)] at enrolment were selected. Patients were divided into four categories based on the presence/absence of APLA associated manifestations and presence/absence of the APLA viz SLE-APS, SLE-APLA, SLE: events but no APLA, and SLE: no events, no APLA (reference group). 1035 SLE patients at least 1 APLA antibody was detected in 372 (35.9%). LA was present in 206 (19.9%), aCL in 126 (12.2%) and β2-GPI in 178 (17.2%). There were 88 thrombotic events in 83 patients (8.0%); 73 (82.9%) being arterial; APLA positivity was present in 37 (44.6%) [AOR 1.70 (1.054, 2.76)]. SLE-APS patients were younger and had higher mortality [AOR 4.11 (1.51, 11.3)], neuropsychiatric and hematologic disease. SLE-APLA also had a higher mortality rate [AOR 2.94 (1.06, 8.22)] than the reference group. The mortality was highest in the subset of patients with thrombotic events in the presence of APLA [AOR 7.67 (1.25, 46.9)]. The mere presence of APLA also conferred higher mortality even in the absence of thrombotic events [AOR 3.51 (1.43, 8.63)]. Hematologic manifestations (36.1%) were the most common non-criteria-manifestation. One-third of SLE patients have APLA and its presence is associated with non-criteria hematologic manifestations, arterial thrombosis and higher mortality rate.

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Data availability

Data will be shared on a reasonable request to the corresponding author. Note This work was presented in the American College of Rheumatology (ACR) convergence meet in 2022. Shobha V, Rajasekhar L, Manuel S, Kavadichanda C, Mathew A, Gupta R, Rathi M, Ghosh P, Tripathy S, Jain A, Aggarwal A. Clinical Profiling and Antiphospholipid Antibody (aPL) Associations in Indian Systemic Lupus Erythematosus (SLE) Cohort [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/clinical-profiling-and-antiphospholipid-antibody-apl-associations-in-indian-systemic-lupus-erythematosus-sle-cohort/.

Abbreviations

APLA:

Antiphospholipid antibodies

SLE:

Systemic lupus erythematosus

INSPIRE:

Indian Systemic Lupus Erythematosus Inception Cohort for Research

LA:

Lupus anticoagulant

aCL:

Anticardiolipin antibody

β2GPI:

Anti-β2-glycoprotein I

APS:

Antiphospholipid syndrome

SLEDAI:

SLE Disease Activity Index

SLICC:

Systemic Lupus Erythematosus international collaborating clinics

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Funding

This work was supported by the Department of Biotechnology, Government of India [BT/PR23111/MED/30/1852/2017].

Author information

Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, India

    Vineeta Shobha, Sandra Manuel & V. Nayana

  2. Department of Clinical Immunology and Rheumatology, Nizam Institute of Medical Sciences, Hyderabad, India

    Liza Rajasekhar

  3. Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India

    Chengappa Kavadichanda & Deepika Kounassegarane

  4. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India

    Ashish J. Mathew

  5. Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India

    Ranjan Gupta

  6. Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manish Rathi

  7. Department of Clinical Immunology and Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata, India

    Parasar Ghosh

  8. Department of Rheumatology, SCB Medical College, Cuttack, India

    Saumya Ranjan Tripathy & Bidyut Das

  9. Division of Epidemiology and Biostatistics, St. John’s Research Institute, St. John’s Medical College Hospital, Bengaluru, India

    Sumithra Selvam

  10. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Abhishek Kumar Singh, Ankita Singh & Amita Aggarwal

  11. Department of Clinical Immunology and Rheumatology, SMS Medical College & Hospital, Jaipur, India

    Avinash Jain

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  1. Vineeta Shobha
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Contributions

VS: conception, acquisition, analysis, interpretation of data, drafting of manuscript. SM: acquisition, analysis, interpretation of data, drafting of manuscript. NV: acquisition, analysis, interpretation of data. LR: conception, acquisition, analysis, interpretation of data. CK: acquisition, analysis, interpretation of data. DK: acquisition. AJM: acquisition, interpretation of data. RG: acquisition, interpretation of data. MR: acquisition, interpretation of data. PG: acquisition, interpretation of data. SRT: acquisition, interpretation of data. BD: acquisition, interpretation of data. SS: analysis, interpretation of data. AJ: acquisition, interpretation of data. AA: acquisition, analysis, interpretation of data, drafting of manuscript. AKS: acquisition, interpretation of data. AS: acquisition, interpretation of data. In addition, all co-authors read the draft and are familiar with the final, revised version of the manuscript, and take full responsibility for the integrity and accuracy of all aspects of the work.

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Correspondence to Amita Aggarwal.

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Ethics approval was obtained from respective ethics committees: SGPGI: Institutional ethics Committee, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IEC Ref No.- 2017-14-EMP-95 dated 19.05.2018.

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Shobha, V., Rajasekhar, L., Manuel, S. et al. Pattern of disease expression in SLE patients with antiphospholipid antibodies: data from Indian Systemic Lupus Erythematosus Inception cohort (INSPIRE). Rheumatol Int 44, 819–829 (2024). https://doi.org/10.1007/s00296-023-05511-2

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