Rheumatology Advance Access originally published online on November 22, 2005
Rheumatology 2006 45(2):242-243; doi:10.1093/rheumatology/kei195
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LETTER TO THE EDITOR |
Dementia associated with antiphospholipid antibodies: reply
Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia and 1 Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Insular, Las Palmas de Gran Canaria, Canary Islands, Spain
Correspondence to: Ricard Cervera. E-mail: rcervera{at}clinic.ub.es
SIR, The authors of this letter describe a patient with Sneddon's syndrome and dementia, without prior focal symptoms or signs of stroke, who expressed lupus anticoagulant activity in two consecutive determinations. Unfortunately, no information on treatment and follow-up is provided. Similar cases were included in our recently published series of 30 patients (25 from a literature review and five from our clinics) with dementia and antiphospholipid syndrome (APS); one-third of them had Sneddon's syndrome [1], thus reinforcing the importance of such an association.
The authors also comment on some additional case reports of dementia and Sneddon's syndrome that were not cited in our article. Unfortunately, most of these reports do not give information about the antiphospholipid antibody (aPL) status, or the patients reported do not fulfil strict criteria for their classification as APS [2], because either aPLs were not detected [3–5] or only one positive determination was described [6].
As we indicate in our article [1], active antithrombotic prophylaxis is needed in patients with dementia and APS, and we agree with the authors of this letter that the use of either antiplatelet medication or anticoagulation will depend on the individual clinical characteristics (i.e. the presence of valve vegetations, carotid plaques and/or previous thrombotic events) and, therefore, definite recommendations will not be possible until data from controlled trials become available.
The authors have declared no conflicts of interest.
References
- Gómez-Puerta JA, Cervera R, Calvo LM et al. Dementia associated with the antiphospholipid syndrome: clinical and radiological characteristics of 30 patients. Rheumatology 2005;44:95–9.
[Abstract/Free Full Text] - Wilson WA, Gharavi AE, Koike T et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999;42:1309–11.[CrossRef][ISI][Medline]
- Wright RA, Kokmen E. Gradually progressive dementia without discrete cerebrovascular events in a patient with Sneddon's syndrome. Mayo Clin Proc 1999;74:57–61.[ISI][Medline]
- Geschwind DH, FitzPatrick M, Mischel PS, Cummings JL. Sneddon's syndrome is a thrombotic vasculopathy: neuropathologic and neuroradiologic evidence. Neurology 1995;45:557–60.
[Abstract/Free Full Text] - Devuyst G, Sindic C, Laterre EC, Brucher JM. Neuropathological findings of a Sneddon's syndrome presenting with dementia not preceded by clinical cerebrovascular events. Stroke 1996;27:1008–10.[Medline]
- Jura E, Palasik W, Meurer M, Palester-Chlebowczyk M, Czlonkowska A. Sneddon's syndrome (livedo reticularis and cerebrovascular lesions) with antiphospholipid antibodies and severe dementia in young man: a case report. Acta Neurol Scand 1994;89:143–6.[Medline]
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