Síndrome antifosfolípido no trombótico:

manifestaciones inflamatorias hematológicas y neurológicas

Palabras clave: Cefalea, Corea, Demencia, Epilepsia, Mielitis, Trombocitopenia, Síndrome Antifosfolípido

Resumen

El síndrome antifosfolípido (SAF) es una entidad caracterizada por la presencia de anticuerpos antifosfolípidos y características clínicas como la pérdida fetal recurrente y la trombosis venosa o arterial. El diagnóstico del SAF se realiza extrapolando criterios de clasificación que incluyen criterios clínicos y de laboratorio, con manifestaciones trombóticas en su gran mayoría. Sin embargo, hay una gran variedad de manifestaciones no trombóticas de la enfermedad no incluidas en los criterios de clasificación. Dichas manifestaciones “extra-criterio” son aquellas que, debido a su frecuencia y a la relevancia que tienen para la toma de decisiones, son hallazgos de valor. Entre ellas, destacan características inflamatorias en dominios como el hematológico, de las cuales la principal es la trombocitopenia. De las diferentes manifestaciones neurológicas, debido a su frecuencia o gravedad, resaltan la migraña, la epilepsia, la demencia y otras graves como la corea y la mielitis.  En la presente revisión se reseña la información disponible sobre las manifestaciones de dos dominios frecuentes y relevantes “extra-criterio” del síndrome antifosfolípido: las hematológicas y las neurológicas.

|Resumen
= 95 veces | PDF
= 55 veces|

Descargas

La descarga de datos todavía no está disponible.

Biografía del autor/a

Jose Carlos Álvarez, Universidad de Antioquia

Residente de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Mario Ardila, Universidad de Antioquia

Residente de Neurología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Tomás Urrego-Callejas, Universidad de Antioquia

Médico general, Universidad de Antioquia. Grupo de Inmunología Celular e Inmunogenética; Grupo de Estudio de las Vasculitis Sistémicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Daniel Jaramillo-Arroyave, Universidad de Antioquia

Médico Internista y Reumatólogo. MSc epidemiología. Reumatólogo y epidemiólogo IPS Universitaria, Servicios de Salud, Universidad de Antioquia, Medellín, Colombia.

Citas

(1) Hughes GRV. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. Br Med J. 1983;287(6399):1088–9. DOI 10.1136/bmj.287.6399.1088

(2) Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med. 2018;378(21):2010–21. DOI 10.1056/NEJMra1705454.

(3) Wilson WA, Gharavi AE, Koike T, Lockshin MD, Ware Branch D, Piette JC, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: Report of an International Workshop. Arthritis Rheum. 1999;42(7):1309–11. DOI 10.1002/1529-0131(199907)42:7<1309::AID-ANR1>3.0.CO;2-F.

(4) Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295–306. DOI 10.1111/j.1538-7836.2006.01753.x.

(5) Sciascia S, Amigo MC, Roccatello D, Khamashta M. Diagnosing antiphospholipid syndrome: “extra-criteria” manifestations and technical advances. Nat Rev Rheumatol. 2017;13(9):548–60. DOI 10.1038/nrrheum.2017.124.

(6) Abreu MM, Danowski A, Wahl DG, Amigo MC, Tektonidou M, Pacheco MS, et al. The relevance of “non-criteria” clinical manifestations of antiphospholipid syndrome: 14th International Congress on Antiphospholipid Antibodies Technical Task Force Report on Antiphospholipid Syndrome Clinical Features. Autoimmun Rev. 2015;14(5):401–14. DOI 10.1016/j.autrev.2015.01.002.

(7) Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46(4):1019–27. DOI 10.1002/art.10187.

(8) Cervera R, Tektonidou MG, Espinosa G, Cabral AR, González EB, Erkan D, et al. Task Force on Catastrophic Antiphospholipid Syndrome (APS) and Non-criteria APS Manifestations (II): Thrombocytopenia and skin manifestations. Lupus. 2011;20(2):174–81. DOI 10.1177/0961203310395052.

