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Lupus vasculitis: Differential diagnosis with antiphospholipid syndrome

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Abstract

The inflammatory process of systemic lupus erythematosus (SLE) vasculitis occurs in up to 56% of patients with SLE, whereas the vaso-occlusive incidence of antiphospholipid syndrome in SLE (which is not exclusive of SLE vasculitis) reaches up to 15%. Both situations can be life-threatening, requiring the appropriate therapeutic approach. Aggressive anti-inflammatory therapy is used in the case of SLE vasculitis and aggressive antithrombotic/anticoagulant treatment in the other. However, often the differential diagnosis between the two entities is difficult to achieve, especially when a tissue biopsy to help establish the diagnosis is topographically difficult to obtain or is clinically contraindicated. Such situations are discussed and appropriate guidelines for a correct diagnosis suggested.

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References and Recommended Reading

  1. Drenkard C, Villa AR, Reyes E, et al.: Vasculitis in systemic lupus erythematosus. Lupus 1997, 6:235–242. An important study of SLE vasculitis in a large cohort of patients.

    PubMed  CAS  Google Scholar 

  2. Perez-Vazquez ME, Villa AR, Drenkard C, et al.: Influence of disease duration, continued follow-up and further antiphospholipid testing on the frequency and classification category of antiphospholipid syndrome in a cohort of patients with SLE. J Rheumatol 1993, 20:437–442.

    PubMed  CAS  Google Scholar 

  3. Simioni P, Prandoni P, Zanon E, et al.: Deep venous thrombosis and lupus anticoagulant. A case-control study. Haemost Thromb 1996, 76:187–189.

    CAS  Google Scholar 

  4. Gladman DD, Urowitz MB: Systemic lupus erythematosus: clinical features. In Rheumatology. Edited by Klippel JH, Dieppe PA. London: Mosby; 1998:1–18.

    Google Scholar 

  5. Flores-Suarez LF, Alarcon-Segovia D: Vasculitis in connective tissue diseases. Curr Rheumatol Reports 2000, 2:396–401.

    Google Scholar 

  6. Cuellar MC, Espinoza LR: Laboratory testing in the evaluation and diagnosis of vasculitis. Curr Rheumatol Reports 2000, 2:417–422. A very good presentation of the wide range of clinical tests available for the diagnosis of vasculitis, and their use in its differential diagnosis.

    CAS  Google Scholar 

  7. Sundy JS, Haynes BF: Cytokines and adhesion molecules in the pathogenesis of vasculitis. Curr Rheumatol Reports 2000, 2:402–410.

    CAS  Google Scholar 

  8. Carvvalho D, Savage COS, Isenberg D, Pearson JD: IgG antiendothelial cell autoantibodies from patients with SLE stimulate the release of two endothelial cell-derived mediators manner, which enhance adhesion molecule expression and leukocyte adhesion in an autocrine manner. Arthritis Rheum 1999, 42:631–640.

    Article  Google Scholar 

  9. Moore PM: Vasculitis of the central nervous system. Curr Rheumatol Reports 2000, 2:376–382.

    CAS  Google Scholar 

  10. Shintani S, Ono K, Hinoshita H, et al.: Unusual neuroradiological findings in systemic lupus erythematosus. Eur Neurol 1993, 33:13–16.

    PubMed  CAS  Google Scholar 

  11. Ko SF, Lee TY, Cheng TT, et al.: CT findings at lupus mesenteric vasculitis. Acta Radiol 1997, 38:115–120.

    PubMed  CAS  Google Scholar 

  12. Harris KG, Tran DD, Sickels WJ, et al.: Diagnosing intracranial vasculitis: the role of MR and angiography. Am J Neuroradiol 1994, 15:317–330.

    PubMed  CAS  Google Scholar 

  13. Imbes SG: Diffuse cerebral vasculitis with normal results on brain MR imaging. Am J Roentgenol 1999, 173:1494–1496.

    Google Scholar 

  14. Cloft HJ, Philips CD, Dix JE, et al.: Correlation of angiography and MR imaging in cerebral vasculitis. Acta Radiol 1999, 40:83–87.

