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APS - Neurology Related   Antiphospholipid Antibodies and Stroke in Young Women   Stroke. 2002;33:2396. © 2002 American Heart Association, Inc. Conclusions— The results from this study support the importance of antiphospholipid antibodies as an independent risk factor for stroke in young women.   Antiphospholipid Antibodies and Subsequent Thrombo-occlusive Events in Patients With Ischemic Stroke   JAMA. 2004;291:576-584.   Antiphospholipid antibodies in cerebral ischemia.   Stroke. 1991 Jun;22(6):750-3.   Antiphospholipid antibodies in young adults with stroke.   J Thromb Thrombolysis. 2005 Oct;20(2):105-12. CONCLUSIONS: Antiphospholipid antibodies, particularly Lupus Anticoagulant, is an independent risk factor for first and possibly recurrent ischemic stroke in young adults. The best therapeutic strategy for preventing antiphospholipid antibody-associated recurrent stroke is not clear.   ANTIPHOSPHOLIPID ANTIBODIES SYNDROME (APS) ASSOCIATED WITH HYPERHOMOCYSTEINEMIA RELATED TO MTHFR GENE C677T AND A1298C HETEROZYGOUS MUTATIONS IN A YOUNG MAN WITH IDIOPATHIC HYPOPARATHYROIDISM (DIGEORGE SYNDROME)   Journal of Clinical Endocrinology & Metabolism 2006, 10.1210/jc.2005-2782. Conclusions: APS, revealed by anti-beta-2-glycoprotein (anti-2-GPI) and anti-prothrombin (anti-PT) antibodies positivity, and moderate HHcy related to heterozygous C677T and A1298C point mutations of the MTHFR gene, were identified as a possible cause of thrombotic disorder responsible for the widespread presence of cutaneous and cerebral lesions.   Antiphospholipid antibodies syndrome in 'Stroke in young'.   Mehndiratta MM, Bhattacharya A, Gupta M, Khawaja GK, Puri V. Antiphospholipid antibodies syndrome in 'Stroke in young'. Neurol India 1999;47:122-6 Promotes an INR of greater than 3.0.   Antiphospholipid antibody syndrome manifested as a postoperative cerebrovascular event in a child.   South Med J. 2000 Nov;93(11):1115-9.   Antiphospholipid syndrome and stroke   Rinsho Shinkeigaku. 2005 Nov;45(11):852-5. Antiphospholipid syndrome is characterized by arterial or venous thrombosis, and the presence of antiphospholipid antibodies (aPL). APL are considered to be a cause of an acquired hypercoagulable state leading to stroke and transient ischemic attack (TIA). We examined the causes in 50 young patients with ischemic stroke. The most prevalent cause was atherosclerosis and the incidence of APS was 12.5%. APL comprise a heterogeneous group of autoantibodies, such as beta2-glycoprotein I dependent anticardiolipin antibody (beta2-GPIaCL), lupus anticoagulant (LA), and other antiphospholid-protein antibodies. We examined the incidence and the pathogenic role of antiphospholipid protein antibodies. The subjects comprised 250 patients (155 male, 95 females) with ischemic stroke, aged 26 to 92 years (mean 72 years). We measured beta2-GPI aCL, IgG aCL, LA, phosphatidyserine dependent antiprothrtombin antibody (PS-PT), antiphosphatidyl-serine antibody (PS), antiphosphatidyl-inositol antibody (PI) in each patient. The incidence of beta2-GPI aCL, IgG aCL, LA, phosphatidyserine, PS-PT, PS, and PI was 2.8%, 12%, 9.2%, 7.2%, 9.6%, and 8.8%, respectively. The incidence of young stroke patients under 50 years was 5.2%. Among 13 young stroke patients, 5 had SLE. Among 23 patients with LA., 18 (78%) patients had PS-PT. Anti-PS-PT antibody is closely related to LA. Antinuclear antibody was detected in 79% of the patients with aPS and/or aPI. We compared the carotid ultrasonographic findings in positive aPI or aPS patients with those in negative ones. Increased IMT, plaque score and carotid stenosis were more common in aPI and aPS-positive patients than in negative ones Three of 5 patients who showed positive beta2-GPI, aCL and LA, simulataneously, had sysyemic lupus erythematosus as an immulological background. Two of 3 patients with PI and/or PS and beta2-GPI and/or LA were patients with SLE. Antiphospholipid antibody was considered to be a risk factor of stroke, especially in SLE and/or young female patients. The incidence of lupus anticoagulant is more common than beta2-GPI aCL in ischemic stroke. In SLE patients with stroke, multi-antiphospholipid-protein antibodies was inclined to be present. LA is closely related to ant-PS-PT and aPI and aPS are associated with anti-nuclear antibody and precipitation of atherosclerosis.   Antiphospholipid-Protein Antibodies and Ischemic Stroke   (Stroke. 1998;29:1755-1758.) © 1998 American Heart Association, Inc.   APS and MS     Association of antiphospholipid antibodies with central nervous system disease in systemic lupus erythematosus.   Am J Med. 1995 Oct;99(4):397-401.   Brain vascular changes in the case of primary antiphospholipid syndrome.   Folia Neuropathol. 1996;34(2):92-6. Morphological picture of arterial fibromuscular dysplasia (FMD) of carotid and cerebral arteries associated with intracranial aneurysm and thrombotic small vessel vasculopathy in a 34-year-old woman with primary antiphospholipid syndrome (PAPS) is presented. The patient died because of hemorrhage caused by aneurysm rupture. In the walls of the aneurysm and aneurysmal dilatation of middle cerebral artery dysplastic changes of FMD type were found. The case fulfills the clinical and serological criteria of antiphospholipid syndrome (APS). Microscopic examination of the brain showed occlusion of small cerebral vessels, characteristic for antiphospholipid syndrome. It was caused by fibrin thrombi and endothelial proliferation or fibrous webs in the vessel lumen. Neither features of systemic lupus erythematosus (SLE) nor related autoimmune diseases were observed in the morphological examination of the brain, skin and internal organs. Therefore, it was feasible to confirm the diagnosis of PAPS in the patient with FMD of the large cephalic arteries.   Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature.   Medicine (Baltimore). 2000 Jan;79(1):57-68.   Central nervous system involvement in the antiphospholipid (Hughes) syndrome   Rheumatology 2003; 42: 200-213. The antiphospholipid (Hughes) syndrome (APS) is characterized by arterial and/or venous thrombosis and pregnancy morbidity in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disorder or secondary to a connective tissue disease, most frequently systemic lupus erythematosus. Central nervous system (CNS) involvement is one of the most prominent clinical manifestations of APS, and includes arterial and venous thrombotic events, psychiatric features and a variety of other non-thrombotic neurological syndromes. In this review we focus on the common and some of the less common CNS manifestations that have been reported in association with antiphospholipid antibodies.   Cerebral microembolism, a disease marker for ischemic cerebrovascular events in the antiphospholipid syndrome of systemic lupus erythematosus?   Acta Neurol Scand. 1999 Jun;99(6):356-61. CONCLUSION: MES may be related to disease activity in patients with SLE and APS. Their detection may help to assess individual cerebrovascular risk and contribute to therapeutic decision making and therapeutic monitoring.   Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome.   Am J Med. 1989 Apr;86(4):391-9.   Chorea and antiphospholipid antibodies: Treatment with methotrexate   Neurology 2001;56:137-138. © 2001 American Academy of Neurology.   Cognitive Deficits in Patients With Antiphospholipid Syndrome   Arch Intern Med. 2006;166:2278-2284. Conclusions Cognitive deficits may often be found among patients with APS, independent of any history of central nervous system involvement. Livedo reticularis and the presence of white matter lesions on brain magnetic resonance imaging are associated with an increased risk for cognitive dysfunction in APS.   Dementia associated with the antiphospholipid syndrome: clinical and radiological characteristics of 30 patients   Rheumatology Advance Access originally published online on September 14, 2004. Rheumatology 2005 44(1):95-99; doi:10.1093/rheumatology/keh408.   Factor V Leiden and Antiphospholipid Antibodies Are Significant Risk Factors for Ischemic Stroke in Children   Stroke. 2000;31:1283. © 2000 American Heart Association, Inc.   Features Associated with Epilepsy in the Antiphospholipid Syndrome   J Rheumatol 2004;31:1344-8. Conclusion. Epilepsy is common in APS and most of the risk seems to be linked to vascular disease as manifested by extensive CNS involvement, valvulopathy, and livedo reticularis and to the presence of SLE. These factors, however, explain only part of the increased occurrence of epilepsy in APS and other causes such as direct immune interaction in the brain should be investigated.   Hemidystonia symptomatic of primary antiphospholipid syndrome in childhood.   Mov Disord. 1993 Jul;8(3):383-6. We suggest that PAPS must always be considered when isolated or recurrent focal cerebral ischaemia, and particularly hemidystonia, occur in childhood.   Hypoperfusion of brain single photon emission computerized tomography in patients with antiphospholipid antibodies.   J Dermatol Sci. 1997 Jan;14(1):20-8. Hypoperfusion areas might be caused by microarterial thrombosis, microvenous thrombosis or vascular spasms. Early detection of cerebral abnormalities allows steps to be taken to protect against irreversible progress of cerebral blood flow. Therefore, brain SPECT should be performed in patients with antiphospholipid antibodies.   Low dose aspirin after ischemic stroke associated with antiphospholipid syndrome   Neurology 2003;61:111-114 © 2003 American Academy of Neurology   Management of the neurological manifestations of APS--what do the trials tell us?   Thromb Res. 2004;114(5-6):489-99. CONCLUSIONS: (1) aPL are a risk factor for incident stroke (Grade A, established as useful for the given condition in the specified population). (2) The evidence to support the role of aPL in recurrent stroke is conflicting and, therefore, inconclusive. (3) Warfarin at moderate-intensity doses is equally effective in preventing a recurrent thrombotic event as warfarin at high-intensity doses in patients with APS (Grade A evidence, established as useful for the given condition in the specified population). (4) Warfarin, at moderate-intensity doses is as effective as aspirin (at a dose of 325 mg/day) in preventing recurrent thrombotic events in patients who are aPL-positive at the time of an initial stroke (Grade B evidence, probably useful for the given condition in the given population). (5) Currently there are no data to support the use of any prophylactic therapy in patients with aPL and no clinical manifestations for the purposes of preventing an incident stroke.   Migraine in Hughes syndrome—heparin as a therapeutic trial?   Q J Med 2001; 94: 114-115 © 2001 Association of Physicians   Migraine, memory loss, and "multiple sclerosis ". Neurological features of the antiphospholipid (Hughes’) syndrome   Postgraduate Medical Journal 2003;79:81-83 © 2003 Fellowship of Postgraduate Medicine   Multiple sclerosis, neuropsychiatric lupus and antiphospholipid syndrome: where do we stand?   Rheumatology Advance Access originally published online on January 11, 2005 Rheumatology 2005 44(4):434-442; doi:10.1093/rheumatology/keh532 Rheumatology Vol. 44 No. 4 © British Society for Rheumatology 2005. A trial of anticoagulation might be worthwhile in some patients with atypical MS and consistently positive aPL.   Neurological involvement as a poor prognostic factor in catastrophic antiphospholipid syndrome: autopsy findings in 12 cases   Source: Lupus, Volume 12, Number 2, 1 February 2003, pp. 93-98(6)   Neurometabolite Markers of Cerebral Injury in the Antiphospholipid Antibody Syndrome of Systemic Lupus Erythematosus   Stroke. 1998;29:2254-2260.   Recurrent acute transverse myelopathy: Association with antiphospholipid antibody syndrome   Shaharao V, Bartakke S, Muranjan MN, Bavdekar MS, Bavdekar SB, Udani1 VP. Recurrent acute transverse myelopathy: Association with antiphospholipid antibody syndrome. Indian J Pediatr 2004;71:559-561   Some considerations about the possible pathological mechanisms at work in antiphospholipid syndrome and stroke   Rev Neurol. 2003 Oct 1-15;37(7):654-7. INTRODUCTION AND DEVELOPMENT: Over the last two decades antiphospholipid syndrome (APS) has started to be recognized from the association of apparently anionic phospholipid-specific antibodies with thrombosis, thrombocytopenia and recurrent foetal losses. This syndrome affects patients with systemic lupus erythematosus and is considered to be an important cause of thromboembolic disease. Antiphospholipid antibodies are serum immunoglobulins that react with negatively charged phospholipids, albeit directly or by means of a cofactor, affect the coagulation system, and promote thrombosis. Recent research has been directed towards gaining an understanding of the mechanisms by which these antibodies are able to play a direct role in the pathophysiology of thrombosis, and the extent to which certain risk factors, such as smoking, high blood pressure, lipid disorders and so on, exert an influence over the expression of phospholipids in the cerebral endothelium. CONCLUSION: These antibodies have no single mechanism of action; different authors have described different pathological mechanisms, which help us to understand the heterogeneous clinical manifestations of APS.   