Journal
AUTOIMMUNITY REVIEWS
Volume 14, Issue 5, Pages 401-414Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.autrev.2015.01.002
Keywords
Antiphospholipid Syndrome; GRADE system; Clinical features; Non-criteria manifestations; Accuracy
Categories
Funding
- Brazilian Foundation for Higher Education Personnel Training Coordination (CAPES paep) [2240/201340]
- Rio de Janeiro Research Foundation [FAPERJ: APQ2 110.023/2013]
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The purpose of this task force was to critically analyze nine non-criteria manifestations of APS to support their inclusion as APS classification criteria. The Task Force Members selected the non-criteria clinical manifestations according to their clinical relevance, that is, the patient-important outcome from clinician perspective. They included superficial vein thrombosis, thrombocytopenia, renal microangiopathy, heart valve disease, livedo reticularis, migraine, chorea, seizures and myelitis, which were reviewed by this International Task Force collaboration, in addition to the seronegative APS (SN-APS). GRADE system was used to evaluate the quality of evidence of medical literature of each, selected item. This critical appraisal exercise aimed to support the debate regarding the clinical picture of APS. We found that the overall GRADE analysis was very low for migraine and seizures, low for superficial venous thrombosis, thrombocytopenia, chorea, longitudinal myelitis and the so-called seronegative APS and moderate for APS nephropathy, heart valve lesions and livedo reticularis. The next step can be a critical redefinition of an APS gold standard, for instance derived from the APS ACTION registry that will include not only current APS patients but also those with antiphospholipid antibodies not meeting current classification criteria.(C) 2015 Elsevier B.V. All rights reserved.
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