Antiphospholipid syndrome in Asians: clinical manifestations, serological markers and outcome of the National University of Singapore/National University Hospital antiphospholipid cohort (original) (raw)

2003, APLAR Journal of Rheumatology

Background: There is a paucity of studies on antiphospholipid syndrome (APS) in Asian patients. Aim: This is the first study in Singapore to describe the clinical features, serological markers and outcomes of one of the largest cohort of APS patients in Southeast Asia. Method: One hundred and forty-six patients were studied. Results: Within the study group, 89 were primary APS and 57 secondary APS. Age range: 16-84 years (mean Age: 50.1 years). Male : female ratio: 1 : 2.1. Racial distribution: Chinese, 69.2%; Malays, 18.5%; Indians, 11.7%. Systemic lupus erythematosus was the commonest disease associated in 48 patients (32.9%), while 17 (11.6%) had lupus-like disease. Eighty-two (56.2%) patients had arterial thrombosis, 37 (25.3%) patients had venous thrombosis, 14 (9.6%) had arterial and venous thrombosis while 17 (11.6%) had obstetric manifestations; 28.8% had thrombocytopenia. Clinical manifestations were diverse with neurological (49.3%), cardiac (40%), renal (23.6%) involvement. There were also several unusual presentations. Recurrent thrombosis occurred in 24.6%. Two had catastrophic APS and there were 12 deaths (9.6%). Antiphospholipid antibody testing included lupus anticoagulant, serum aCL IgG, IgM and IgA, anti-β2 glycoprotein I (aβ2-GPI) IgG, IgM, and IgA. The serological positivity rates of the various antiphospholipid antibodies were reported. aβ2-GPI was positive in 67% of those tested, of which aβ2-GPI IgA was the most common subtype. The presence of the aβ2-GPI was associated with recurrent venous thrombosis. Conclusion: The clinical manifestations of APS in Asian patients were diverse and multisystemic. Recurrent thrombosis rate was high with significant morbidity and mortality.