Update on Antiphospholipid Syndrome: Ten Topics in 2017

Abstract

Purpose of review: This review focuses on new clinical aspects of antiphospholipid syndrome (APS) in the last 5 years.

Recent findings: The pathogenesis of APS is related to endothelial activation by mechanisms other than autoantibody-mediated massive coagulation. These include Toll-like receptors, the m-TORC pathway, and neutrophil activation, inducing an uncontrolled inflammatory cascade. Given these new pathogenetic hypotheses, the treatment of APS could be directed towards a fine balance between anticoagulation and immunomodulation. A hot topic is how to consider asymptomatic antiphospholipid (aPL) carriers, with or without systemic lupus erythematosus (SLE), during pregnancy, or during their life in general: to treat or not to treat? New findings on long-standing APS, regarding survival, comorbidities, and evolution in other autoimmune conditions, have become available, including new insights into aPL as potential risk factors for damage accrual in SLE and potential implications on neuropsychological involvement of children exposed to maternal aPL in utero. This review summarizes recent findings on the management, treatment, and prevention of patients affected by APS or with aPL.

Keywords: APS treatment; Anti-phospholipid antibodies; Asymptomatic carrier; Neuropsychological development; Obstetric APS; Thrombosis’ pathogenesis.