Stroke and antiphospholipid syndrome: the treatment debate   Rheumatology Advance Access originally published online on April 19, 2005 Rheumatology 2005 44(8):971-974; doi:10.1093/rheumatology/keh666   The Antiphospholipid Syndrome and "Multiple Sclerosis"     The blood disease that mimics MS - Hughes Syndrome   How APS can mimic MS.   Thrombotic cerebral arteriopathy in patients with the antiphospholipid syndrome.   Mod Pathol. 1993 Nov;6(6):644-53. CONCLUSIONS: The cerebrovascular changes of the antiphospholipid syndrome are derived from a chronic thrombotic microangiopathy. The findings support the hypothesis that antiphospholipid antibodies can cause recurring episodes of intravascular thrombosis.   Top of Page APS - Opthalmology Related   A case of optic neuritis associated with anticardiolipin antibodies   Rinsho Shinkeigaku. 1992 Mar;32(3):330-2. We reported a case of optic neuritis with the persistence of severe visual loss and central scotoma in a 26-year-old woman who was proven to have biologic false positive test for syphilis, and the elevated serum titres of IgG and IgM anticardiolipin antibodies. C.S.F. findings showed the absence of oligoclonal bands and the presence of IgM anticardiolipin antibody. She was treated twice at intervals of two weeks with methylprednisolone 1000 mg intravenously daily for three days (pulse therapy), and was started on oral prednisolone 60 mg daily which tapered gradually. After the second treatment of the pulse therapy, her visual acuity was improved remarkably and the titre of anticardiolipin antibodies became normal. Her clinical course seemed to be different from that of the optic neuritis of multiple sclerosis, in which many of patients recover near normal visual acuity after a first attack. We suggested that antiphospholipid antibodies might play a role in the etiology of her optic neuritis.   Antiphospholipid Antibody Syndrome   The most common ocular pathology is thrombosis with resultant ischemia. This manifests as central retinal vein or artery occlusion (CRVO or CRAO), anterior ischemic optic neuropathy (AION), transient ischemic attack (TIA), amaurosis fugax, isolated retinal hemorrhages and cotton wool spots, and retinal neovascularization. While these conditions typically occur in the elderly, APAS patients may experience them earlier in life. Besides the ocular manifestations, thrombi often affect other systems. Venous thromboses of the arm and leg, sagital, pelvic, mesenteric, portal and axillary vessels, and pulmonary embolism have all been encountered in APAS. With thrombosis in the arterial system, cerebrovascular accidents have also occurred. Thrombocytopenia (reduced platelet count) may also occur in these patients.   Bilateral retinal vascular occlusion during antiphospholipid antibody syndrome: a case report   J Fr Ophtalmol. 2005 May;28(5):503-7 DISCUSSION AND CONCLUSION: Central retinal artery or vein occlusion in a young patient must suggest the diagnosis of antiphospholipid antibody syndrome. The bilateralism of vascular occlusion is considered a severe factor because of its consequence on functional ocular and vital prognosis, where it can sound the alarm to the extension of thrombotic events to other vessels in the body. Antiphospholipid syndrome must be studied in cases of severe retinal vascular occlusion in young patients. Its diagnosis is important because the risk of recurrent thrombotic events may endanger functional and vital prognosis.   Central retinal venous occlusion with co-existent thrombotic thrombocytopenic purpura and antiphospholipid syndrome   British Journal of Ophthalmology 2003;87:658-659 © 2003 BMJ Publishing Group   Handbook of Ocular Disease Management Antiphospholipid Syndrome   Patients with antiphospholipid antibody syndrome (APAS) tend to be under age 50 and female. Up to 2% of women may have antiphospholipid antibodies. Many will also have lupus or other autoimmune diseases.   Ocular symptoms in association with antiphospholipid antibodies.   Graefes Arch Clin Exp Ophthalmol. 1998 Sep;236(9):658-68 CONCLUSIONS: We did not find a clear correlation between APA activity or the immunoglobulin classes in the individual and the severity of the ocular disease. The benefit from a therapy with the antiplatelet agent acetylsalicylic acid was evident in a reduction of the patients' transient visual disturbances and, in most cases, no further progression of permanent visual field defects was observed.   Ophthalmic signs in antiphospholipid syndrome. Patient description   Klin Oczna. 2004;106(4-5):661-3 CONCLUSIONS: presented characteristic general and ophthalmic signs point to APS.   Primary antiphospholipid antibody syndrome and retinal occlusive vasculopathy.   Am J Ophthalmol. 1997 Jun;123(6):848-50 CONCLUSIONS: In retinal vascular occlusions of unexplained origin, antiphospholipid antibodies may play an important role in the pathogenesis. Detecting these antibodies in the serum of patients with retinal vascular occlusion helps determine the appropriate treatment with long-term oral anticoagulants.   Retinal vein occlusion in two patients with primary antiphospholipid syndrome.   Korean J Intern Med. 2001 Dec;16(4):274-6   Review of severe vaso-occlusive retinopathy in systemic lupus erythematosus and the antiphospholipid syndrome: associations, visual outcomes, complications and treatment.   Clin Experiment Ophthalmol. 2004 Feb;32(1):87-100 Conclusion: Severe vaso-occlusive retinopathy is a rare form of retinopathy in SLE often associated with poor visual prognosis and neovascularization. It may be a manifestation of the antiphospholipid syndrome. Treatment is aimed at preventing further thrombosis and complications arising from neovascularization.   Sudden painless unilateral vision loss caused by branch retinal artery occlusion: implications for the primary care physician.   Am J Med Sci. 2004 Jan;327(1):44-6   Visual disturbances and pathologic ocular findings in primary antiphospholipid syndrome.   Ophthalmology. 1999 Aug;106(8):1537-40 CONCLUSIONS: Ocular involvement in PAS is uncommon. Transient visual disturbances are common, although most of them are related to central nervous system rather than ocular ischemia. Pathologic ophthalmic findings are unlikely to be found in asymptomatic patients or in patients with transient visual disturbances. Routine retinal fluoroangiography performed on patients with PAS is unproductive.   Top of Page APS - Other   A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome   Rheumatology 2002; 41: 924-929 © 2002 British Society for Rheumatology. Conclusion. While traditional risk factors were similar between groups, pregnancy and surgical procedures increased the risk of thrombosis. Hypertension and smoking were associated with arterial events. Possessing a combination of risk factors may increase the occurrence of arterial thrombosis but not venous thrombosis. Use of aspirin and/or hydroxychloroquine may be protective against thrombosis in asymptomatic aPL-positive individuals.   Abdominal Thrombotic and Ischemic Manifestations of the Antiphospholipid Antibody Syndrome: CT Findings in 42 Patients1   Radiology. 2001;218:768-771. CONCLUSION: Patients who have circulating antiphospholipid antibodies are at risk for major abdominal vascular thromboses and organ infarction. Radiologists must be familiar with this syndrome; they may be the first physicians to suggest the diagnosis on the basis of findings of unusual or recurrent sites of thrombosis, especially in young patients.   Adrenal failure followed by status epilepticus and hemolytic anemia in primary antiphospholipid syndrome   Thrombosis Journal 2005, 3:6. doi:10.1186/1477-9560-3-6. Published: 18 April 2005. Conclusion: Adrenal failure is a rare complication of APS in children with only five cases reported to date. As shown in our patient, this syndrome can manifest in a diverse set of simultaneously occurring symptoms.   An unusual cause of acute abdominal pain – A case presentation   BMC Blood Disorders 2006, 6:1 doi:10.1186/1471-2326-6-1. Conclusion: This case presented to us as an acute abdominal pain. Subsequent investigations revealed the presence of splenic infarction. Coagulation risk factors for thrombosis proved negative. Haematological investigations revealed the presence of anticardiolipin antibodies at the first instance but subsequent determinations were negative. Hence, it mimicked Hughes syndrome initially but the criteria for temporal persistence of anticardiolipin antibody was not fulfilled. Unusual surgical presentation of a thrombotic abnormality as abdominal pain due to splenic infarction.   Anti-phospholipid reactivity against cardiolipin metabolites occurring during endothelial cell apoptosis   Arthritis Research & Therapy 2006, 8:R180 doi:10.1186/ar2091. We have recently shown that cardiolipin (CL) and its metabolites move from mitochondria to other cellular membranes during death receptor-mediated apoptosis. In this study we investigate the immunoreactivity to CL derivatives occurring during endothelial apoptosis in patients with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). We compared the serum immunoreactivity to CL to that of its derivatives monolysocardiolipin (MCL), dilysocardiolipin (DCL), and hydrocardiolipin (HCL), by means of both enzyme-linked immunosorbent assay and thin layer chromatography (TLC) immunostaining. In addition, we investigated the composition of phospholipid extracts from the plasma membrane of apoptotic endothelial cells and the binding of patients' sera to the surface of the same cells by using high performance TLC and immunofluorescence analysis. The average reactivity to MCL was comparable to that of CL and significantly higher than that for DCL and HCL in patients studied, both in the presence or in the absence of beta2-Glycoprotein I. Of relevance for the pathogenic role of these autoantibodies, IgG from patients' sera showed an increased focal reactivity with the plasma membrane of endothelial cells undergoing apoptosis. Interestingly, the phospholipid analysis of these light membrane fractions showed an accumulation of both CL and MCL. Our results demonstrated that a critical number of acyl chains in CL derivatives is important for the binding of anti-phospholipid antibodies and that MCL is an antigenic target with immunoreactivity comparable to CL in APS and SLE. Our finding also suggests a link between apoptotic perturbation of CL metabolism and the production of these antibodies.   Antiphospholipid antibodies in patients with sensorineural hearing loss.   Eur Arch Otorhinolaryngol. 2005 Aug;262(8):622-6. Sensorineural hearing loss can be associated with autoimmune diseases and the presence of antiphospholipid antibodies. Sixty patients (mean age 47 years, range 18-76 years) with sudden sensorineural hearing loss were studied with audiograms, stapedial thresholds, otoacoustic emissions, positional and caloric testing. The serologic testing included antibodies against phosphatidylserine and beta(2)-glycoprotein. Additionally, a group of 34 patients (mean age 65 years, range 31-81 years) with normal tension glaucoma was examined because in a previous study these patients were reported to have elevated concentrations of antiphospholipid antibodies with a coincidence of progressive sensorineural hearing loss. The baseline for antiphospholipid antibody levels was established in a control group of 40 healthy blood donors. In 12 of the 60 patients with sudden sensorineural hearing loss, levels of antiphospholipid antibodies were elevated. Antiphosphatidylserine IgM antibodies were significantly lower compared to controls and patients with the combination of hearing loss and normal tension glaucoma (Fisher's exact two-sided test, P < 0.01). Our data suggest that antibodies against beta2-glycoprotein seem to coincidence with an acute event, such as sudden sensorineural hearing loss, whereas antibodies against phosphatidylserine IgG are detectable in the prolonged sequel, such as in patients with progressive sensorineural hearing loss and normal tension glaucoma.   Antiphospholipid antibody in localised scleroderma   Annals of the Rheumatic Diseases 2003;62:771-774. Conclusions: These results suggest that aCL and LAC are the major autoantibodies in patients with generalised morphoea.   Antiphospholipid antibody syndrome complicated by Grave's disease.   J Dermatol. 2002 Dec;29(12):776-80. The report describes a woman with primary antiphospholipid antibody syndrome complicated with Grave's disease. Developing symptoms included a small cutaneous nodule on her finger and subsequently ecchymotic purpura on the cheeks, ears, buttocks and lower legs. Histological examinations showed thrombosed vessels in the dermis without or with hemorrhage, respectively. Laboratory investigation revealed positive lupus anticoagulant and immunogenic hyperthyroidism due to Grave's disease. There is a close relationship between the cutaneous manifestation of antiphospholipid antibody syndrome and the activities of Grave's disease and a possible link of antiphospholipid antibody syndrome with Grave's disease was suggested both by the etiology of the disease as well as the disease activity.   Antiphospholipid antibody syndrome in a six-year-old female patient.   Am J Ophthalmol. 