    Article  PubMed  CAS  Google Scholar 

  15. Yuh WT, Ueda T, Maley JE, et al.: Diagnosis of microvasculopathy in CNS vasculitis: value of perfusion and diffusion. J MRI 1999, 10:310–313.

    CAS  Google Scholar 

  16. Stenson AW: Roentgenographic findings in major vasculitis syndromes. Rheum Dis Clin North Am 1990, 16:293–308.

    Google Scholar 

  17. Boey ML, Colaco CB, Gharavi AE, et al.: Thrombosis in SLE: striking association with the presence of circulating lupus anticoagulant. Br Med J 1983, 287:1021–1023.

    CAS  Google Scholar 

  18. Hughes GR: Thrombosis, abortion, cerebral disease and the lupus anticoagulant. Br Med J 1983, 287:1088–1089.

    CAS  Google Scholar 

  19. Hughes GR: The anticardiolipin syndrome. Clin Exp Rheumatol 1985, 3:285–286.

    PubMed  CAS  Google Scholar 

  20. Wilson WA, Gharavi EA, Koike T, et al.: International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Report of an International Workshop. Arthritis Rheum 1999, 42:1309–1311. This is the formal paper on which the diagnosis of definite APS is based.

    Article  PubMed  CAS  Google Scholar 

  21. Godfrey T, D’Cruz D: Antiphospholipid syndrome: General features. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:8–19.

    Google Scholar 

  22. Levine SR, Brey RL, Sawaya KL, et al.: Recurrent stroke and thrombo-occlusive events in the antiphospholipid syndrome. Ann Neurol 1995, 38:119–124.

    Article  PubMed  CAS  Google Scholar 

  23. Navarrete MG, Brey RL, Levine SR: Cerebral disease in the antiphospholipid syndrome. In Hughes Syndrome. Edited by Khamashta MA. London, Springer; 2000:43–58. A very good review about clinical manifestations of cerebral disease in APS with emphasis on its differential diagnosis.

    Google Scholar 

  24. Shah NM, Khamashta MA, Atsumi T, Hughes GVR: Outcome of patients with anticardiolipin antibodies: a 10 year follow-up of 52 patients. Lupus 1998, 7:3–6.

    Article  PubMed  CAS  Google Scholar 

  25. Schwartz M, Rochas M, Weller B, et al.: High association of anti-cardiolipin antibodies with psychosis. J Clin Psychiatry 1998, 59:20–23.

    PubMed  CAS  Google Scholar 

  26. Wolkowitz OM, Reus VI, Canick J, et al.: Glucocorticoid medication, memory and steroid psychosis in medical illness. Ann NY Acad Sci 1997, 823:81–96.

    Article  PubMed  CAS  Google Scholar 

  27. Specker C, Siebler M, Schneider M: Imaging of microemboli in antiphospholipid syndrome. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:195–200.

    Google Scholar 

  28. Toubi E, Khamashta MA, Pannara A, Hughes GRV: Association of antiphospholipid antibodies with central nervous system disease in SLE. Am J Med 1995, 99:397–401.

    Article  PubMed  CAS  Google Scholar 

  29. Sailer M, Burchert W, Ehrenheim C, et al.: Positron emission tomography and magnetic resonance imaging for cerebral involvement in patients with SLE. J Neurol 1997, 244:186–193.

    Article  PubMed  CAS  Google Scholar 

  30. Battagliotti CA: Skin manifestations of the antiphospholipid antibody syndrome. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:59–69. A very well-illustrated review of various forms of skin manifestations in APS.

    Google Scholar 

  31. Amigo MC, Garcia-Torres R: Kidney disease in antiphospholipid syndrome. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:70–81. A very good classification of renal involvement in APS and its clinical and histopathologic manifestations.

    Google Scholar 

  32. Nochy D, Daugas E, Droz D, et al.: The intrarenal vascular lesions associated with primary antiphospholipid syndrome. J Am Soc Nephrol 1999, 10:507–518.

