AB0492 PREVALENCE OF IGA ANTICARDIOLIPIN ANTIBODY AND ITS ASSOCIATION WITH PREGNANCY MORBIDITY IN ASIAN INDIAN PATIENTS WITH PRIMARY ANTIPHOSPHOLIPID ANTIBODY SYNDROME AND SYSTEMIC LUPUS ERYTHEMATOSUS – A CROSS SECTIONAL STUDY
Authors: Harshini Alur Shivakumar, K Jayakanthan, Mahasampath Gowri, John Mathew, Debashish Danda
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> There are many clinical and laboratory parameters which have been proven to be associated with increased risk of pregnancy morbidity in patients with SLE and APS. This study was undertaken as there is a lacuna in explaining all the pregnancy related morbidity in this group <h3>Objectives:</h3> Primary: Correlation of IgA anticardiolipin antibody with the risk for pregnancy morbidity in patients with APS/SLE Secondary: Association of IgA Anticardiolipin antibody with the risk of thromboembolic events <h3>Methods:</h3> Patients diagnosed as SLE and/or Primary APS who are married and conceived atleast once were recruited and 3ml blood sample was obtained from them. Patients with history of recurrent infections, which could suggest probable IgA deficiency, were excluded. Demographic data including duration of illness, number of pregnancies, thromboembolic events, disease activity were noted. They were categorized into two different groups depending on whether they had a pregnancy morbidity or not. The blood samples were subjected to IgA Anticardiolipin assay by ELISA. <h3>Results:</h3> A total number of 186 patients were recruited with mean age 34.54(+/-7.32)years, mean duration of illness of 5.52(+/-4.31)yrs with a diagnosis of 76.88% SLE, 7.53% primary APS and 15.59% SLE with secondary APS. On assessment of disease activity, mean SLEDAI score was found to be 4.46+/-6.32. Out of the total, 14.71% patients had conceived once, 14.56% twice, 16.72% patients thrice and 18.41% had conceived more than three times. 36.56% patients had pregnancy morbidity (majority being pregnancy induced hypertension 14.52%, prematurity 11.29%, IUGR 10.22%, pre-ecclampsia in 3.76%, eclampsia 1.08%,), 19.35% patients had history of thromboembolic events (6.45% pulmonary embolism, 5.38% deep vein thrombosis, 3.76% visceral vessel thrombosis, 0.54% cortical vein thrombosis, 6.99% other vessel thrombosis). 33.87% patients had positivity for antiphospholipid antibodies with 27.82% lupus anticoagulant positive, 20.97% IgG Anticardiolipin positive and 17.35% anti-beta2 glycoprotein positive. IgA Anticardiolipin was found to be positive in 4.84%(n=9) out of which, 10.29% were in the group with pregnancy morbidity as against 1.69% without pregnancy morbidity. Out of the total positives titre in 37.5% were indeterminate, 25% low positive and 37.5% high positive. All patients who had high titre positivity had pregnancy morbidity. The positivity of IgA anticardiolipin in the patient group with thromboembolic events was 5.56%. <h3>Conclusion:</h3> Among patients with SLE, APS or SLE and APS, the overall prevalence of IgA anticardiolipin antibody was found to be about 4.84%, which is much less as compared to the percentages reported by other groups<sup>[1]</sup> IgA Anticardiolipin antibody positivity was more in patients with pregnancy morbidity compared to patients without a pregnancy morbidity. In this study however, statistical significance was not reached. Similar studies with larger number of patients are required. We also need to prospectively follow up such patients with IgA ACLA and evaluate for morbidity during pregnancy <h3>References</h3> [1] Clinical significance of IgA anticardiolipin and anti-beta2-GP1 antibodies in patients with systemic lupus erythematosus and primary antiphospholipid syndrome, Clin Rheumatol. 2006 Mar;25(2):199-204 <h3>Disclosure of Interests:</h3> None declared