2003 Apr;135(4):542-4 CONCLUSIONS: Although uncommon, retinovascular thrombosis in children can occur in APA syndrome. Testing for ACA and lupus anticoagulant should be considered.   Antiphospholipid Antibody Syndrome Ulcers   © 1996-2005, American College of Physicians. All rights reserved.   Antiphospholipid antibody syndromes and the Internet.   Lupus. 1996 Oct;5(5):418-24. Information regarding the antiphospholipid antibody syndrome is accessible on the Internet, and encompasses both physician specific and patient specific files. The quantity and quality of data available at these sites, however, varies greatly and both search-refining and data manipulating protocols and software need improvement.   Antiphospholipid inner ear syndrome.   Laryngoscope. 2005 May;115(5):879-83. CONCLUSIONS: These data support the hypothesis that antiphospholipid antibodies are involved in the pathogenesis of some forms of inner ear dysfunction, presumably by causing microthrombus formation in the labyrinthine vasculature. Basic science studies are required to better understand the mechanisms by which antiphospholipid antibodies mediate inner ear dysfunction. Clinical studies to evaluate the efficacy of anticoagulation in this group of patients are also required.   Antiphospholipid Syndrome Has Many Faces   04/18/2002 By Anne MacLennan Review of Arthritis & Rheumatism Volume 46, Issue 4, 2002. Pages: 1019-1027.   Asymptomatic sensorineural hearing loss in patients with systemic lupus erythematosus.   J Clin Rheumatol. 2006 Oct;12(5):217-20. CONCLUSION: If it can be established how often this ASNHL progresses to a clinical problem, it can be important that, as part of initial studies, patients with SLE undergo audiometric tests.   Colonic ulcers in propylthiouracil induced vasculitis with secondary antiphospholipid syndrome   Postgraduate Medical Journal 2005;81:338-340. A 48 year old white woman was admitted to the hospital because of several bouts of migratory polyarthritis, weight loss, fever, and abdominal pain over a period of 15 months. She had been taking propylthiouracil 100 mg daily for three years for hyperthyroidism treatment. A test for antineutrophil cytoplasmic autoantibodies (ANCA) was positive with a perinuclear pattern of staining. Antiphospholipid antibodies were also detected. Colonoscopy showed several ulcers on intestinal mucosa and the biopsy specimen showed intense microscopic vasculitis. The patient is well after methylprednisolone pulse therapy and eight months of oral azathioprine. A surveillance colonoscopy showed complete healing of intestinal ulcers. No recurrence of symptoms has occurred and autoantibodies are negative, 10 months after treatment finished. The sequence of events suggests a propylthiouracil induced vasculitis p-ANCA positive and an antiphospholipid syndrome. This is the first report of colonic ulcers diagnosed and successfully treated in such circumstances.   Endocrinologic manifestations of the antiphospholipid syndrome.   Lupus. 2006;15(8):485-9. Clinicians should keep a high index of suspicion for adrenal insufficiency in patients with APS.   Genomics and targeting antithrombotic therapy in antiphospholipid syndrome   Blood, 15 February 2006, Vol. 107, No. 4, pp. 1249.   HCV and HIV may trigger antiphospholipid syndrome   Last Updated: 2004-04-16 12:25:03 -0400 (Reuters Health)   Infectious origin of the antiphospholipid syndrome   Annals of the Rheumatic Diseases 2006;65:2-6; doi:10.1136/ard.2005.045443   Ischemic Colitis due to Antiphospholipid Antibody Syndrome   Comments: This 69 year old lady presented to the hospital with sudden onset of left lower quadrant pain and bloody diarrhea. She described having experienced similar episodes over the past 25 years occurring every several years but recently with increasing frequency. The episodes have typically lasted several days before resolving without sequella. A CT scan on this admission showed marked wall thickening of the distal transverse colon, the splenic flexure, and the descending colon. Inflammatory changes were seen in the surrounding pericolic fat. The wall thickening had a somewhat nonspecific appearance, although increased mucosal and serosal enhancement raised the possibility of ischemia. On the basis of this study, the differential diagnosis included either an infectious or an inflammatory process. Colonoscopy was then performed. The right and transverse colon was normal but the splenic flexure down to the sigmoid was diffusely abnormal with marked ulceration and mucosal edema. The broad segments of ulceration favored the diagnosis of an ischemic etiology and the prior history of periodic occurrence of these events made an infectious etiology less likely. Biopsies were performed and these showed focal ulceration with acute inflammatory exudates adjacent to intact mucosa. Other areas show crypt dropout, with regeneration seen in the remaining crypts and fibrin deposition in the lamina propria. These features were most suggestive of ischemic colitis. Cultures for C. diff and other pathogens were negative. At four week follow-up, complete healing was demonstrated in the affected areas. Colonic ischemia most frequently involves the splenic flexure and the left colon and can mimic inflammatory bowel disease or malignancy. While full thickness injury and acute perforation can occur, the mucosal changes usually resolve within 2 weeks. Stricture formation is rare. Usually no cause for the event can be determined. E coli O157 is a pathogen frequently associated with colonic ischemia. During her workup she was found to have an ANA positive at 1:2560 in a homogeneous and speckled pattern and a positive antiphospholipid antibody titer on two consecutive studies, thus establishing the diagnosis of antiphospholipid antibody syndrome as the cause of her recurrent ischemic events. Antiphospholipid antibody syndrome is caused by a class of antibodies which includes lupus anticoagulant and anti cardiolipin antibodies and appear to be directed against a spectrum of plasma proteins bound to phospholipids involved in the clotting cascade. Anti-phospholipid antibody syndrome more commonly is associated with pregnancy loss, recurrent CVAs, thrombophlebitis, pulmonary emboli and deep venous thrombosis. Prospective studies report rates of recurrent thromboembolic events in the range of 7-10% per patient per year. Anticoagulation therapy with warfarin reduces the rate of recurrent thrombotic events. Contributed by: Alexandra Gutierrez, M.D. G.I. Fellow Massachusetts General Hospital   Management of antiphospholipid antibody syndrome: a systematic review.   JAMA. 2006 Mar 1;295(9):1050-7. CONCLUSIONS: In patients with APS, moderate-intensity warfarin is effective for preventing recurrent venous thrombosis and perhaps also arterial thrombosis. Aspirin appears to be as effective as moderate-intensity warfarin for preventing recurrent stroke in patients with prior stroke and a single positive test result for antiphospholipid antibody. The optimal treatment of other thrombotic aspects of APS needs to be addressed in well-designed prospective studies.   Neuroendocrine manifestations of phospholipid antibody disease identified by long-term follow-up study of patients with phospholipid antibodies.   Ann N Y Acad Sci. 2006 Jun;1069:386-90. In conclusion: (1) Inflammatory disease may develop in some patients with aPL and appears to be set off by pregnancy, a known trigger for clinical thrombotic events in aPL patients. (2) Thyroid cancer may be associated with aPL, and this association warrants further study with larger number of patients.   Nonthrombotic Manifestations of the Antiphospholipid Syndrome: Away from Thrombosis?   © 2006. The Journal of Rheumatology Publishing Company Limited.   Perioperative medical management of antiphospholipid syndrome: hospital for special surgery experience, review of literature, and recommendations.   J Rheumatol. 2002 Apr;29(4):843-9. Patients with antiphospholipid syndrome (APS), who are predisposed to vascular thrombotic events, are at additional risk for thrombosis when they undergo surgery. Serious perioperative complications (recurrent thrombosis, catastrophic exacerbation, or bleeding) occur despite prophylaxis. We describe our perioperative experience with APS patients who underwent a variety of surgeries, review the literature, and discuss strategies that may guide other physicians in their perioperative evaluation and management of patients with APS. Recommendations: perioperative strategies should be clearly identified before surgical procedure; pharmacological and physical antithrombosis interventions vigorously employed; periods without anticoagulation kept to a minimum; and any deviation from a normal course should be considered a potential disease related event.   Photocopy Machines and Occupational Antiphospholipid Syndrome   IMAJ 2008;10:52–54. Two patients who worked for several years in the operation and maintenance of photocopy machines developed an autoimmune disease. In both, early manifestations were thromboembolic phenomena associated with anticardiolipin antibodies. Joint and kidney involvement emerged later, with the appearance of other autoantibodies. These two patients were occupationally exposed to ultraviolet irradiation, ozone emission, and possibly some oxides of heavy metals. To our knowledge this is the first report of occupational autoimmune disease in photocopy machine workers, and the first description of antiphospholipid syndrome as an occupational disease. The possible cause-effect inter-relationship between their occupational exposure and autoimmune disease is discussed.   Spectrum of vascular pathology affecting patients with the antiphospholipid syndrome.   Hum Pathol. 1995 Jul;26(7):716-24. A thrombotic microangiopathy that is identified in patients with the antiphospholipid syndrome (APS) represents only a part of the vascular pathology that can be associated with antiphospholipid antibodies (aPL). Tissues from two autopsies, four renal biopsies, two skin biopsies, and one amputated leg were obtained from six patients who met criteria for the diagnosis of APS. Three patients had systemic lupus erythematosus (SLE), one had lupus-like disease, and two had a primary APS. Five of the patients were hypertensive. Arteries of three patients disclosed fibrin thrombi along with widespread obstruction by recanalized intimal connective tissue. Small renal, leptomeningeal, and pulmonary arteries showed concentric cellular and fibrous intimal hyperplasia indistinguishable from hypertensive vascular disease. Glomerular capillary and afferent arteriolar thrombi were found in renal biopsies from two SLE patients. One of these SLE patients required a leg amputation in which the popliteal artery demonstrated thrombosis, intimal hyperplasia, and acute inflammation. The findings support clinical and experimental data that indicate aPLs cause thrombosis but suggest diversity in the pathogenetic mechanisms aPLs are capable of promoting. Inflammation seems to be rare and to accompany thrombosis. Intimal hyperplasia is particularly common. Its involvement of renal arteries may contribute to hypertension that develops in some APS patients.   Spontaneous recovery of sudden sensorineural hearing loss: possible association with autoimmune disorders.   J Am Acad Audiol. 2006 Jul-Aug;17(7):498-505.   Superior mesenteric artery thrombosis associated with antiphospholipid syndrome.   West J Med. 1991 August; 155(2): 174–176.   The Antiphospholipid Story   © 2003. The Journal of Rheumatology Publishing Company Limited.   The systemic nature of the antiphospholipid syndrome.   Scand J Rheumatol. 2004;33(6):365-72. Antiphospholipid syndrome (APS, Hughes' syndrome) is a systemic autoimmune disorder characterized by arterial and/or venous thrombosis and recurrent foetal loss, accompanied by mild to moderate thrombocytopaenia and elevated titres of antiphospholipid antibodies (aPLs): lupus anticoagulant (LAC) and/or anticardiolipin (aCL) antibodies. APS was defined originally in 1983 in systemic lupus erythematosus (SLE) patients, but later it was found that APS can be primary or secondary to other autoimmune diseases or malignancy. During the past 20 years many organs have been reported to be involved in this syndrome and the clinical manifestations are seen in every medical field. Moreover, many aPLs have been found in APS besides aCLs and LACs, which bind to the autoantigen beta-2-glycoprotein I (beta2GPI). Treatment for APS, based on antiplatelet and anticoagulation drugs, is dependent on various parameters, including whether SLE is also present, classical vs non-classical manifestations of the diseases, women with APS based on pregnancy morbidity, the presence of elevated aCL antibody titres in the absence of clinical manifestations, and catastrophic APS.   