Foddai Silvia G, Radin Massimo, Cecchi Irene, Rubini Elena, Barinotti Alice, Alba Paula, Gimen Alonso Carla, Rossi Daniela, Roccatello Dario, Sciascia Savino
University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, Italy.
Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
Rheumatology (Oxford). 2024 Oct 1;63(10):2770-2775. doi: 10.1093/rheumatology/keae058.
To assess the impact of the updated ACR/EULAR APS classification criteria on two large research cohorts.
Consecutive patients who tested persistently positive for at least one aPL in the last three years were enrolled. The first APS Sydney index event was considered and computed for the comparison between Sydney and 2023 APS criteria. When computing the 2023 APS criteria, additional manifestations were also considered.
The cohort comprised 249 patients (185 with APS and 64 aPL carriers according to Sydney criteria). The 185 patients had as first index event venous thrombosis in 55 cases (29.8%), arterial thrombosis in 63 (34%) and pregnancy morbidity in 67 (36.2%). When applying the updated criteria, 90 subjects (48.7%) failed to reach the composite score of the new criteria. The percentage of thrombotic APS per Sydney criteria decreased from 47.3% to 34.9% because of high cardiovascular risk in 23 cases, IgM aPL profile in six cases and in two patients for both reasons. Patients with pregnancy morbidity decreased from 26.9% to 3.2% (39 cases of recurrent early pregnancy loss and 20 of fetal losses). Consequently, the percentage of aPL carriers increased from 26% to 61%. When looking at the disease evolution at follow-up, 32 additional patients out of 90 (35.6%) fulfilled the new APS criteria, after developing additional clinical manifestation following index event.
When applying the new APS criteria to our research cohorts, not-negligible differences exist in patients' classification. A multidisciplinary approach will be mandatory to assess the impact of the new criteria on research and, ultimately, patients' care.
评估更新后的美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）抗磷脂综合征（APS）分类标准对两个大型研究队列的影响。
纳入过去三年中至少一项抗磷脂抗体（aPL）持续检测呈阳性的连续患者。考虑并计算首个APS悉尼指数事件，以比较悉尼标准和2023年APS标准。计算2023年APS标准时，也考虑了其他临床表现。
该队列包括249例患者（根据悉尼标准，185例为APS患者，64例为aPL携带者）。185例患者的首个指数事件为静脉血栓形成55例（29.8%）、动脉血栓形成63例（34%）和妊娠并发症67例（36.2%）。应用更新后的标准时，90名受试者（48.7%）未达到新标准的综合评分。由于23例心血管风险高、6例IgM aPL谱型以及2例患者同时存在这两种原因，根据悉尼标准诊断的血栓形成性APS百分比从47.3%降至34.9%。妊娠并发症患者从26.9%降至3.2%（39例复发性早期妊娠丢失和20例胎儿丢失）。因此，aPL携带者的百分比从26%增至61%。在随访观察疾病演变时，90例中的32例（35.6%）在指数事件后出现其他临床表现，从而符合新的APS标准。
将新的APS标准应用于我们的研究队列时，患者分类存在不可忽视的差异。必须采用多学科方法来评估新标准对研究以及最终对患者护理的影响。