    PubMed  CAS  Google Scholar 

  33. Font J, Cervera R: Cardiac manifestations in the antiphospholipid syndrome. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:32–42. A very good presentation of the cardiac involvement in APS, with emphasis on its differential diagnosis.

    Google Scholar 

  34. Ziporen L, Goldberg I, Arad M, et al.: Libman-Sacks endocarditis in the antiphospholipid syndrome: immunopathogenic findings in deformed heart valves. Lupus 1996, 5:196–205.

    PubMed  CAS  Google Scholar 

  35. Amital H, Langevitz P, Levy Y, et al.: Valvular deposition of antiphospholipid antibodies in the antiphospholipid syndrome: A clue to the origin of the disease. Clin Exp Rheumatol 1999, 17:99–102.

    PubMed  CAS  Google Scholar 

  36. Pierangeli SS, Gharavi AE, Harris EN: Anticardiolipin testing. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:205–213.

    Google Scholar 

  37. Montecucco C, Caporali R: Hemocytopenias in antiphospholipid syndrome. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:20–31.

    Google Scholar 

  38. Gharavi AE, Pierangeli SS: Infections and antiphospholipid antibodies. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:135–143. An important overview on the significance of postinfectious aCL-positive findings and their clinical implications.

    Google Scholar 

  39. Sammaritano LR: Drug-induced antiphospholipid antibodies. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:144–154.

    Google Scholar 

  40. Mackie IJ, Donohoe S, Machin SJ: Lupus anticoagulant measurements. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:214–224.

    Google Scholar 

  41. Lie JT: Vasculopathy of the antiphospholipid syndrome revisited: thrombosis is the culprit and vasculitis the consort. Lupus 1996, 5:368–371.

    PubMed  CAS  Google Scholar 

  42. Kim JH, Ha HK, Yoon KH, et al.: CT features of abdominal manifestations of primary antiphospholipid syndrome. J Comput Assist Tomog 1999, 5:678–683.

    Article  Google Scholar 

  43. Isshi K, Hirohata S: Differential roles of the anti-ribosomal P antibody and antineuronal antibody in the pathogenesis of central nervous system involvement in systemic lupus erythematosus. Arthritis Rheum 1998, 41:1819–1827.

    Article  PubMed  CAS  Google Scholar 

  44. West SG, Emlen W, Wener MH, Kotzin BL: Neuropsychiatric lupus erythematosus: a 10-year prospective study on the value of diagnostic tests. Am J Med 1995, 99:153–162.

    Article  PubMed  CAS  Google Scholar 

  45. Georgescu L, Mevorach D, Arnett FC, et al.: Anti-P antibodies and neuropsychiatric lupus erythematosus. Ann NY Acad Sci 1997, 823:263–269.

    Article  PubMed  CAS  Google Scholar 

  46. Belmont HM: Catastrophic antiphospholipid syndrome. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:27–134.

    Google Scholar 

  47. Asherson RA: The catastrophic antiphospholipid syndrome, 1998. A review of the clinical features, possible pathogenesis and treatment. Lupus 1998, 7:S55–62.

    Article  PubMed  Google Scholar 

  48. Roubey RAS: Antiphospholipid antibody-negative syndrome: Other phospholipids. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:253–260.

    Google Scholar 

  49. Hunt BJ, Ames PRJ: Antiphospholipid syndrome: differential diagnosis. In Hughes Syndrome. Edited by Khamashta MA. London: Springer; 2000:449–456. An important overview about the differential diagnosis of APS with other thromboembolic (venous and arterial) risk factors.

    Google Scholar 

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  1. Division of Clinical Immunology, Bnai Zion Medical Center, POB 4940, 31048, Haifa, IL, Israel

    Theo Dov Golan MD

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  1. Theo Dov Golan MD
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Golan, T.D. Lupus vasculitis: Differential diagnosis with antiphospholipid syndrome. Curr Rheumatol Rep 4, 18–24 (2002). https://doi.org/10.1007/s11926-002-0019-8

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