Urologic damage of the primary antiphospholipid syndrome   Arch Esp Urol. 2004 Sep;57(7):707-23. The antiphospholipid syndrome is an acquired autoimmune systemic disease generating a permanent hypercoagulability status with recurrent multiorgan thrombotic events due to circulating antiphospholipid antibodies. It may be secondary to a heterogeneous group of diseases (mainly lupus) and drugs, or primary if it appears isolated without any demonstrable systemic disease or concomitant medication. It is mainly characterized by venous or arterial recurrent thrombosis, recurrent abortion, thrombocytopenia, and circulating antiphospholipid auto-antibodies. Treatment with anticoagulants and correction of the hypercoagulable status contributing factors, arterial or venous thrombosis, and vascular risk aim to avoid new thrombosis episodes. Genitourynary system may be affected in any of its parts, generally by arterial or venous thrombosis. Kidney is the most frequently affected organ, in addition to transplanted kidney grafts, adrenal glands, bladder and testicles. There is a relationship between antiphospholipid syndrome and infertility. For the first time, we describe bladder involvement presenting as hyperreflexic neurogenic bladder with detrusor-sphincter dyssynergia after spontaneous spinal cord thrombosis in an asymptomatic adolescent with primary antiphospholipid syndrome which was unknown before.   Top of Page APS - Pregnancy   A Multicenter, Placebo-Controlled Pilot Study of Intravenous Immune Globulin Treatment of Antiphospholipid Syndrome During Pregnancy   The American Journal of Obstetrics and Gynecology 01/01/2000 (Volume 182, Number 1)   A study of sixty pregnancies in patients with the antiphospholipid syndrome.   Clin Exp Rheumatol. 1996 Mar-Apr;14(2):131-6.   Antiphospholipid antibodies and pregnancy loss     Antiphospholipid antibodies and pregnancy rates and outcome in in vitro fertilization patients   Authors: A. Denis, M. Guido, R. Adler, P. Bergh, C. Brenner, R. Scott, Jr. Source: Fertility and Sterility: June, 1997 (Vol. 67) Pages 1084-1090.   Antiphospholipid Antibodies in Predicting Adverse Pregnancy Outcome   Annals of Internal Medicine. 15 March 1994 | Volume 120 Issue 6 | Pages 470-475   Antiphospholipid Antibody Syndrome   by Sara Marder, M.D. Instructor and Fellow in Maternal and Fetal Medicine Department of Obstetrics and Gynecology Yale University School of Medicine   Antiphospholipid Antibody Syndrome (APS) or Hughes and Pregnancy   7/28/2003   Antiphospholipid Antibody Syndrome and Pregnancy Article by Stella Nowicki, DDS   Background: Antiphospholipid syndrome (APS) is a recently recognized autoimmune condition that may manifest with fetal loss, thrombosis, or autoimmune thrombocytopenia. Women with these clinical features should be tested for lupus anticoagulant (LAC) and anticardiolipin (aCL) antibodies; most patients with APS have both LAC and aCL immunoglobulin G (IgG) antibodies. The diagnosis of APS requires the presence of both clinical and biological features. Systemic lupus erythematosus (SLE) is a chronic systemic disease with diverse clinical and laboratory manifestations. LAC (and aCL) predisposes to clotting in vivo, predominantly by interfering with the antithrombotic role of phospholipids (PLs); therefore, it is associated with clinical thrombosis, not bleeding. The antiphospholipid (aPL) autoantibodies bind moieties on negatively charged PLs or moieties formed by the interaction of negatively charged PLs with other lipids, PLs, or proteins. aPL antibodies belong to the large family of antibodies that react with negatively charged PLs, including cardiolipin, phosphatidylglycerol, phosphatidylinositol, phosphatidylserine, phosphatidylcholine, and phosphatidic acid. Last Updated: September 4, 2005   Antiphospholipid Syndrome (aPL)   Because of the higher risks for stroke, pregnancy loss, and other complications with aPL, mothers need close monitoring of the disease. More frequent prenatal visits are often needed.   Antiphospholipid Syndrome (aPL)   Antiphospholipid syndrome is an autoimmune disease in which the body produces large amounts of antiphospholipid antibodies. Phospholipids are a special type of fat containing phosphate that makes up the outer walls of the body's cells. Antiphospholipid antibodies attack the phospholipids. This causes many different problems including increased blood clotting. Cardiolipin is one type of phospholipid and specific anticardiolipin antibodies may develop.   Antiphospholipid syndrome and pregnancy   Akush Ginekol (Sofiia). 2004;43(1):36-42. The antiphospholipid antibody syndrome (APLS) is multisystem, autoimmune disease, which is characterized by: thrombosis, obstetrics complications and thrombocytopenia. The two most clinically significant antiphospholipid antibodies (APLa) that are associated with recurrent pregnancy loss and thrombosis are anticardiolipin antibodies (ACL) and lupus anticoagulant (LA). The laboratory diagnosis is based on the presence of moderate to high positive ACL and/or LA. The inhibitory effect of antiphospholipid antibodies /APLa/ on trophoblast intercellular fusion, hormone production and invasion may cause pregnancy loss. Once placentation is established their thrombogenic action leads to decreased placental perfusion and subsequent infarction. The APLa--mediated inhibition of trophoblastic invasion and APLa--mediated vasculopathy in the placental bed arteries result in abnormal uterine artery /UA/ Doppler waveforms. The association between APLa and high resistance index /RI/ and/or diastolic notch /DN/ in the Doppler waveforms is high predictive for adverse pregnancy outcome, including pre-eclampsia/eclampsia, intrauterine growth retardation, placental abruption, intrauterine fetal death. Maternal treatment and careful monitoring of fetal well-being are mandatory in the management of these high-risk pregnancies.   Antiphospholipid Syndrome in Pregnancy: A Randomized, Controlled Trial of Treatment   Obstetrics & Gynecology 2002;100:408-413 © 2002 by The American College of Obstetricians and Gynecologists   Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment.   Obstet Gynecol 2002; 100:408-13.   Clearance of Antiphospholipid Antibodies in Pregnancies Treated With Heparin   Obstetrics & Gynecology 2001;97:394-398 © 2001 by The American College of Obstetricians and Gynecologists   Management of thrombosis in antiphospholipid syndrome and systemic lupus erythematosus in pregnancy.   Ann N Y Acad Sci. 2005 Jun;1051:606-12. Pregnancy is a high risk period for thrombosis in women with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) with antiphospholipid antibodies (aPL). Thrombosis may affect the mother, both in the venous and arterial beds, and also have a role in pregnancy loss. Thromboprophylaxis thus is warranted in most of these women. However, specific regimens containing low-dose aspirin, unfractionated heparin (UH), low molecular weight heparin (LMWH), and even dicumarinics in some circumstances after the first trimester are still a matter of controversy. Women with previous thrombosis should receive full antithrombotic doses of UH or LMWH during the whole pregnancy. Treatment of pregnancy losses is more debated, consisting of low-dose aspirin with or without associated heparin. The choice of treatment for a given patient must always take into account the woman's opinion after a careful discussion with the treating physician. Peripartum thromboprophylaxis with LMWH in women receiving aspirin-only regimens and prevention of osteoporosis in those treated with heparin are considered essential in the medical management of these patients.   Obstetric Implications of Antiphospholipid Antibodies: Pregnancy Loss and Other Complications   Clinical Obstetrics and Gynecology: Volume 44(1) March 2001 pp 2-10   Pregnancy Loss in the Antiphospholipid-Antibody Syndrome — A Possible Thrombogenic Mechanism   N Engl J Med 1997;337 (154-160)   TNF- Is a Critical Effector and a Target for Therapy in Antiphospholipid Antibody-Induced Pregnancy Loss   The Journal of Immunology, 2005, 174: 485-490. The antiphospholipid syndrome (APS) is characterized by recurrent fetal loss, intrauterine growth restriction, and vascular thrombosis in the presence of antiphospholipid (aPL) Abs. Our studies in a murine model of APS induced by passive transfer of human aPL Abs have shown that activation of complement and recruitment of neutrophils into decidua are required for fetal loss, and emphasize the importance of inflammation in aPL Ab-induced pregnancy loss. In this study, we examine the role of TNF- in pregnancy complications associated with aPL Abs in a murine model of APS. We show that aPL Abs are specifically targeted to decidual tissue and cause a rapid increase in decidual and systemic TNF- levels. We identify the release of TNF- as a critical intermediate that acts downstream of C5 activation, based on the fetal protective effects of TNF- deficiency and TNF blockade and on the absence of increased TNF- levels in C5-deficient mice treated with aPL Abs. Our results suggest that TNF- links pathogenic aPL Abs to fetal damage and identify TNF blockade as a potential therapy for the pregnancy complications of APS.   Use of the Low-Molecular-Weight Heparin Nadroparin During Pregnancy: A Review   from Current Medical Research and Opinion Posted 04/02/2003. Summary: Antithrombotic therapy is often used during pregnancy for the treatment and prevention of venous thromboembolism, the prevention of systemic embolism in patients with heart valve prostheses and the prevention of foetal loss in patients with antiphospholipid syndrome. Low-molecular-weight heparins (LMWHs), including nadroparin, have largely replaced unfractionated heparin as the anticoagulant of choice. The use of the LMWH nadroparin in pregnant women at an increased risk of thromboembolism or foetal loss is discussed in this review. Deep vein thrombosis can be effectively treated or prevented with nadroparin without any serious adverse events. Nadroparin 0.1 ml/10 kg sc once daily prevents thromboembolic complications in pregnant women with heart valve prostheses. Nadroparin is also effective in preventing foetal loss, through contributing to normal placental development and in decreasing the risk of premature delivery in pregnant women with antiphospholipid syndrome or women with herpes and antiphospholipid syndrome. These results demonstrate nadroparin is effective, easy to administer and associated with a low incidence of foetal and maternal complications. The use of nadroparin at a prophylactic dose of 0.3 ml (2850 IU AXa, 95 IU/kg) (for high-risk patients, 0.3-0.6 ml) sc once daily, and a therapeutic dose of 0.1 ml/10 kg (95 IU/kg) sc twice daily, is in line with the latest international guidelines of the American College of Chest Physicians.   Top of Page APS - Seronegative APS - SNAPS   *SERONEGATIVE ANTIPHOSPHOLIPID ANTIBODY SYNDROME (SNAPS)…AND SNAPPING TO IT!!   By: Gale McCarty, MD, FACR, FACP “You don’t have the syndrome because your tests are low level or negative…” or “You have livedo, a heart valve problem, and thrombocytopenia, but these aren’t listed as criteria for diagnosis” are comments made frequently by healthcare providers from many specialties to patients with clinical features suggesting the Antiphospholipid Antibody Syndrome (APS).   Antiphospholipid syndrome without antiphospholipid antibodies at the time of the thrombotic event: transient 'seronegative' antiphospholipid syndrome?   Clin Exp Rheumatol. 1997 Sep-Oct;15(5):541-4. The antiphospholipid syndrome (APS) is characterized by the presence of venous and arterial thrombosis, recurrent fetal losses and thrombocytopenia, associated with the presence of antiphospholipid antibodies (aPL). This syndrome may be "primary" or may be associated with other diseases, mainly systemic lupus erythematosus (SLE). However, some patients present the clinical picture of this syndrome but without evidence of aPL in their serum. The term "seronegative" APS has been proposed to categorize these patients. Here with we present two patients with seronegativity for aPL at the time of a thrombotic event, but in whom these antibodies were detected 2 and 7 months later.   Pyoderma gangrenosum associated with the secondary antiphospholipid syndrome     Seronegative antiphospholipid syndrome   Annals of the Rheumatic Diseases 2004;63:608 © 2004 by BMJ Publishing Group Ltd & European League Against Rheumatism   Seronegative antiphospholipid syndrome   Annals of the Rheumatic Diseases 2003;62:1127 © 2003 by BMJ Publishing Group Ltd & European League Against Rheumatism   Seronegative antiphospholipid syndrome associated with plasminogen activator inhibitor.   Lupus. 1994 Jun;3(3):201-3.   Top of Page APS Support Groups & Chat   *APS Friends & Support Forum   A forum run by Heidi & Tina founders of the APS Foundation of America, Inc., a non profit organization. This forum is an information source and a friendly support group for people who have Antiphospholipid Antibody Syndrome or for anyone who's lives are touched by it. It is sometimes referred to as APS, APLS, or APLA and is known as Hughes Syndrome or "Sticky Blood" in the UK. APS is associated with recurrent clotting events including premature stroke, repeated miscarriages, phlebitis, venous thrombosis and pulmonary thromboembolism. If this disease touches your life in some way, please feel free to join in our discussions! :) We're glad to have you visit!   Antiphospholipid Antibody Syndrome   This group is primarily intended for patients, caregivers, and physicians to foster discussions and share experiences related to APS. APLA are antibodies directed against certain phospholipids. Antiphospholipid syndrome is defined as the presence of antiphospholipid antibodies, arterial or venous thrombosis, recurrent spontaneous abortions, and thrombocytopenia. The syndrome can occur within the context of several diseases, mainly autoimmune, or it may be present without any recognizable disease, the so-called primary antiphospholipid syndrome. