Raynaud Phenomenon, Migraine Linked to aPS/PT Antibodies in Primary Antiphospholipid Syndrome

The presence of antibodies to phosphatidylserine/prothrombin complex (aPS/PT) is associated with Raynaud phenomenon and migraine in patients with primary antiphospholipid syndrome (PAPS), according to findings published in Lupus.

A total of 67 consecutive patients with thrombotic PAPS were enrolled in this cross-sectional study. Using an enzyme-linked immunosorbent assay (ELISA), the investigators collected data on the presence of immunoglobulin G (IgG) and immunoglobulin M (IgM) aPS/PT antibodies and their associations with Raynaud phenomenon, migraine, and valvular lesions. Venous thrombosis was more common than isolated arterial thrombosis in this cohort (80.6% vs 4.5%, respectively; P <.0001).

In this patient population, a total of 29 (43.3%) patients had positive aPS/PT antibodies. Of these patients, there were more IgM antibodies than the IgG isotype (40.3% vs 17.9%, respectively; P =.014). Patients with triple antiphospholipid (aPL) antibodies were more likely to have aPS/PT antibodies compared with patients with either single or double aPL antibodies (85.7% vs 30.8% and 35.7%, respectively; P =.03). In addition, significantly greater frequencies of migraine and Raynaud phenomenon were observed among patients with PAPS who presented with positive aPS/PT antibodies (P =.0001).

This study included a limited patient dataset, and findings from this small patient population may not be generalizable to a larger patient population. Investigators also did not measure aPL and aPS/PT levels throughout the study period. Because of aPL and aPS/PT levels are known to fluctuate with time, this study is limited to associations found with measurements obtained at baseline only.

Investigators of this study “suggest that aPS/PT antibodies could be involved in the pathogenesis of untypical vascular [antiphospholipid syndrome] manifestations,” yet little is known regarding the utility of aPS/PT antibodies as a biomarker for risk stratification.

Reference

Kopytek M, Natorska J, Undas A. Antiphosphatidylserine/prothrombin (aPS/PT) antibodies are associated with Raynaud phenomenon and migraine in primary thrombotic antiphospholipid syndrome [published online January 1, 2018]. Lupus. doi: 10.1177/0961203317751644