(9) Vreede AP, Bockenstedt PL, Mccune WJ, Knight JS. Cryptic conspirators: a conversation about thrombocytopenia and antiphospholipid syndrome. Curr Opin Rheumatol. 2019;31(3):231–40. DOI 10.1097/BOR.0000000000000595.

(10) Krause I, Blank M, Fraser A, Lorber M, Stojanovich L, Rovensky J, et al. The association of thrombocytopenia with systemic manifestations in the antiphospholipid syndrome. Immunobiology. 2005;210(10):749–54. DOI 10.1016/j.imbio.2005.10.005.

(11) Unlu O, Erkan D, Barbhaiya M, Andrade D, Nascimento I, Rosa R, et al. The Impact of Systemic Lupus Erythematosus on the Clinical Phenotype of Antiphospholipid Antibody–Positive Patients: Results From the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Clinical Database and Repository. Arthritis Care Res. 2019;71(1):134–41. DOI 10.1002/acr.23584.

(12) Gómez-Puerta JA, Martín H, Amigo MC, Aguirre MA, Camps MT, Cuadrado MJ, et al. Long-term follow-up in 128 patients with primary antiphospholipid syndrome: Do they develop lupus? Med. 2005;84(4):225–30. DOI 10.1097/01.md.0000172074.53583.ea.

(13) Frison L, Lombardi A, Caputo I, Semenzato G, Fabris F, Vianello F. Relevance of antiphospholipid antibody profile in the clinical outcome of ITP: a single-centre study. Hematol (United Kingdom). 2019;24(1):134–8. DOI 10.1080/10245332.2018.1532649.

(14) Diz-Küçükkaya R, Hacihanefioǧlu A, Yenerel M, Turgut M, Keskin H, Nalçaci M, et al. Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: A prospective cohort study. Blood. 2001;98(6):1760–4. DOI 10.1182/blood.v98.6.1760.

(15) Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829–66. DOI 10.1182/bloodadvances.2019000966.

(16) McVerry BA, Spearing R, Smith A. SLE anticoagulant: transient inhibition by high dose immunoglobulin infusions. Br J Haematol. 1985;61:579–80. DOI 10.1111/j.1365-2141.1985.tb02863.x.

(17) Lidar M, Masarwa S, Rotman P, Carmi O, Rabinowicz N, Levy Y. Intravenous immunoglobulins for rheumatic disorders and thromboembolic events—a case series and review of the literature. Immunol Res. 2018;66(6):668–74. DOI 10.1007/s12026-018-9047-y.

(18) Erkan D, Vega J, Ramón G, Kozora E, Lockshin MD. A pilot open-label phase II trial of rituximab for non-criteria manifestations of antiphospholipid syndrome. Arthritis Rheum. 2013;65(2):464–71. DOI 10.1002/art.37759.

(19) Sciascia S, Radin M, Cecchi I, Rubini E, Bazzan M, Roccatello D. Long-term effect of B-cells depletion alone as rescue therapy for severe thrombocytopenia in primary antiphospholipid syndrome. Semin Arthritis Rheum. 2019;48(4):741–4. DOI 10.1016/j.semarthrit.2018.04.001.

(20) FDA prescribing and Labeling Information [Internet]. U.S Food and Drug Administration; 1998. [Citado 2021 Marzo 02] Disponible en: https://n9.cl/cnhrk

(21) LaMoreaux B, Barbar-Smiley F, Ardoin S, Madhoun H. Two cases of thrombosis in patients with antiphospholipid antibodies during treatment of immune thrombocytopenia with romiplostim, a thrombopoietin receptor agonist. Semin Arthritis Rheum. 2016;45(4):e10–2. DOI 10.1016/j.semarthrit.2015.07.008.