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   Antiphospholipid Syndrome Online Support Group   A community of patients, family members and friends dedicated to dealing with Antiphospholipid Syndrome, together. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   APLSUK   A group for people who have Hughes Syndrome / Antiphospholipid Syndrome. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   APS Forum on Brain Talk Communities   Small and not so active, but free to join. Has alot of other forums as well. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   APS Message Board at Medicine.net   Another small one, I believe free to join. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   AutoImmunity Community   AutoImmunity Community is a message board dedicated to the courageous people battling any of the over 60 autoimmune diseases, and is especially beneficial for those with multiple conditions. Friends and family are always welcome, as well as those who simply suspect they have an autoimmune disease. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   Blood Clot Survivors DVT/PE/APS   A group of persons who have survived blood clots, strokes, PE's, or who have APS. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   Blood Clots Under 40   Welcome to the Blood Clot group. This is a group for younger people (or the young at heart!) to get support and advice if they are suffering from any form of blood clot, or if you are on Coumadin or Warfarin. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   Clotters Anonymous   For general discussion of issues and health conditions surrounding blood clots, including, but not limited to deep vein thrombosis, pulmonary embolism, genetic clotting disorders and arterial clotting conditions such as atrial fibrillation and stroke. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   eHealth Forum   Make sure you read the rules of this forum! The slightest step across their lines you are banned. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   Lupus Patients Understanding and Support   Support Group and Forum. The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   Pulmonary Embolism   Suffering an episode of DVT or Pulmonary Embolism is a life threatening/changing event. Doctors are vague in sharing information about your prognosis or even your treatment. This group will serve as a place where people can compare their diagnosis and treatments and perhaps help each other in this scary journey!! The APSFA does not endorse nor is affiliated with this group, we are just sharing it with you as a courtesy. The only support group that APSFA is affiliated with is APS Friends & Support Forum. It is worth noting that not all of the information presented comes from healthcare professionals. The APSFA does not have any control over the content of the this website and cannot confirm that all information provided by it is accurate.   Top of Page Autoimmune Diseases - Other   Adults And Primary Immune Deficiency Diseases     All About Multiple Sclerosis   All About Multiple Sclerosis aims to provide accurate and comprehensive medical information about multiple sclerosis (MS) written in plain English by people living with the disease and its symptoms. It contains a detailed description of multiple sclerosis, a large archive of news stories about MS, an MS encyclopedia and a large links section containing hundreds of commented and rated links. It also has a list of famous people with multiple sclerosis and personal accounts, poems and essays by people with MS. The site receives no sponsorship from pharmaceutical or other financially interested companies and maintains absolute editorial independence.   American Autoimmune-Related Diseases Association   The American Autoimmune Related Diseases Association is dedicated to the eradication of autoimmune diseases and the alleviation of suffering and the socioeconomic impact of autoimmunity through fostering and facilitating collaboration in the areas of education, research, and patient services in an effective, ethical and efficient manner.   American Behcets Disease Association   The American Behcet's Foundation was founded by a parent of a child with Behcet's Disease in 1978 in Orange County, California. In 1986, the Organization changed its name to The American Behcet's Association (ABA) and was moved to Rochester, Minnesota. Recently the name was changed to the American Behcet's Disease Association (ABDA) to clarify the nature of the organization. In 1987, the American Behcet's Association was incorporated as a nonprofit organization in the state of Minnesota and in 1989, was granted 501(c)3 tax exempt status by the Internal Revenue Service. In 1988, a medical advisory board was formed of Behcet's experts from around the country.   ANA Staining Pattern     Arthritis as Seen Through the Eyes   About one in four patients with rheumatoid arthritis reports ocular symptoms. Know these signs and symptoms to help you understand the disease and effectively treat these patients. 1/15/2006   Arthritis Help and Advice   © 2004 ArthritisHelper.com. All rights reserved.   Atherosclerosis in Patients With Autoimmune Disorders   Arterioscler Thromb Vasc Biol. 2005 Jun 23   AUTOIMMUNE DISEASE IN WOMEN - THE FACTS   The term "autoimmune disease" refers to a varied group of more than 80 serious, chronic illnesses that involve almost every human organ system. It includes diseases of the nervous, gastrointestinal, and endocrine systems as well as skin and other connective tissues, eyes blood, and blood vessel. In all of these diseases, the underlying problem is similar--the body's immune system becomes misdirected, attacking the very organs it was designed to protect.   Autoimmune Diseases   A PDF File Explaining Autoimmune Testing   Autoimmune Diseases in Asthma   Copyright © 2006 by the American College of Physicians. 20 June 2006 | Volume 144 Issue 12 | Pages 877-883. Conclusions: Asthma status may affect the prevalence of major autoimmune disorders. Preexisting asthma seems to protect against the development of autoimmune disorders to varying degrees in men and women.   Bechet's Disease     Borderline Rheumatic Conditions   Professor J.C.W. Edwards MD FRCP, Professor in Connective Tissue Medicine, University College, London. © 1999.   Cardiac involvement in systemic autoimmune disease   Pol Arch Med Wewn. 2003 Apr;109(4):375-81. Systemic autoimmune diseases form a diverse group which includes: systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), scleroderma, dermato-polymyositis, Wegener's granulomatosis, Sjogren syndrome. Although multisystem involvement is the hallmark of these diseases, the heart seems to be less affected than other organ systems. The aim of the study was to study possible cardiac abnormalities in patients with documented systemic autoimmune diseases and to assess whether there was any relation between antiphospholipid, anti-dsDNA antibodies and myocardial dysfunction findings. 76 patients (53 with SLE, 9 with MCTD, 8 with scleroderma, 6 with Wegener's granulomatosis) were subjected to our study, 69% of these patients manifested cardiac involvement, based on two-dimentional echocardiografic examination (36%--post-inflammatory valvular thickening, 20%--pericardial effusions, 15%--valvular regurgitation, 7%--left atrial enlargement, 5%--left ventricular hypertrophy, 4%--left ventricular dysfunction). None of the patients showed characteristic, acute Libman-Sacks endocarditis, which probably can be explained by chronic corticosteroid-treatment. Clinical evidence of cardiac abnormalities has been observed, in as many as 58% of cases with positive echocardiographic findings. The frequency and extend of cardiac pathology positively correlated with the detection of antiphospholipid antibodies. No such relationship was observed in patients with the presence of very high titers of antinuclear antibodies (anti-dsDNA). In conclusion, our results indicate that echocardiography is a useful method for assessment and monitoring cardiac involvement in the systemic autoimmune diseases.   Cell therapy for autoimmune diseases   Arthritis Research & Therapy 2007, 9:206. Cell therapy, pioneered for the treatment of malignancies in the form of bone marrow transplantation, has subsequently been tested and successfully employed in autoimmune diseases. Autologous haemopoietic stem cell transplantation (HSCT) has become a curative option for conditions with very poor prognosis such as severe forms of scleroderma, multiple sclerosis, and lupus, in which targeted therapies have little or no effect. The refinement of the conditioning regimens has virtually eliminated transplant-related mortality, thus making HSCT a relatively safe choice. Although HSCT remains a nonspecific approach, the knowledge gained in this field has led to the identification of new avenues. In fact, it has become evident that the therapeutic efficacy of HSCT cannot merely be the consequence of a high-dose immuno-suppression, but rather the result of a resetting of the abnormal immune regulation underlying autoimmune conditions. The identification of professional and nonprofessional immunosuppressive cells and their biological properties is generating a huge interest for their clinical exploitation. Regulatory T cells, found abnormal in several autoimmune diseases, have been proposed as central to achieve long-term remissions. Mesenchymal stem cells of bone marrow origin have more recently been shown not only to be able to differentiate into multiple tissues, but also to exert a potent antiproliferative effect that results in the inhibition of immune responses and prolonged survival of haemopoietic stem cells. All of these potential resources clearly need to be investigated at the preclinical level but support a great deal of enthusiasm for cell therapy of autoimmune diseases.   Connective Tissue Diseases: The Big Three   Discusses Lupus, Sjogren's and Antiphospholipid Antibody (Hughes) Syndrome.   Demyelination in rheumatic diseases   Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:290-295; doi:10.1136/jnnp.2005.075861. Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) characterised by multifocal areas of demyelination in the white matter of the brain and spinal cord. Autoantibodies, for example antinuclear antibodies, can also be present. MS and other demyelinating processes, such as transverse myelitis and optic neuritis (which may be clinically isolated cases or be part of the clinical spectrum of MS), are sometimes difficult to differentiate from CNS involvement in systemic autoimmune diseases like systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Sjoegren’s syndrome (SS), and Adamantiades-Behcet disease (BD). An acute isolated neurological syndrome presents the biggest diagnostic problem, since it is common in MS, but can also be the only feature or first manifestation in SLE, APS, SS, and BD. Indeed, the clinical presentation and lesions evidenced by magnetic resonance imaging may be similar.   Dry.Org : Internet Resources for Sjogren's Syndrome     eMedicine - Livedoid Vasculopathy : Article by Noah S Scheinfeld, MD, JD, FAAD   Last Updated: January 18, 2006. Livedoid vasculopathy (LV), or livedoid vasculitis, is a disease characterized by ulceration of the lower extremities. It can evolve into a dermatologic finding termed atrophie blanche (AB). LV is a distinct condition that is not usually the result of other diseases, as Jorizzo elegantly noted in 1998.   Encouraging Results With Rituximab in Relapsing MS   Medscape Medical News 2007. © 2007 Medscape Registration Required   Graves Disease Page     Guillain-Barrè Syndrome Fact Sheet   reproduced from an article by The National Institute of Neurological Disorders and Stroke Reviewed June 6, 2001   Handy Hints on Keeping Warm   Raynaud's is a common condition in which blood is prevented from reaching the extremities of the body, mainly the fingers and toes, on exposure to the cold or any slight change in temperature. A small number of people who have Raynaud's also develop scleroderma, a disease which affects the connective tissue.   Heidi Whitaker Kathy Browning Healthy Divas   If you, or someone you love, has received the diagnosis of Multiple Sclerosis, Lupus, Chronic Fatigue Syndrome, Fibromyalgia, Rheumatoid Arthritis, Scleroderma, Sjogren’s Disease, Goodpasture's Syndrome, Wegener's Granulomatosis, Polymyalgia Rheumatica, Temporal Arteritis / Giant Cell Arteritis, Type I Diabetes Mellitus, Hashimoto’s Thyroditis, Graves’ Disease, Celiac Disease, Crohn’s Disease, Ulcerative Colitis, Guillain-Barre Syndrome, Epstein-Barr Syndrome, Addison’s Disease, Primary Biliary Sclerosis, Primary Bilary Cirrhosis, Sclerosing Cholangitis, Autoimmune Hepatitis, Raynaud’s Phenomenon or any of the other eighty autoimmune disease, this website is for you. And, even though it may look like it, HealthyDivas.com is not just for females. Men need to know this information too!   