Abstract
Although low-dose methotrexate (MTX) has been used to treat several autoimmune diseases like lupus erythematosus, rheumatoid arthritis, etc., it has not yet been used to treat patients with primary antiphospholipid syndrome (PAPS). Parallel to clinical follow-up of female patient with a severe form of PAPS, antiphospholipid antibodies (aPL), blood coagulation, and hematological parameters in the peripheral blood have been monitored. MTX improved ulcers, livedo reticularis, decreased aPL titers, increased platelet counts, and improved blood coagulation parameters (e.g., factor VIII) and was well tolerated. Low-dose MTX was safe and effective in the presented case with PAPS. The clinical benefit may be due to the downregulation of increased aPL titers and amelioration of disturbed coagulation parameters.
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References
Kahn P, Ramanujam M, Bethunaickan R et al (2008) Prevention of murine antiphospholipid syndrome by BAFF blockade. Arthritis Rheum 58:2824–2834
Miyakis S, Lockshin MD, Atsumi T et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306
Atsumi T, Furukawa S, Amengual O et al (2005) Antiphospholipid antibody associated thrombocytopenia and the paradoxical risk of thrombosis. Lupus 14:499–504
Krause I, Blank M, Fraser A et al (2005) The association of thrombocytopenia with systemic manifestations in the antiphospholipid syndrome. Immunobiology 210:749–754
Palomo IG, Segovia FM, Alarcon ML et al (2007) An insight into the pathophysiology of thrombosis in antiphospholipid syndrome. Front Biosci 12:3093–3103
Lim W, Crowther MA, Eikelboom JW (2006) Management of antiphospholipid antibody syndrome: a systematic review. JAMA 295:1050–1057
Satomi A, Koiwa F, Ogata H et al (1998) Plasma exchange for thrombocytopenia in antiphospholipid syndrome: a case report. Ther Apher 2:157–159
Trappe R, Loew A, Thuss-Patience P et al (2006) Successful treatment of thrombocytopenia in primary antiphospholipid antibody syndrome with the anti-CD20 antibody rituximab–monitoring of antiphospholipid and anti-GP antibodies: a case report. Ann Hematol 85:134–135
Vlachoyiannopoulos PG, Toya SP, Katsifis G et al (2008) Upregulation of antiphospholipid antibodies following cyclophosphamide therapy in patients with systemic lupus erythematosus. J Rheumatol 35:1768–1775
Böhm I (2003) Decrease of B-cells and autoantibodies after low-dose methotrexate. Biomed Pharmacother 57:278–281
Boehm IB, Boehm GA, Bauer R (1998) Management of cutaneous lupus erythematosus with low-dose methotrexate: indication for modulation of inflammatory mechanisms. Rheumatol Int 18:59–62
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Boehm, I. Drug treatment-induced downregulation of antiphospholipid antibodies in PAPS. Clin Rheumatol 28, 1347–1348 (2009). https://doi.org/10.1007/s10067-009-1257-1
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DOI: https://doi.org/10.1007/s10067-009-1257-1