Antiphospholipid Antibody Syndrome – In-Depth Overview

Adapted from a talk at The SLE Workshop at Hospital for Special Surgery

A syndrome is a collection of events that constitute a specific illness. Antiphospholipid Antibody Syndrome (APS) includes a series of symptoms as follows:

  1.  Repeated clotting in veins (for example – a pulmonary embolus) or arteries (examples include a stoke, a blood clot in an arm or a leg, or a coronary).
  2. Recurrent pregnancy loss, usually in mid to late pregnancy as opposed to early pregnancy.
  3. An antibody test has to be strongly positive. Having a weak or trace positive test is fairly common in the general population and is not enough to diagnose the syndrome.

The above symptoms are specifically characteristic of APS. However, there are a lot of other symptoms that are also associated with APS. Such symptoms include skin changes and low platelets.

You may have heard different terms used when referring to tests for the antibody. The antiphospholipid antibody is the more general term. The anticardiolipin antibody refers to a type of phospholipid. Another test for the antibody is the Lupus Anticoagulant Test. These terms are all equivalent from the patient’s point of view. In other words, they all test for the same thing. The only difference is in the type of measurement.

In the 1900’s, certain people had false positive test results for syphilis. This was a curiosity without clinical importance at the time, but rediscovered in the 1940’s. By the 1950’s, it was foundthat this false positive syphilis test had something to do with lupus. Today, although known as a clue to diagnosis, a false positive syphilis test is not sufficient for a diagnosis of lupus or APS.

In the 1950’s and 1960’s it was realized that the antiphospholipid antibodies had something to do with blood clots. In 1983, Hughes, Gharavi, and Harris developed a simple test for the antibodies called an ELISA. Clinical descriptions of various things that happened to people who had this antibody were also noted. In 1985, descriptions of what happened in pregnancy for people with this antibody were also noted.

Up until 1989, it was thought that APS was a subset of lupus. However, enough cases were seen in which people had APS without having Lupus. It was decided that it should be categorized as a separate illness. Several names have been used to describe it. The most common name is PAPS (primary antiphospholipid syndrome). It is also sometimes called Hughes’ syndrome. In 1990, the B2-Glycoprotein 1 was discovered. The importance of this protein will be reviewed later.

See the complete article on the Hospital for Special Surgery’s website


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