Immunological abnormalities in primary APS evolving into SLE: 6 years follow-up in women with repeated pregnancy loss

We have performed a prospective study to determine the prevalence of immuno logical abnormalities and the evolution from primary antiphospholipid syndr ome (APS) into systemic lupus erythematosus (SLE) in women who had had unex plained repeated pregnancy loss (PL) and APS. Of 105 women with abortions o r fetal deaths, 33(31%) fulfilled criteria for APS. Among these patients wi th primary APS, 24% had antinuclear antibodies (ANA), 91% had elevated circ ulating immune complexes (CIC), 70% had low total haemolytic complement (CH 100), 52% had low levels of complement 4 (C4) and 30% had low levels of com plement 3 (C3), in a significantly higher prevalence than women whose pregn ancies were successful (control group). Through out a 6 y follow-up, 3 (9%) of the patients with APS who had autoimmune related abnormalities when ent ered into the study developed features of lupus like disease (LLD) or fullb lown SLE. Our findings suggest that women with unexplained repeated PL with APS who presented with positive ANA, high levels of CIC, low levels of CH1 00, C3 and C4, may define a subset of patients exhibiting immunological alt erations similar to those of SLE. These parameters may help in the assessme nt of prognosis in APS patients with FL. Those patients should be carefully surveyed with regard to the development of connective tissue diseases.