RESUMEN
To compare clinical and laboratory findings between patients with primary antiphospholipid syndrome (PAPS) versus secondary APS due to rheumatic fever (APS-RF) (according to Jones criteria). Seventy-three APS patients (Sapporo criteria) were enrolled, and demographic, clinical, and laboratory data were collected. Exclusion criteria were heart congenital abnormalities and previous infectious endocarditis. Patients were divided into two groups: PAPS (n = 68) and APS-RF (n = 5). The mean current age, disease duration, frequencies of female gender, and Caucasian race were similar in APS-RF and PAPS patients (P > 0.05). Remarkably, the frequency of stroke was significantly higher in APS-RF compared to PAPS patients (80% vs. 25%, P = 0.02). Of note, echocardiogram of these patients did not show intracardiac thrombus. No significant differences were found in peripheral thromboembolic events (P = 1.0), pulmonary thromboembolism (P = 1.0), miscarriage (P = 0.16), thrombocytopenia (P = 0.36), arterial events (P = 0.58), and thrombosis of small vessels (P = 1.0). There were no differences in the frequencies of comorbidities such as diabetes mellitus, hypertension, smoking, and hyperlipidemia in both groups (P > 0.05). The frequencies of lupus anticoagulant, IgG, and IgM anticardiolipin were similar in two groups. APS patients associated with rheumatic fever without infective endocarditis may imply a high stroke risk as compared with PAPS, and future studies are needed to confirm this finding.
Asunto(s)
Síndrome Antifosfolípido/epidemiología , Fiebre Reumática/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Anticuerpos Anticardiolipina/sangre , Anticuerpos Antinucleares/sangre , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/etnología , Biomarcadores/sangre , Brasil/epidemiología , Comorbilidad , Ecocardiografía Doppler , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Fiebre Reumática/diagnóstico , Fiebre Reumática/etnología , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etnología , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: Increasing evidence incriminates bacteria, especially Mycoplasma fermentans, as possible arthritogenic agents in humans. The purpose of this study was to investigate M. fermentans in the bloodstream of patients with rheumatoid arthritis. METHODS: Two hundred and nineteen blood samples from patients with rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and healthy individuals were screened by bacterial culture and direct PCR in order to detect mycoplasmas; IgM and IgG against M. fermentans PG18 were also detected by ELISA and Immunoblotting assays in patients with rheumatoid arthritis and healthy individuals. RESULTS: Blood samples from patients with antiphospholipid syndrome and healthy individuals were negative for mycoplasma by culture or direct PCR. In blood samples from patients with systemic lupus erythematosus were detected by direct PCR M. fermentans in 2/50 (2%), M. hominis in 2/50 (2%) and U. urealyticum in 1/50 (0.5%). In patients with RA M. fermentans was detected by culture in 13/87 blood samples and in 13/87 by direct PCR, however, there was only concordance between culture and direct PCR in six samples, so M. fermentans was detected in 20/87(23%) of the blood samples from patients with RA by either culture or PCR. Antibody-specific ELISA assay to M. fermentans PG18 was done, IgM was detected in sera from 40/87 patients with RA and in sera of 7/67 control individuals, IgG was detected in sera from 48/87 RA patients and in sera from 7/67 healthy individuals. Antibody-specific immunoblotting to M. fermentans PG18 showed IgM in sera from 35/87 patients with RA and in sera from 4/67 healthy individuals, IgG was detected in sera from 34/87 patients and in sera from 5/67 healthy individuals. CONCLUSION: Our findings show that only M. fermentans produce bacteremia in a high percentage of patients with RA. This finding is similar to those reported in the literature. IgM and IgG against M. fermentans PG18 were more frequent in patients with RA than healthy individuals.
Asunto(s)
Indio Americano o Nativo de Alaska , Anticuerpos Antibacterianos/sangre , Artritis Reumatoide/microbiología , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Mycoplasma fermentans/inmunología , Adulto , Anciano , Síndrome Antifosfolípido/etnología , Síndrome Antifosfolípido/microbiología , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/etnología , Estudios de Casos y Controles , ADN Bacteriano/sangre , Ensayo de Inmunoadsorción Enzimática , Humanos , Lupus Eritematoso Sistémico/etnología , Lupus Eritematoso Sistémico/microbiología , México , Persona de Mediana Edad , Mycoplasma fermentans/genética , Mycoplasma fermentans/aislamiento & purificación , Mycoplasma hominis/inmunología , Reacción en Cadena de la Polimerasa , Ureaplasma urealyticum/inmunologíaRESUMEN
A great variety of clinical and immunological features have been described in patients with the antiphospholipid syndrome (APS), but information on their prevalence and characteristics in Latin American mestizo patients with the primary APS is scarce. To analyze the prevalence and characteristics of the main clinical and immunological manifestations in a cohort of patients with primary APS of mestizo origin from Latin America and to compare them with the European white patients, clinical and serological characteristics of 100 patients with primary APS from Colombia, Mexico, and Ecuador were collected in a protocol form that was identical to that used to study the "Euro-Phospholipid" cohort. The cohort consisted of 92 female patients (92.0%) and eight (8.0%) male patients. They were all mestizos. The most common manifestations were deep vein thrombosis (DVT; 23.0%), livedo reticularis (18.0%), migraine (18.0%), and stroke (18.0%). The most common pregnancy morbidity was early pregnancy losses (54.1% of pregnancies). Several clinical manifestations were more prevalent in the Latin American mestizo than in the European patients (transient global amnesia, pulmonary microthrombosis, arthralgias, and early pregnancy losses) and vice-versa (DVT, stroke, pulmonary embolism, and thrombocytopenia). Latin American mestizo patients with primary APS have a wide variety of clinical and immunological manifestations with several differences in their prevalence in comparison with European white patients.