(22) Borrell H, Nolla JM, Narváez J. Letter to the editor. Commentary to the article: LaMoreaux B, Barbar-smiley F, Ardoin S, Madhoun H. Two cases of thrombosis in patients with antiphospholipid antibodies during treatment of immune thrombocytopenia with romiplostin, a thrombopoietin recepto. Semin Arthritis Rheum. 2016;45(5):e16. DOI 10.1016/j.semarthrit.2015.10.007.

(23) González-López TJ, Alvarez-Román MT, Pascual C, Sánchez-González B, Fernández-Fuentes F, Pérez-Rus G, et al. Use of eltrombopag for secondary immune thrombocytopenia in clinical practice. Br J Haematol. 2017;178(6):959–70. DOI 10.1111/bjh.14788.

(24) Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019;78(10):1296–304. DOI 10.1136/annrheumdis-2019-215213.

(25) Mantha S, Miao Y, Wills J, Parameswaran R, Soff GA. Enoxaparin dose reduction for thrombocytopenia in patients with cancer: a quality assessment study. J Thromb Thrombolysis. 2017;43(4):514–8. DOI 10.1007/s11239-017-1478-0.

(26) Fleetwood T, Cantello R, Comi C. Antiphospholipid syndrome and the neurologist: From pathogenesis to therapy. Front Neurol. 2018;9:1–13. DOI 10.3389/fneur.2018.01001.

(27) Islam M, Alam F, Kamal M, Wong K, Sasongko T, Gan S. ‘Non-Criteria’ Neurologic Manifestations of Antiphospholipid Syndrome: A Hidden Kingdom to be Discovered. CNS Neurol Disord - Drug Targets. 2016 Oct 19;15(10):1253–65. DOI 10.2174/1871527315666160920122750.

(28) Islam MA, Alam F, Kamal MA, Gan SH, Sasongko TH, Wong KK. Presence of anticardiolipin antibodies in patients with dementia: A systematic review and meta-analysis. Front Aging Neurosci. 2017;9:1–12. DOI 10.3389/fnagi.2017.00250.

(29) Islam MA, Alam F, Cavestro C, Calcii C, Sasongko TH, Levy RA, et al. Antiphospholipid antibodies in epilepsy: A systematic review and meta-analysis. Autoimmun Rev. 2018;17(8):755–67. DOI 10.1016/j.autrev.2018.01.025.

(30) Islam MA, Alam F, Wong KK. Comorbid association of antiphospholipid antibodies and migraine: A systematic review and meta-analysis. Autoimmun Rev. 2017;16(5):512–22. DOI 10.1016/j.autrev.2017.03.005.

(31) Katzav A, Shoenfeld Y, Chapman J. The pathogenesis of neural injury in animal models of the antiphospholipid syndrome. Clin Rev Allergy Immunol. 2010;38(2–3):196–200. DOI 10.1007/s12016-009-8154-x.

(32) Appenzeller S, Lapa AT, De Carvalho JF, Peres FA, Shoenfeld Y. Cognitive dysfunction and antiphospholipid antibodies. Curr Rheumatol Rep. 2012;14(1):95–8. DOI 10.1007/s11926-011-0224-4.

(33) García-Carrasco M, Galarza C, Gómez-Ponce M, Cervera R, Rojas-Rodríguez J, Espinosa G, et al. Antiphospholipid syndrome in Latin American patients: Clinical and immunologic characteristics and comparison with European patients. Lupus. 2007;16(5):366–73. DOI 10.1177/0961203307077108.

(34) Krause I, Lev S, Fraser A, Blank M, Lorber M, Stojanovich L, et al. Close association between valvar heart disease and central nervous system manifestations in the antiphospholipid syndrome. Ann Rheum Dis. 2005;64(10):1490–3. DOI 10.1136/ard.2004.032813.

(35) Stojanovich L, Kontic M, Djokovic A, Marisavljevic D, Ilijevski N, Stanisavljevic N, et al. Association between systemic non-criteria aps manifestations and antibody type and level: Results from the Serbian National Cohort Study. Clin Exp Rheumatol. 2013;31(2):234–42.

