Document Detail

Amputation of digits or limbs in patients with antiphospholipid syndrome.
MedLine Citation:
PMID:  18206213     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe the characteristics of patients with peripheral vascular disease leading to amputation of digits or limbs encountered in patients with the antiphospholipid syndrome (APS). METHODS: Twenty-one cases derived from several geographical centers (Brazil, Serbia, Italy, Israel, United Kingdom, and South Africa) are presented. The major clinical, serological, and histopathological data (where available) of this cohort are described, documented, and analyzed. RESULTS: Patients were suffering mainly from systemic lupus erythematosus (9 patients) or primary APS (8 patients). Peripheral vascular occlusions occurred during the course of the catastrophic APS in 5 patients. The vascular occlusions occurred both early and very late in the course of the disease (time after APS diagnosis, 0-38 years). Vasculitis was present in 7 patients and 5 demonstrated the typical antiphospholipid antibody (aPL)--vasculopathy with complicating bland thrombosis. Myocardial infarctions had occurred in 4 patients but it was not possible to determine whether they suffered from premature atherosclerotic disease or whether the infarctions were aPL-related. The appearance of livedo reticularis preceding the arterial thrombosis was noted in 9 patients. Cryoglobulinemia was detected in only 1 patient. CONCLUSIONS: Peripheral vascular disease leading to amputation of digits or limbs is a severe complication encountered in patients with APS. In the absence of histopathology, it may be difficult to distinguish whether concomitant atherosclerotic occlusions, vasculitis, or aPL-related thrombosis of peripheral vessels is the main cause of the vascular ischemia. Treatment should, therefore, include full anticoagulation as well as corticosteroids and immunosuppression in these patients.
Ronald A Asherson; Ricard Cervera; Evandro Klumb; Ljudmila Stojanovic; Piercarlo Sarzi-Puttini; Janet Yinh; Silvia Bucciarelli; Gerard Espinosa; Roger Levy; Yehuda Shoenfeld
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-02-21
Journal Detail:
Title:  Seminars in arthritis and rheumatism     Volume:  38     ISSN:  1532-866X     ISO Abbreviation:  Semin. Arthritis Rheum.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-29     Completed Date:  2009-01-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306053     Medline TA:  Semin Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  124-31     Citation Subset:  IM    
Division of Immunology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
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MeSH Terms
Anticoagulants / therapeutic use
Antiphospholipid Syndrome / complications,  therapy*
Arterial Occlusive Diseases / complications*
Extremities / blood supply,  surgery
Fingers / blood supply,  surgery
Ischemia / surgery*
Lupus Erythematosus, Systemic / complications*
Middle Aged
Reg. No./Substance:

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