Organ damage progression in antiphospholipid antibody carriers: a longitudinal cohort study

Abstract

Abstract Background The DIAPS scale is a useful tool for quantifying organ damage in antiphospholipid syndrome (APS). However, little is known about the kinetics of organ damage in antiphospholipid antibody (aPL) carriers. This study aimed to characterize damage progression in aPL carriers, assess the impact of 2023 ACR/EULAR laboratory domains, autoimmune disease, and thromboprophylaxis on this progression, and determine whether organ damage at diagnosis is associated with the later development of clinical manifestations. Methods A retrospective observational study was conducted, including patients who met the 2023 ACR/EULAR domains 7 or 8 without clinical symptoms between January 2018 and March 2024. A total of 985 patients were analysed. Results The overall mean DIAPS score was slightly higher in patients with persistent LA compared with those without (0.429 [IQR 0.134–0.723] vs. 0.350 [IQR 0.132–0.569]). The time*autoimmune disease interaction was significant (F = 4.532, p = 0.000), indicating a steeper increase in DIAPS among patients with associated autoimmune disease. Primary thromboprophylaxis with antiplatelet agents did not modify DIAPS progression (F = 1.357, p = 0.220). Finally, organ damage at the time of serological diagnosis was associated with a higher likelihood of progression to clinical APS. Conclusions Among aPL carriers, persistent LA positivity emerged as the most robust serological predictor of organ damage accrual. Accumulated organ damage appears to progress more rapidly in aPL carriers with an associated autoimmune disease. Organ damage at diagnosis was associated with an increased likelihood of progressing to clinical APS.