(36) Noureldine MHA, Haydar AA, Berjawi A, Elnawar R, Sweid A, Khamashta MA, et al. Antiphospholipid syndrome (APS) revisited: Would migraine headaches be included in future classification criteria? Immunol Res. 2017;65(1):230–41. DOI 10.1007/s12026-016-8831-9.

(37) Shoenfeld Y, Lev S, Blatt I, Blank M, Font J, von Landenberg P, et al. Features associated with epilepsy in the antiphospholipid syndrome. J Rheumatol. 2004 Jul;31(7):1344–8.

(38) Falip M, Miro J, Jaraba S, Cuso S, Capdevila O, Graus F, et al. Immunosuppressive therapy for pharmacoresistant epilepsy due to primary antiphospholipid syndrome. Scand J Rheumatol. 2015;44(6):515–7. DOI 10.3109/03009742.2015.1041155.

(39) Gómez-Puerta JA, Cervera R, Calvo LM, Gómez-Ansón B, Espinosa G, Claver G, et al. Dementia associated with the antiphospholipid syndrome: Clinical and radiological characteristics of 30 patients. Rheumatology. 2005;44(1):95–9. DOI 10.1093/rheumatology/keh408.

(40) Tektonidou MG, Varsou N, Kotoulas G, Antoniou A, Moutsopoulos H. Cognitive Deficits in Patients With Antiphospholipid Syndrome: association with clinical, laboratory, and brain magnetic resonance imaging findings. Arch Intern Med. 2006;166(20):2278–84. DOI 10.1001/archinte.166.20.2278.

(41) Coín MA, Vilar-López R, Peralta-Ramírez I, Hidalgo-Ruzzante N, Callejas-Rubio JL, Ortego-Centeno N, et al. The role of antiphospholipid autoantibodies in the cognitive deficits of patients with systemic lupus erythematosus. Lupus. 2015;24(8):875–9. DOI 10.1177/0961203315572717.

(42) Peluso S, Antenora A, De Rosa A, Roca A, Maddaluno G, Morra VB, et al. Antiphospholipid-related chorea. Front Neurol. 2012;OCT(October):1–7. DOI 10.3389/fneur.2012.00150.

(43) Reiner P, Galanaud D, Leroux G, Vidailhet M, Haroche J, Huong DLT, et al. Long-term outcome of 32 patients with chorea and systemic lupus erythematosus or antiphospholipid antibodies. Mov Disord. 2011 Nov;26(13):2422–7. DOI 10.1002/mds.23863.

(44) Rodrigues CEM, de Carvalho JF. Clinical, Radiologic, and Therapeutic Analysis of 14 Patients with Transverse Myelitis Associated with Antiphospholipid Syndrome: Report of 4 Cases and Review of the Literature. Semin Arthritis Rheum. 2011;40(4):349–57. DOI 10.1016/j.semarthrit.2010.05.004.

(45) Katsiari CG, Giavri I, Mitsikostas DD, Yiannopoulou KG, Sfikakis PP. Acute transverse myelitis and antiphospholipid antibodies in lupus. No evidence for anticoagulation. Eur J Neurol. 2011;18(4):556–63. DOI 10.1111/j.1468-1331.2010.03208.x.

(46) Guerra H, Pittock SJ, Moder KG, Fryer JP, Gadoth A, Flanagan EP. Frequency of Aquaporin-4 Immunoglobulin G in Longitudinally Extensive Transverse Myelitis With Antiphospholipid Antibodies. Mayo Clin Proc. 2018;93(9):1299–304. DOI 10.1016/j.mayocp.2018.02.006.

Publicado
2021-03-25
Cómo citar
1.
Álvarez JC, Ardila M, Urrego-CallejasT, Jaramillo-ArroyaveD. Síndrome antifosfolípido no trombótico: . Iatreia [Internet]. 25 de marzo de 2021 [citado 17 de mayo de 2021];1(1). Disponible en: https://revistas.udea.edu.co/index.php/iatreia/article/view/342707
Sección
Artículos de revisión