Antiphospholipid antibody syndromes.

There is no doubt that in some individuals the presence of antibodies to negatively charged phospholipids currently measured as the lupus anticoagulant, a biologically false positive VDRL, and anticardiolipin antibodies is associated with certain clinical features, in particular, a predisposition to both arterial and venous thrombosis and, in women, to fetal wastage. This syndrome may be seen in patients with readily identifiable connective tissue disease, in patients with an ill-defined disease, and in clinically healthy individuals who only manifest signs of this syndrome when they are pregnant or when taking oral contraceptives. This last group have given rise to the term "subclinical" autoimmune disease, but it remains to be seen whether these women stay healthy or go on to develop overt clinical autoimmune disease states. Current recommendations for treating pregnant patients with these antibodies are based on uncontrolled studies, and there is a need for well controlled age-matched, parity-matched studies to be done. Similarly, the discrepant reports addressing the significance of these antibodies and their laboratory associations emphasize the need for standardization of the tests used to measure these antibodies with international standards for the cardiolipin assay an absolute must. These problems are being addressed. This exciting field of research that has extended the world of autoimmunity far beyond the limits of rheumatology, has given rheumatologists, hematologists and obstetricians a new challenge: to find the link between antibodies, blood clots, and babies.