Placental pathology in systemic lupus erythematosus with antiphospholipid antibodies

Systemic lupus erythematosus (SLE) is associated with a poor pregnancy outc ome. Antiphospholipid antibodies (APL), which include lupus anticoagulant ( LAC) and anticardiolipin antibodies (aCL), are frequently found in patients with SLE, and their presence has been associated with fetal loss. To exami ne placental pathologic features of SLE patients with APL, we performed a p athologic study on 47 placental tissue samples from 47 pregnant SLE patient s with APL (15 patients; four LAC single-positive patients, seven aCL singl e-positive patients, four LAC and aCL double-positive patients) and without APL (32 LAC and aCL double-negative patients). The incidence of extensive infarction, decidual vasculopathy, decidual thrombosis and perivillous fibr inoid change, which have been thought to be characteristic lesions of APL p lacenta, was significantly higher in the LAC and aCL double-positive patien ts than in the patients without APL. Conversely, the above-mentioned lesion s between the LAC or aCL single-positive patients and the APL negative pati ents did not differ significantly. Among the 15 patients with APL, two of t he three patients with both decidual vasculopathy and thrombosis had extens ive infarction associated with fetal death. Moreover, the patients having f etal death showed LAC and aCL double-positivity. In conclusion, this study indicated that the LAC and aCL double-positivity is an important factor for extensive infarction resulting from decidual vasculopathy and decidual thr ombosis in the SLE placenta. Moreover, it was indicated that LAC and aCL do uble-positivity is an important risk factor for fetal death in the SLE pati ent.