Asunto(s)
Síndrome Antifosfolípido/etnología , Adulto , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/inmunología , Colombia/epidemiología , Ecuador/epidemiología , Femenino , Humanos , Masculino , México/epidemiología , Prevalencia , Población BlancaRESUMEN
In an effort to identify alleles associated with an increased risk of venous thrombosis in patients with primary antiphospholipid syndrome, we studied the G20210A polymorphism (the G-->A mutation at nucleotide position 20210) in the 3'-untranslated region of the prothrombin gene in a group of 14 patients with primary antiphospholipid syndrome. We did not find any patient with the mutated gene. Since the prothrombin mutation is more prevalent in white populations, this finding may be related with the genetic composition of the Mexican mestizos, in whom the white component is low. The polymorphism of the prothrombin gene in Mexican mestizo patients with antiphospholipid syndrome does not seem to be related to the thrombophilia observed in these patients.
Asunto(s)
Síndrome Antifosfolípido/genética , Indígenas Norteamericanos , Polimorfismo Genético , Protrombina/genética , Regiones no Traducidas 3'/genética , Síndrome Antifosfolípido/etnología , Humanos , México/epidemiologíaRESUMEN
OBJECTIVE: To investigate the prevalence of anticardiolipin antibodies (aCL) and isotype distribution and their clinical associations with the features of the antiphospholipid syndrome (APS) in 3 different ethnic groups of patients with systemic lupus erythematosus (SLE). METHODS: The study population consisted of 152 African-American, 136 Afro-Caribbean (Jamaican), and 163 Hispanic (Colombian) unselected patients with SLE. Serum samples were studied for the prevalence of aCL and isotype distribution. All aCL measurements were performed in the same laboratory by ELISA. RESULTS: Positive results for 1 of the 3 aCL isotypes were found in 42 African-Americans (28%), 28 Afro-Caribbeans (21%), and 43 Hispanics (26%). IgG aCL was the dominant isotype in Hispanic and African-American patients, while IgA was the dominant isotype in Afro-Caribbeans. Of note, IgA aCL was found in all Afro-Caribbean patients who were aCL positive, while only 3 patients in this group had IgG aCL and 2 had IgM aCL. Clinical features of the APS were found to correlate better in Hispanics than in African-Americans and Afro-Caribbean patients with aCL isotypes. CONCLUSION: Our data suggest the existence of ethnic differences in the prevalence and isotype distribution of aCL as well as in their clinical relevance in patients with SLE. Further studies of the role of genetic and/or environmental factors in the observed differences are required.
Asunto(s)
Anticuerpos Anticardiolipina/análisis , Isotipos de Inmunoglobulinas/análisis , Lupus Eritematoso Sistémico/etnología , Lupus Eritematoso Sistémico/inmunología , Adolescente , Adulto , Anciano , Síndrome Antifosfolípido/etnología , Síndrome Antifosfolípido/inmunología , Síndrome Antifosfolípido/patología , Niño , Preescolar , Colombia/etnología , Ensayo de Inmunoadsorción Enzimática , Etnicidad , Femenino , Humanos , Inmunoglobulina A/análisis , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Jamaica/etnología , Lupus Eritematoso Sistémico/patología , Masculino , Persona de Mediana Edad , Estados Unidos/etnologíaAsunto(s)
Síndrome Antifosfolípido/etnología , Síndrome Antifosfolípido/inmunología , Antígeno HLA-DR5/análisis , Alelos , Síndrome Antifosfolípido/genética , Genes , Antígenos HLA-DR/análisis , Cadenas HLA-DRB1 , Humanos , Complejo Mayor de Histocompatibilidad/genética , México/etnología , Fenotipo , Valores de ReferenciaRESUMEN
The authors present the case of a twenty-one-year-old woman with familial Mediterranean fever who during her first pregnancy developed a primary antiphospholipid syndrome. This is an association not reported previously.