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Anticardiolipin antibodies in childhood rheumatic disorders

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Anticardiolipin antibodies (aCL) have been reported to occur in a
wide variety of autoimmune and non-autoimmune disorders in
adults. Our objective was to investigate the prevalence and
isotype distribution of aCL and its relationship with the
features of antiphospholipid syndrome (APS) in childhood
rheumatic disorders.

Between November 1995 and May 1996, all patients
who visited our paediatric rheumatology clinic whose
guardians signed a consent form participated in the study. The
study population included 106 patients (36 systemic lupus
erythematosus (SLE), 28 juvenile rheumatoid arthritis (JRA),
11 fibromyalgia, 7 sarcoidosis, 5 dermatomyositis, 3 rheumatic
fever (RF), 3 vasculitis, 2 scleroderma, and 11
miscellaneous). aCL measurements were performed by enzyme
linked immunoabsorbent assay (ELISA). All patients were
carefully evaluated for symptoms and signs of APS. Eighteen of
the 106 patients (17%) were tested positive for one or more of
the three aCL isotypes. In SLE, aCL were found positive in 13
of 36 (37%); in JRA 2 of 28 (7%); in sarcoidosis 2 of 7; and
in RF 1 of 3. aCL of IgG isotype were found positive in 16
patients (11 SLE, 2 sarcoidosis, 2 JRA, and 1 RF). This
isotype was usually detected at low titers (16-24 GPL). aCL of
IgM isotype were found positive in five patients (2
sarcoidosis, 2 SLE, 1 JRA), and aCL of IgA isotype were found
positive in only three patients (2 SLE, 1 sarcoidosis).

Clinical features of APS were rarely seen in our SLE
population and were not associated with the presence of aCL.
None of the patients in the other groups exhibited any
clinical manifestations of APS. In conclusion, aCL were found
in 37% of our childhood SLE patients as compared with only 7%
in JRA. These were mostly aCL of IgG isotype of low titers and
therefore were not associated with the main features of APS.
Prospective studies with a larger sample size may be needed to
ascertain the exact prevalence and clinical significance of
aCL in childhood-onset SLE.

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