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Ceberio-Hualde L.,St Thomas Hospital | Shoenfeld Y.,Tel Aviv University | de Ramon E.,Hospital Carlos Haya | Buonaiuto V.,Hospital Carlos Haya | And 27 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objectives: To assess the prevalence of the main causes of morbi-mortality in the antiphospholipid syndrome (APS) during a 10-year-follow-up period and to compare the frequency of early manifestations with those that appeared later. Methods: In 1999, we started an observational study of 1000 APS patients from 13 European countries. All had medical histories documented when entered into the study and were followed prospectively during the ensuing 10 years. Results: 53.1% of the patients had primary APS, 36.2% had APS associated with systemic lupus erythematosus and 10.7% APS associated with other diseases. Thrombotic events appeared in 166 (16.6%) patients during the first 5-year period and in 115 (14.4%) during the second 5-year period. The most common events were strokes, transient ischaemic attacks, deep vein thromboses and pulmonary embolism. 127 (15.5%) women became pregnant (188 pregnancies) and 72.9% of pregnancies succeeded in having one or more live births. The most common obstetric complication was early pregnancy loss (16.5% of the pregnancies). Intrauterine growth restriction (26.3% of the total live births) and prematurity (48.2%) were the most frequent fetal morbidities. 93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of catastrophic APS occurred and 5 (55.6%) of them died. The survival probability at 10 years was 90.7%. Conclusions: Patients with APS still develop significant morbidity and mortality despite current treatment. It is imperative to increase the efforts in determining optimal prognostic markers and therapeutic measures to prevent these complications. © 2014 BMJ Publishing Group Ltd & European League Against Rheumatism.

Sebastiani G.D.,Unita Operativa Complessa di Reumatologia | Iuliano A.,Unita Operativa Complessa di Reumatologia | Prevete I.,Unita Operativa Complessa di Reumatologia | Minisola G.,Unita Operativa Complessa di Reumatologia
International Journal of Clinical Rheumatology | Year: 2012

Opportunistic infections (OIs) are not frequently seen in systemic lupus erythematosus (SLE). However, when present they are very dangerous, being potentially fatal in the majority of cases. Immunosuppressive therapy is the strongest risk factor for OI and correlates with death during infective episodes, but there are other factors predisposing to infection in SLE patients, such as several defects of the immune system that are intrinsic to the disease. The diagnosis of OI in SLE may be overlooked, owing to the fact that SLE flares may mimic infection with fever and inflammatory syndrome, and needs special attention in patients at risk. Finally, we have to consider that OIs could be a trigger of SLE too. © 2012 Future Medicine Ltd.

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