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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Amputation of Digits or Limbs in Patients with Antiphospholipid Syndrome
Seminars in Arthritis and Rheumatism, Volume 38, No. 2, Year 2008
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Description
Objective: To describe the characteristics of patients with peripheral vascular disease leading to amputation of digits or limbs encountered in patients with the antiphospholipid syndrome (APS). Methods: Twenty-one cases derived from several geographical centers (Brazil, Serbia, Italy, Israel, United Kingdom, and South Africa) are presented. The major clinical, serological, and histopathological data (where available) of this cohort are described, documented, and analyzed. Results: Patients were suffering mainly from systemic lupus erythematosus (9 patients) or primary APS (8 patients). Peripheral vascular occlusions occurred during the course of the catastrophic APS in 5 patients. The vascular occlusions occurred both early and very late in the course of the disease (time after APS diagnosis, 0-38 years). Vasculitis was present in 7 patients and 5 demonstrated the typical antiphospholipid antibody (aPL)-vasculopathy with complicating bland thrombosis. Myocardial infarctions had occurred in 4 patients but it was not possible to determine whether they suffered from premature atherosclerotic disease or whether the infarctions were aPL-related. The appearance of livedo reticularis preceding the arterial thrombosis was noted in 9 patients. Cryoglobulinemia was detected in only 1 patient. Conclusions: Peripheral vascular disease leading to amputation of digits or limbs is a severe complication encountered in patients with APS. In the absence of histopathology, it may be difficult to distinguish whether concomitant atherosclerotic occlusions, vasculitis, or aPL-related thrombosis of peripheral vessels is the main cause of the vascular ischemia. Treatment should, therefore, include full anticoagulation as well as corticosteroids and immunosuppression in these patients. © 2008 Elsevier Inc. All rights reserved.
Authors & Co-Authors
Asherson, Ronald A.
South Africa, Johannesburg
School of Pathology
Cervera, Ricard
Spain, Barcelona
Hospital Clinic Barcelona
Klumb, Evandro
Brazil, Rio de Janeiro
Universidade do Estado do Rio de Janeiro, Faculdade de Ciencias Medicas
Stojanovic, Ljudmila
Serbia, Belgrade
University of Belgrade
Sarzi-Puttini, Piercarlo
Italy, Milan
Ospedale Luigi Sacco - Polo Universitario
Yinh, Janet
United States, Boston
Tufts Medical Center
Bucciarelli, Silvia
Spain, Barcelona
Hospital Clinic Barcelona
Espinosa, Gerard
Spain, Barcelona
Hospital Clinic Barcelona
Levy, Roger
Brazil, Rio de Janeiro
Hospital Universitario Pedro Ernesto
Shoenfeld, Yehuda Yulius
Israel, Tel Aviv-yafo
Tel Aviv University
Statistics
Citations: 46
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.1016/j.semarthrit.2007.10.013
ISSN:
00490172
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cohort Study
Study Locations
South Africa