Husbands and Wives Living With Multiple Sclerosis   Abstract Abstract: Multiple sclerosis (MS) frequently is diagnosed in young adults. Coping with symptoms of MS is challenging not only for the person with the disease, but also for his or her spouse. The well spouse often assumes the caregiving role. The purpose of this qualitative research was to investigate the experiences of persons whose spouses have MS. Twelve people participated in a 2-hour focus group: 8 men and 4 women. The husbands were, on average, 50 years old, and the wives averaged 55 years old. The length of time since diagnosis ranged from 2 to 11 years for the husbands and from 3 to 13 years for the wives. The focus group discussions were audiotaped and transcribed verbatim. Participants talked freely. Four major themes emerged: caregiver roles, need for information, relationship changes, and barriers. Men attempted to protect their wives' energy, intervening for them. Wives encouraged independence in their husbands. Spouses need information about MS, complementary interventions, and support. They want increased public awareness of invisible symptoms and awareness in the workplace of continuing capabilities of persons with MS. Role reversals were challenging for the women who felt that "MS is the third person in a marriage." Spouses need help to maintain appropriate boundaries. Limitations of the study include the small, economically homogeneous sample and the single encounter with the subjects. A longitudinal intervention study is needed. Registration Required.   Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)   Last Updated: February 8, 2006. Leukocytoclastic vasculitis (LCV) is a histopathologic term commonly used to denote a small-vessel vasculitis. Many possible causes exist for this condition, but a cause is not found in as many as 50% of patients. The disorder may be localized to the skin, or it may manifest in other organs. The internal organs most commonly affected are the gastrointestinal tract and the kidneys. Joints are also commonly affected. The prognosis is good when no internal involvement is present. The disorder may be acute or chronic.   International Still's Disease Foundation   The purpose of the International Still's Disease Foundation is to: provide support to those who suffer from Still's Disease, encourage and facilitate communication between Still's Disease sufferers, provide information on Still's Disease to those with the disease, their families, and health care workers and increase general awareness of Still's Disease.   Livedoid Vasculopathy   Last Updated: January 18, 2006 Livedoid vasculopathy (LV), or livedoid vasculitis, is a disease characterized by ulceration of the lower extremities. It can evolve into a dermatologic finding termed atrophie blanche (AB).   MR in neurological syndromes of connective tissue   Signature: Med Sci Monit, 2002; 8(6): MT105-111   Multiple Sclerosis     Multiple Sclerosis Health Center   Multiple sclerosis affects 2.5 million people worldwide, including 400,000 Americans. Get in-depth information here on multiple sclerosis symptoms and treatments. Plus, find daily help in our online support group.   Multiple sclerosis is an autoimmune disease that affects the central nervous system (the brain and spinal cord).   Review Date: 8/6/2007   Myasthenia Gravis   Myasthenia Gravis Association   Myasthenia Gravis   Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The name myasthenia gravis, which is Latin and Greek in origin, literally means "grave muscle weakness." With current therapies, however, most cases of myasthenia gravis are not as "grave" as the name implies. In fact, for the majority of individuals with myasthenia gravis, life expectancy is not lessened by the disorder.   National Jewish Center for Immunology and Respiratory Medicine   This organization publishes booklets for the public and offers an information line staffed by trained nurses. 1-800-222-LUNG   New Study Linking Asbestos To Autoimmunity Is Preliminary, But Promising, Says American Autoimmune Related Diseases Association   More Studies Needed On Possible Environmental Triggers of Autoimmune Disease   NINDS Sjogren's Syndrome Information Page   Sjogren's syndrome is an autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. Sjogren's syndrome is also associated with rheumatic disorders such as rheumatoid arthritis. The hallmark symptoms of the disorder are dry mouth and dry eyes. In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness, and may affect other organs of the body including the kidneys, blood vessels, lungs, liver, pancreas, and brain. Last updated January 25, 2006   No evidence for an association between the -871 T/C promoter polymorphism in the B-cell-activating factor gene and primary Sjögren's syndrome   Arthritis Research & Therapy 2006, 8:R30 doi:10.1186/ar1884 Published 9 January 2006 Polyclonal B cell activation might be related to pathogenic over-expression of B-cell-activating factor (BAFF) in primary Sjögren's syndrome (pSS) and other autoimmune diseases. We therefore investigated whether BAFF over-expression in pSS could be a primary, genetically determined event that leads to the disease. The complete BAFF gene was sequenced in Caucasian pSS patients and control individuals. The only single nucleotide polymorphism frequently observed, namely -871 T/C in the promoter region, was then genotyped in 162 French patients with pSS and 90 French control individuals. No significant differences in allele (T allele frequency: 49.7% in patients with pSS versus 50% in controls; P = 0.94) and genotype frequencies of BAFF polymorphism were detected between pSS patients and control individuals. BAFF gene polymorphism was not associated with a specific pattern of antibody secretion either. T allele carriers had significantly increased BAFF protein serum levels (mean values of 8.6 and 5.7 ng/ml in patients with TT and TC genotypes, respectively, versus 3.3 ng/ml in patients with CC genotype; P = 0.01), although no correlation was observed between BAFF polymorphism and mRNA level. In conclusion, BAFF gene polymorphism is neither involved in genetic predisposition to pSS nor associated with a specific pattern of antibody production.   Ocular manifestations of autoimmune disease   American Family Physician, Sept 15, 2002 by Sayjal J. Patel, Diane C. Lundy Patients with autoimmune diseases are frequently encountered by family physicians. It is important to understand not only the systemic effects of these diseases but also their ocular manifestations. Most ocular complications involve the cornea but may also include the conjunctiva, uvea, sclera, retina, and surrounding structures (Figure 1). The majority of these diseases will ultimately need to be referred to an ophthalmologist.   Ocular Manifestations of Behcet’s Disease   Indian Pediatrics 2005; 42:942-945   Plasmapheresis and Autoimmune Disease   Plasmapheresis is a process in which the fluid part of the blood, called plasma, is removed from blood cells by a device known as a cell separator. The separator works either by spinning the blood at high speed to separate the cells from the fluid or by passing the blood through a membrane with pores so small that only the fluid part of the blood can pass through. The cells are returned to the person undergoing treatment, while the plasma, which contains the antibodies, is discarded and replaced with other fluids. Medication to keep the blood from clotting (an anticoagulant) is given through a vein during the procedure.   Psoriatic Arthritis   © Arthritis Research Campaign 2004. All rights reserved. Published December 2004. Medical advice or information last amended: October 2005. Useful addresses checked/amended: October 2005   Questions and Answers about Raynaud's Phenomenon   The NIAMS gratefully acknowledges the assistance of Paul Plotz, M.D., NIAMS, NIH; Phillip J. Clements, M.D., of the University of California, Los Angeles; Jay D. Coffman, M.D., of the Boston University Medical Center; and Frederick M. Wigley, M.D., of The Johns Hopkins University School of Medicine in the preparation and review of this booklet. NIH Publication No. 01-4911   Radiographic joint damage in rheumatoid arthritis is associated with differences in cartilage turnover and can be predicted by serum biomarkers: an evaluation from 1 to 4 years after diagnosis   Arthritis Research & Therapy 2006, 8:R31 doi:10.1186/ar1882 Published 10 January 2006 This study shows that the concentration of serum biomarkers of cartilage collagen breakdown and proteoglycan turnover, but not of collagen synthesis, are related to joint destruction in RA. The use of these biomarkers may be of value when studying progression of joint damage in patients with RA.   Raynaud Phenomenon   AJN, American Journal of Nursing August 2005 Volume 105 Number 8 Pages 56 - 65   Raynaud Phenomenon Article by Jeffrey R Lisse, MD, FACP   Background: Raynaud phenomenon refers to reversible ischemia of peripheral arterioles. This can be in response to various stimuli but is most commonly caused by exposure to cold or stress. Raynaud phenomenon (secondary Raynaud) should be distinguished from Raynaud disease (primary Raynaud). They are distinct disorders that share a similar name. Raynaud disease is the occurrence of the vasospasm alone, with no association with another illness. Raynaud phenomenon is usually used in the context of vasospasm associated with another illness, most commonly an autoimmune disease. Other terms used for this distinction are primary Raynaud (disease) and secondary Raynaud (phenomenon). Young female patients who have had Raynaud phenomenon alone for more than 2 years and have not developed any additional manifestations are at low risk for developing an autoimmune disease. Most of these patients are considered to have primary Raynaud. These patients do not exhibit capillary nailfold changes. If such changes are noted on nailfold capillaroscopy, other autoimmune diseases should be considered in the differential diagnoses. The same should be said for older and male patients who have Raynaud phenomenon, as vasospastic symptoms may predate systemic disease by as much as 20 years. In some studies, 46-81% of patients have secondary Raynaud. Although Raynaud phenomenon has been described with various autoimmune diseases, the most common association is with progressive systemic sclerosis (scleroderma; 90% prevalence) and mixed connective-tissue disease (85% prevalence). Raynaud phenomenon has also been described with such diverse diseases as systemic lupus erythematosus and other disorders not classified as autoimmune, including frostbite, vibration injury, polyvinyl chloride exposure, and cryoglobulinemia. Last Updated: April 5, 2006   Raynaud's Association     Rheumatoid Arthritis Health Center   Rheumatoid arthritis affects more than 2 million Americans, mostly women. Here you'll find in-depth information on rheumatoid arthritis, its causes, symptoms, treatments, and pain relief methods. Plus, find daily support in our online support group.   Rheumatoid Arthritis: What You Should Know   This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Copyright © 2005 by the American Academy of Family Physicians. Individuals may photocopy this material for their own personal reference, and physicians may photocopy for use with their own patients. Written permission is required for all other uses, including electronic uses.   Scleroderma Foundation - Home Page     Sjögren syndrome and systemic lupus erythematosus are distinct conditions   Dermatology Online Journal 12 (1): 4. Abstract: Sjögren syndrome (SS) and systemic lupus erythematosus (SLE) are both collagen vascular diseases that can be accompanied by Ro antibodies. Clinical evidence suggests that they are wholly distinct diseases. SS is strongly linked to lymphoma while lupus is not. SS patients do not commonly exhibit photosensitivity even though anti-Ro antibodies circulate in their blood; SLE patients generally exhibit photosensitivity. SS does not respond to hydroxychloroquine in a reproducible fashion whereas SLE does. SS has not been linked to parvovirus B19, but SLE has. However, SS and SLE do have similarities. Their autoantibody profiles are similar. They effect women more than men and have similar HLA haplotypes and autoantibodies; this is not likely coincidence but it may not clinically relevant.   Sjögren’s Syndrome   US Pharm. 2007;32(3):72-81. The most important concept to realize when selecting appropriate treatment for a patient with Sjögren's syndrome is that therapy must be adapted to the individual patient's needs and responses. Each patient will present with some similar symptoms but also with a unique set of symptoms and complaints. Pharmacists can have an active role in helping patients manage this syndrome. Providing excellent pharmaceutical care and continuity of care is the first step. Counseling and teaching patients about the syndrome as well as providing tips for improving patients' quality of life can have a dramatic impact.   