Antiphospholipid antibodies

Very heterogeneous group of autoantibodies in terms of specificity, isotype and affinity, directed against phospholipids (cardiolipin, phosphaditylcholine, phosphatidylethanolamine, phosphaditylserine, phospaditylinositol).

They can be detected by 3 assay methods:

• Anti-Cardiolipin-AK (ACA)
• Lupus anticoagulant test
• Beta2-glycoprotein

In vitro, the autoantibodies lead to a prolongation of the PTT, but also of the Quick value (lupus anticoagulant!); in vivo, however, accelerated coagulation, a tendency to thrombosis, abortions and thrombopenia occur, especially in the case of high-titer detection; see below. Antiphospholipid antibody syndrome).

Cardiolipin-Ak are also formed in active tuberculosis (see Erythema induratum below).

The secondary occurrence of antiphospholipid antibodies (PLA) has been associated with various underlying diseases:

• SLE (PLA pos. in 25-50% of patients).
• Sjögren's syndrome (42%)
• Rheumatoid arthritis (33%)
• Thrombotic thrombocytopenic purpura(30%)
• Psoriatic arthritis (28%)
• Systemic scleroderma (25%)
• Mixed connective tissue disease (22%)
• Polymyalgia rheumatica (20%)
• M. Behçet 's disease (20%)
• Livedo racemosa
• Sneddon's syndrome
• Antiphospholipid antibody syndrome
• Hashimoto's thyroiditis.

Phospholipid antibodies (PLA) are also used in various infectious diseases ( syphilis). Infectious diseases ( syphilis, hepatitis C, HIV, malaria, parvovirus B19) are described.

Drugs: PLA can occur after various drugs. Interferon alfa, amoxicillin, phenytoin, chlorpromazine, rivaroxaban).

Phospholipid antibodies can interact with the platelet membrane due to their binding to phospholipids and thus act as co-factors in different steps of the coagulation cascade. In vivo, this results in a greater activability of the coagulation system with a tendency to thrombosis.

Clinically, migrating thrombophlebitis may also be present. The reaction of phospholipid antibodies with central nervous membrane components can lead to CNS symptoms, e.g. dizziness, partial disturbance of short- and long-term memory, disturbance of fine motor skills up to brain infarctions with hemiplegia and possible cerebral seizures.

Remember! The term "lupus anticoagulant" is actually a misnomer. Its detection is most strongly associated with an increased risk of thrombosis.

1. Asherson RA et al (2003) Antiphospholipid antibodies and infections. Ann Rheum Dis 62: 388-393
2. Campos LM et al (2003) Antiphospholipid antibodies and antiphospholipid syndromes in 57 children and adolescents with systemic lupus erythematosus. Lupus 12: 820-826
3. Fernandez-Galar M et al (2003) Systemic lupus erythematosus-associated anetoderma and anti-phospholipid antibodies. Clin Exp Dermatol 28: 39-42
4. Lisi S et al (2003) A case of erythema elevatum diutinum associated with antiphospholipid antibodies. J Am Acad Dermatol 49: 963-964
5. Mascarenhas R et al (2003) Familial Sneddon's syndrome. Eur J Dermatol 13: 283-287
6. Meurer M, Degitz K (1992) Antiphospholipid antibodies. dermatologist 43: 11-13
7. Sipek-Dolnicar A et al (2002) Clinical presentations and vascular histopathology in autopsied patients with systemic lupus erythematosus and anticardiolipin antibodies. Clin Exp Rheumatol 20: 335-342
8. by Landenberg P et al (2003) Antiphospholipid antibodies in pediatric and adult patients with rheumatic disease are associated with parvovirus B19 infection. Arthritis Rheum 48: 1939-1947
9. Wall A, Disciple H (1992) Sneddon syndrome with detection of anti-phospholipid antibodies. dermatologist 43: 380-382