Title: Cerebral manifestations in the antiphospholipid syndrome: autoantibodies involved in accelerate the process of atherosclerosis

Ljudmila Stojanovich

University Medical Center, Belgrade, Serbia


Ljudmila Stojanovich received her Ph.D. in Medicine, with the thesis “Neuropsychiatric manifestations in patients with Systemic Lupus Erythematosus” in 1999. She is the scientific director in the Bezhanijska Kosa, University Medical Center of Belgrade University, where she is currently a Research Professor. Dr. Stojanovich’s research focuses on Systemic Lupus Erythematosus, Antiphospholipid Syndrome, and Vaccination in patients with Autoimmune Rheumatic diseases. She is an author of three monographs and of about 250 articles on various aspects of Autoimmune Rheumatic disorders, published in international and domestic journals and in conference proceedings. She is in Editorial Boards (Editorial Boards LUPUS (LONDON). /Reviewer in the “CURRENT CONTENSTS” or “Science citation index”, like LUPUS REWIEWER DATABAS, Cellular and Molecular Neurobiology.


Cerebrovascular manifestations represents common neurological disorder in patients with antiphospholipid syndrome (APS) arising from accelerated atherosclerotic changes of the carotid arteries or as the result of thrombotic event.  However, the importance of antiphospholipid antibodies (aPL) as a risk factor for its occurrence in APS patients remains controversial.  In this study we sought to determine prognostic value of specific aPL presence for Cerebrovascular events in primary (PAPS) and secondary APS (SAPS). The aim of this study was to investigate relationship between cerebrovascular neurological (stroke and transient ischemic attack (TIA) with type of antiphospholipid antibodies.

METHODS:  We analyzed 508 APS patients (Caucasians): 360 with PAPS (78.6% female, 21.4% male) average age 44.00±12.97 years and 148 SAPS patients, most commonly in the context of systemic lupus erythematosus (SLE) (89.9% female, 10.1% male) of average age 47.74±14.84 years.  Patients with APS have been included, consecutively, starting from the year 2000 to date in the prospective manner and registered as the Serbian National Cohort Study.  All patients analyzed have met the 2006 revised Sydney criteria for APS and were evaluated for the presence of aPL: lupus anticoagulant (LA), anti-cardiolipin (aCL: IgG/IgM) and anti-ß2glycoprotein I (ß2GPI: IgG/IgM) antibodies.  The diagnosis of stroke has been established by neurologist.

RESULTS: There was 29.7% aCL IgG, 47.8% aCL IgM, 30.3% ß2GPI IgG, 40.8% ß2GPI IgM and 55.0% LA positive PAPS and 56.1% aCL IgG, 60.1% aCL IgM, 40.5% ß2GPI IgG, 45.3% ß2GPI IgM and 53.4% LA positive SAPS patients.  22.2% PAPS and 29.1% SAPS patients were diagnosed with stroke (p=0.111).  After adjustment for age, current cigarette smoking, diabetes, hypertension and hyperlipidemia, the relative odds for stroke in PAPS patients with ß2GPI IgG positivity was 3.87 (95% confidence interval 1.00 to 3.60, p=0.049, bootstrapped for 1000 samples) whereas in SAPS patients was 5.25 (95% confidence interval 0.10 to 1.81, p=0.021, bootstrapped for 1000 samples)

CONCLUSION: Presence of ß2GPI IgG in PAPS and SAPS patients was independent predictor for cerebrovascular manifestations in our APS cohort.