Sjogren's World     Sneddon Syndrome   This is a rare disorder characterized by livedoid eruption and cerebrovascular defects. There is a distinct association with the Antiphospholipid Antibody syndrome and Lupus erythematosus. Indeed, some investigators believe that this syndrome is a variant of the Antiphophospholipid Antibody Syndrome. Last Updated 12/11/2001   Sneddon's syndrome is a thrombotic vasculopathy: neuropathologic and neuroradiologic evidence   Neurology, Vol 45, Issue 3 557-560, Copyright © 1995 by American Academy of Neurology   Sneddon’s syndrome: additional neurological feature in antiphospholipid (Hughes’) syndrome   Postgraduate Medical Journal 2003;79:550 © 2003 Fellowship of Postgraduate Medicine   The Arthritis Foundation   800-283-7800   The Cold Facts About Seriously Cold Hands   Published/Last Reviewed: August 15, 2005   The Common Thread   Noel R. Rose, M.D., Ph.D., Chair, AARDA National Scientific Advisory Board, Professor of Molecular Microbiology and Immunology and Pathology The Johns Hopkins University The topic that Mrs. Ladd has asked me to discuss with you this afternoon is "Autoimmune Diseases: How Are They Related?" It is a very good topic because it forced me to think about the question.   The Immune System And Primary Immune Deficiency Diseases     The International Scleroderma Network (ISN)   Over 70 volunteers operate the nonprofit International Scleroderma Network (ISN), delivering research, support, education and awareness! Our services include this Scleroderma from A to Z website at www.sclero.org, (with 1200+ pages in 22 languages), the Voices of Scleroderma book series, medical advisory, membership, research fund and support services. YOU can make a difference: Join and support our worldwide initiative to tackle scleroderma now!   The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)   877-22-NIAMS   The Raynaud's Treatment Study (RTS)   Objectives: To evaluate and compare the effectiveness of sustained-release nifedipine, and the effectiveness of temperature biofeedback, for the treatment of patients with Primary Raynaud's Phenomenon.   The Sjögren's Syndrome Foundation About Sjögren's Syndrome FAQs About Sjögren's Syndrome     Thyroid Autoantibodies (TPOAb, TgAb and TRAb)   Thyroid 13(1):45-56, 2003. © 2003 Mary Ann Liebert, Inc. Posted 06/04/2003 Registration Required.   Top 10 Needs of People With Multiple Sclerosis and Their Significant Others   J Neurosci Nurs. 2006;38(5):369-373. ©2006 American Association of Neuroscience Nurses. The purpose of this study was to identify the needs of patients with multiple sclerosis (MS) and their significant others. A quantitative questionnaire, developed from focus groups and consisting of 75 needs statements, was administered to 353 MS patients and 240 significant others. Analysis produced rankings of the 10 most important needs of both groups. Rankings by the MS patients and significant others were similar. Three themes emerged. Psychosocial and other personal needs (relationship with physicians, the MS healthcare team, family, and friends) were ranked with high frequency. Information needs (information regarding MS or available support) and financial security were also ranked as important. The data validate the importance of interdisciplinary care for the MS population. Registration Required   Understanding Autoimmune Diseases   In this report you will learn what an autoimmune disease does in the body. What the underlying causes of autoimmune diseases are and what is important to consider in dealing with it. So that you may have a better understanding of how to get healthy again.   Vasculitis   Also called: Angiitis, Arteritis   Vasculitis   Vasculitis is a general term for a group of uncommon diseases that feature inflammation of the blood vessels. The blood vessels of the body are referred to as the vascular system. The blood vessels are composed of arteries that pass oxygen-rich blood to the tissues of the body and veins that return oxygen-depleted blood from the tissues to the lungs for oxygen. Vasculitis is characterized by inflammation in and damage to the walls of various blood vessels.   Vasculitis and Thrombophlebitis   Last Updated: March 30, 2006. Vasculitis is a descriptive term associated with a heterogeneous group of diseases that results in inflammation of blood vessels. Arteries and veins of any size in any organ may be affected, leading to ischemic damage to organs. The pattern of vessel involvement is highly variable, leading to innumerable clinical presentations. The most common vasculitides of childhood are Henoch-Schönlein purpura and Kawasaki disease. See articles on Kawasaki Disease, Infantile Polyarteritis Nodosa, Polyarteritis Nodosa, and Takayasu Arteritis.   Vasculitis Foundation   The Vasculitis Foundation advocates for early diagnosis, leading edge treatment and ultimately a cure for all types of vasculitis.   What Is Raynaud's Disease?   Raynaud's disease and Raynaud's phenomenon are rare disorders that affect blood vessels. These disorders are marked by brief episodes of vasospasm (narrowing of the blood vessels). Vasospasm causes decreased blood flow to the fingers and toes, and rarely to the nose, ears, nipples, and lips. The fingers are the most commonly affected area, but the toes also are affected in 40 percent of people with Raynaud's. When this disorder occurs without any known cause, it is called Raynaud's disease, or primary Raynaud's. When the condition occurs along with a likely cause, it is known as Raynaud's phenomenon, or secondary Raynaud's. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's. When you have primary or secondary Raynaud's, cold temperatures or stressful emotions can trigger attacks. During these attacks, there is a brief lack of blood flow to the affected body part(s), and the skin can temporarily become white then bluish. As blood flow returns to the area, the skin turns red. The affected areas can throb or feel numb and tingly. With severe Raynaud's, prolonged or repeated episodes can cause sores or tissue death (gangrene). June 2006   What is the evaluation and treatment strategy for Raynaud's phenomenon?   Journal of Family Practice, June, 2005 by Heather Tagliarino, Michael Purdon, Barbara Jamieson   What Is Vasculitis?   Vasculitis is an inflammation of the blood vessels in the body. In vasculitis, the body’s immune system mistakenly attacks the body’s own blood vessels, causing them to become inflamed. Inflammation can damage the blood vessels and lead to a number of serious complications. Vasculitis can affect any of the body’s blood vessels. These include arteries, veins, and capillaries. Arteries are vessels that carry blood from the heart to the body’s organs, veins are the vessels that carry blood back to the heart, and capillaries are the tiny blood vessels that connect the small arteries and veins. August 2006   Top of Page Cardiology & Pulmonology Related Information   American Heart Association     An Approach to Interpreting Spirometry   Am Fam Physician 2004;69:1107-14. Copyright© 2004 American Academy of Family Physicians   AorticDissection.com     B vitamins do not protect hearts   Taking B vitamins to ward off heart attacks and stroke does no good and may even be harmful, say experts. Last Updated: Tuesday, 6 September 2005, 08:32 GMT 09:32 UK   British Heart Foundation     Cardiac Syndrome X   Cardiac syndrome X is a condition where patients have the pain of angina, but they do not have CAD. So even though patients with cardiac syndrome X have symptoms of CAD, the coronary arteries are clear of blockages. Cardiac syndrome X is more common in women, especially women who have gone through menopause. It is not life threatening and does not increase your risk of heart attack or CAD. Updated July 2007   Cardiac syndrome X: a critical overview and future perspectives   Published Online First: 6 January 2006. doi:10.1136/hrt.2005.067330. Heart 2007;93:159-166. ABSTRACT: The classic definition of cardiac syndrome X (CSX) seems inadequate both for clinical and research purposes and should be replaced with one aimed at including a sufficiently homogeneous group of patients with the common plausible pathophysiological mechanism of coronary microvascular dysfunction. More specifically, CSX should be defined as a form of stable effort angina, which, according to careful diagnostic investigation, can reasonably be attributed to abnormalities in the coronary microvascular circulation.   Cardiovascular Diseases in Children   US Pharm. 2007;32(3):52-65. Cardiovascular diseases are becoming increasingly prevalent in children, due at least in part to the rise in childhood obesity. Public awareness is also increasing, and treatment options are improving. Pharmacists have the responsibility of counseling children and their caregivers about pharmacologic and nonpharmacologic therapies and interventions that can improve long-term prognosis. Adherence to complex medication regimens is key to optimal management. In cases of CHDs, for example, pharmacists can provide education about the rationale for drug therapy, and in cases of arrhythmia, they can obtain a thorough medication history to assist in diagnosis or avoidance. More important, pharmacists can stress the possibility of preventing the onset of cardiovascular diseases and encourage lifestyle changes that can help reduce the occurrence of hypertension and obesity.   Chronic Obstructive Pulmonary Disease: Diagnostic Considerations   Am Fam Physician 2006;73:669-76, 677-8. Copyright © 2006 American Academy of Family Physicians.   Chronic Obstructive Pulmonary Disease: What You Should Know   This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://www.familydoctor.org. This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Copyright © 2006 American Academy of Family Physicians.   Coronary Computed Tomography Angiogram (Coronary CTA)   Computed tomography, commonly known as a CT or CAT scan, is a test that uses x-rays and computers to produce cross-sectional images of the body. CT has been used for over 25 years to examine all parts of the body.   High Blood Pressure: What You Should Know   This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://www.familydoctor.org. This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Copyright © 2006 American Academy of Family Physicians.   Keep PAD patients walking   Mar 1, 2006. Geriatrics   Libman-Sacks Endocarditis   Libman-Sacks (verrucous) endocarditis is the most characteristic cardiac manifestation of the autoimmune disease systemic lupus erythematosus (see Systemic Lupus Erythematosus for more information). Libman and Sacks first published a description of these atypical, sterile, verrucous vegetations in 1924. Postmortem studies describe mulberrylike clusters of verrucae on the ventricular surface of the posterior mitral leaflet, often with adherence of the mitral leaflet and chordae to the mural endocardium. The lesions typically consist of accumulations of immune complexes and mononuclear cells. The condition is not always recognized on echocardiographic images. With the introduction of steroid therapy for systemic lupus erythematosus, improved longevity of patients appears to have changed the spectrum of valvular disease. Valvular abnormalities occur as masses (classic Libman-Sacks vegetations; see Image 1), diffuse leaflet thickening, valvular regurgitation, and, infrequently, stenosis. Valvular regurgitation is noted most commonly in patients with leaflet thickening, which is thought to represent the chronic healed phase of disease. The left-sided valves are involved most often. Lesions similar to those described by Libman and Sacks also occur in association with primary or secondary antiphospholipid syndrome. The role of these autoantibodies in the pathogenesis of Libman-Sacks endocarditis is disputed. Lesions are usually clinically silent. Heart failure, valvular dysfunction, valve replacement, embolic phenomena, and secondary infective endocarditis can complicate valvular abnormalities. Last Updated: May 23, 2006   Managing patients with non-ST-segment elevation   NS343 Coady E (2006) Nursing Standard. 20, 37, 49-56. Date of acceptance: March 27 2006.   Managing systolic heart failure   Nursing2006, July 2006, Volume 36 Number 7, Pages 36 - 42.   Pulmonary Vasculitis   The Proceedings of the American Thoracic Society 3:48-57 (2006) © 2006 The American Thoracic Society   Recognizing and Preventing a Heart Attack   Every 30 seconds, someone has a heart attack. Half of the people who have a heart attack die—often within the first hour of having symptoms and before reaching a hospital. Yet, most people wait 2 hours before seeking help.   Stem cell injections may prove beneficial in treating peripheral artery disease   Feb 10, 2006, 16:00, Reviewed by: Dr. Rashmi Yadav. "We think this is a very promising treatment that could help patients with severe peripheral artery disease for whom there is now no effective therapy."   Syndrome X   Angina due to Cardiac Syndrome X   The push is on in pulmonary hypertension   © 2006 Lippincott Williams & Wilkins, Inc. Nursing Made Incredibly Easy! May/June 2006 Volume 4 Number 3, Pages 42 - 52.   The Role of Anti-Endothelial Cell Antibody-Mediated Microvascular Injury in the Evolution of Pulmonary Fibrosis in the Setting of Collagen Vascular Disease   Am J Clin Pathol. 2007;127(1):237-247. ©2007 American Society for Clinical Pathology. We encountered 16 patients with connective tissue disease in whom pulmonary fibrosis developed. Routine light microscopic, ultrastructural, and direct immunofluorescent analyses were conducted, and circulating antibodies, including those of endothelial cell derivation, were assessed using indirect immunofluorescence and Western blot assays. Underlying diseases were dermatomyositis, scleroderma, mixed connective tissue disease, sclerodermatomyositis, Sjögren syndrome, rheumatoid arthritis, and anti-Ro–associated systemic lupus erythematosus. Antibodies to one or more Ro, RNP, Jo 1, OJ, and/or nucleolar antigens were seen in all cases and antiphospholipid antibodies in half. All biopsies revealed microvascular injury in concert with intraparenchymal fibrosis; in some cases, there were corroborative ultrastructural findings of microvascular injury. Patterns of fibroplasia represented nonspecific interstitial pneumonitis and usual interstitial pneumonitis. We noted IgG, IgA, and/or complement in the septal microvasculature. In 6 cases with available serum samples, indirect immunofluorescent endothelial cell antibody studies were positive and Western blot studies showed reactivity of serum samples to numerous endothelial cell lysate–derived proteins. Pulmonary fibrosis, a recognized complication of systemic connective tissue disease, develops in connective tissue disease syndromes with pathogenetically established immune-based microvascular injury at other sites. A similar mechanism of antibody-mediated endothelial cell injury may be the basis of the tissue injury and fibrosing reparative response.   Treatment of Infectious Endocarditis   US Pharm. 2007;32(5):HS-32-HS-43. IE continues to be a life-threatening infection that often requires a prolonged duration of antibiotic therapy and sometimes surgery in order to be treated appropriately. The most common organisms causing IE are Streptococcus, Staphylococcus, and Enterococcus species. The infecting organism, susceptibility patterns, and AHA guideline recommendations should be considered to guide antibiotic therapy as well as the duration of treatment. Newer treatment options for drug-resistant organisms such as MRSA and VRE need to be added to the repertoire of drugs that are currently available for the treatment of IE. However, further research on these agents is needed to establish their safety and efficacy for use in this setting.   What Is Peripheral Arterial Disease?   Peripheral arterial disease (PAD) occurs when a fatty material called plaque (plak) builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs, and limbs. PAD is also known as atherosclerotic peripheral arterial disease. The buildup of plaque on the artery walls is called atherosclerosis (ath-er-o-skler-O-sis), or hardening of the arteries. Atherosclerosis causes the arteries to narrow or become blocked, which can reduce or block blood flow. PAD most commonly affects blood flow to the legs. Blocked blood flow can cause pain and numbness. It also can increase a person's chance of getting an infection, and it can make it difficult for the person's body to fight the infection. If severe enough, blocked blood flow can cause tissue death (gangrene). PAD is the leading cause of leg amputation. June 2006   Workup in chronic lower-extremity ischemia   © 2005 WebMD Inc. All rights reserved.   Top of Page Disability Resources   ADA Technical Assistance Program   Your comprehensive Resource for Information on the Americans with Disabilities Act, Accessible Information Technology, and more!   Advocacy for Patients with Chronic Illness, Inc.   Advocacy for Patients with Chronic Illness, Inc. will provide advocacy services not including litigation. If your claim cannot be resolved without litigation, we will attempt to refer you to an attorney in your area to bring suit on your behalf.   American Association of People with Disabilities (AAPD)   The largest national nonprofit cross-disability member organization in the United States, dedicated to ensuring economic self-sufficiency and political empowerment for the more than 56 million Americans with disabilities. AAPD works in coalition with other disability organizations for the full implementation and enforcement of disability nondiscrimination laws, particularly the Americans with Disabilities Act (ADA) of 1990 and the Rehabilitation Act of 1973.   Angel Flight   A non-profit charitable air medical transportation organization serving needy people and their families. We provide access to specialized medical evaluation, diagnosis, treatment and rehabilitation.   Benefits For People With Disabilities   The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.   But You LOOK Good!   But You LOOK Good! is a 52 page booklet that gives those living with chronic illness and pain a voice about how they feel, what they need and how others can be an encouragement to them. It is a convenient, informative way to educate loved ones about what people living with ongoing illness and pain struggle with, fight for and need from their friends and family. It is easy to read, gives practical ideas on how loved ones can be supportive and is not too long for readers to lose interest!   Coping with Autoimmunity   When you are diagnosed with a serious chronic autoimmune disease, it is normal to question your well-being and your mental ability to cope with the life changes that are part of living successfully-with any serious chronic illness. A few basic suggestions are crucial for you to consider in order for you to manage your illness better.   Disability Evaluation Under Social Security   Blue Book- January 2005   Disability Evaluation Under Social Security   Listing of Impairments - Adult Listings (Part A) Blue Book- January 2005   Disability Evaluation Under Social Security   Listing of Impairments - Childhood Listings (Part B) Blue Book- January 2005   Disabled often overlooked in crisis planning   Agency warns many could perish when disaster strikes   Disabled Online   We are dedicated to providing beneficial resources for the disabled community and their families and friends. DisabledOnline.com offers something for everyone, including: news stories, message boards, disabled topics and chat rooms. We encourage you to use DisabledOnline.com as a place to meet people and gain information that can improve someone's life. Feel free to share our site with your friends and loved ones. Disabled Online is continuously growing, striving to deliver the subjects and tools that meet your needs.   Disaboom.com   Disaboom.com is the revolutionary solution to the difficulties faced by an untapped market of more than 650 million adults worldwide living with disabilities and a valuable resource for their caregivers, families, rehabilitation providers and employers. People who have suffered from stroke, spinal cord injuries, multiple sclerosis, brain injuries, spina bifida, cerebral palsy, arthritis, knee replacements, hip replacements and back surgery have unique needs. Founded by J. Glen House, M.D., who is currently the Medical Director of Penrose Hospital’s Center for Neuro & Trauma Rehabilitation as well as a quadriplegic and leading voice for the disabled community, Disaboom.com is designed by doctors and fellow Disaboomers and is the first online company dedicated to providing a comprehensive resource to meet this market’s specific needs with customized expertise.   DRM Guide to Disability Resources on the Internet   Disability Resources, inc. is a nonprofit 501(c)(3) organization established to promote and improve awareness, availability and accessibility of information that can help people with disabilities live, learn, love, work and play independently.   Emergency Preparedness: Taking Responsiblity for Your Safety   Tips for People with Disabities and Activity Limitations.   Employment Support For People with Disabilities   Our Mission is to promote the employment of Social Security beneficiaries with disabilities by... Designing policies that make work pay. Promoting research and program innovation. Educating the public about programs and services that facilitate entry into the workforce. Partnering with other public and private groups to remove employment barriers for people with disabilities.   Government Funding - Grants - Loans - Ramp Products for Persons with Disabilities   A comprehensive network of assistance and information programs for the physically handicapped and wheelchair bound, to increase access to assistive technology devices and services for individuals with disabilities and their families.   Home Modification   AJN, American Journal of Nursing, October 2006, Volume 106 Number 10, Pages 54 - 63   How the New Medicare Drug Benefit Could Affect Vulnerable Populations   Health Aff. 2006;25(1):248-255. ©2006 Project HOPE Posted 01/18/2006 Lower-income seniors and those with chronic illnesses could continue to have difficulty paying for their medications.   I'm Adapting to Disabilities     Missing Out on Benefits?   BenefitsCheckUp helps thousands of people every day to connect to government programs that can help them pay for prescription drugs, health care, utilities, and other needs.   Money Matters   Dealing with a debt crisis can certainly have a devastating affect on your way of life. When you feel like there is nowhere else to turn, turn to our staff to provide you with avenues you can use in order to remedy the situation and get on with your life.   National Dissemination Center for Children with Disabilities (NICHCY)   We serve the nation as a central source of information on: disabilities in infants, toddlers, children, and youth, IDEA, which is the law authorizing special education, No Child Left Behind (as it relates to children with disabilities), and research-based information on effective educational practices.   Patient Travel and Lodging   Links to charitable or special fare flights to research and treatment sites, a nationwide directory of hospital hospitality houses for patients and families, and fee-for-service ambulance services. Note: The organizations listed below are not Government agencies, and ORD does not endorse or promote any of these organizations. When you enter the Web sites listed below, you will leave the ORD Web site. Please return to our Web site to find more information on rare diseases research and related information, patient support groups and genetic testing laboratories and clinics.   School Services You May Not Know About   By Margaret Gelbwasser Services and programs your child's school offers that you probably don't know about.   Setting Goals While You Cope with a Chronic Illness   Our society as a whole is very goal-oriented, and when you have a chronic illness like Chronic Fatigue Syndrome or Fibromyalgia you may feel discouraged when you can't accomplish as much as "everyone else" does. Setting goals gives you a way to work toward and measure your accomplishments.   SOCIAL SECURITY DISABILITY SSI BENEFITS   Applying for social security disability and SSI benefits, with or without an advocate can be difficult due to how long a claim may take and the high chance of being denied. But those who are denied disability can win benefits by utilizing the appeals process. To increase the chances of winning, applicants should learn about the system and file an appeal when a claim is denied.   Social Security Online     Supporting Self-management in Patients with Chronic Illness   Am Fam Physician 2005;72:1503-10. Copyright © 2005 American Academy of Family Physicians.   The ADA: Your Employment Rights as an Individual With a Disability   The Americans with Disabilities Act of 1990 (ADA) makes it unlawful to discriminate in employment against a qualified individual with a disability. The ADA also outlaws discrimination against individuals with disabilities in State and local government services, public accommodations, transportation and telecommunications. This booklet explains the part of the ADA that prohibits job discrimination. This part of the law is enforced by the U.S. Equal Employment Opportunity Commission and State and local civil rights enforcement agencies that work with the Commission.   The Benefit Eligibility Screening Tool (BEST)   The Benefit Eligibility Screening Tool (BEST) is a tool that you can use to find out if you could be eligible for benefits from any of the programs Social Security administers. This tool will give you eligibility information based on answers you give to the questions on the following pages; however, BEST is not an application for benefits and: will not give you an estimate of benefit amounts. does not know, or ask for, your name or Social Security number. does not access your personal Social Security records.   The National Financial Resources Guidebook for Patients   The National Financial Resources Guidebook for Patients: A State by State Directory of information for patients seeking financial relief for a broad range of needs including housing, utilities, food, transportation to medical treatment, and children's resources.   Website of the National Patient Air Transport HELPLINE   The NATIONAL PATIENT TRAVEL HELPLINE provides information about all forms of charitable, long-distance medical air transportation and provides referrals to all appropriate sources of help available in the national charitable medical air transportation network.   Welcome to Modest Needs®   Modest Needs® is a non-profit organization reaching out to hard-working individuals and families who suddenly find themselves faced with small, emergency expenses that they have no way to afford on their own.   You're Able   Information, products and services for disabled community   Top of Page

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