Antiphospholipid Syndrome (APS) Case Files (Stroke and Thrombosis) By Prof Graham Hughes

Posted on: April 18, 2019
Last Updated: May 6, 2019

Professor Graham Hughes is a Consultant Rheumatologist and the founder and editor of the international journal LUPUS,’ and Head of London Lupus Centre. In 1983 he described the clotting disorder now known as Hughes Syndrome for which he received the World Rheumatology (ILAR) Research Prize in 1993.  

Author Quotes 

 It may be that there is a two-hit phenomena – that you can carry the antibody and get away with it – but something like the oral contraceptive pill will trigger it, or smoking will trigger it, and there’s data for all that – even diet.

 

For the future of aPL testing – it’s a simple test, it should not be complicated. It should be over-the-counter kits like pregnancy tests and it should be available to anyone who requires it.

 

Finally, in the world of lupus it’s changed our treatment… instead of steroid, steroid, steroid, we’re now looking to see that some cases are due to thrombotic, sticky blood disease, rather than inflammation.

 

Summary 

 In this final video excerpt, Prof Hughes discusses two final case studies and his predictions for 2050. 

He presents data for a young medical student who experienced altitude sickness with subsequent loss of consciousness and who was found to have high levels of anticardiolipin antibodies. 

Moving on to his next case study of a 50-year old woman with APS and a fear of flying, he presents examples of how heparin prophylaxis may benefit long-haul sickness.  

In his final case he discusses data from a woman with a cerebellar infarction, and asks if there is a role for immunosuppressives in APS.  

Concluding his presentation, Prof Hughes predicts that by 2050 there will be worldwide testing of APS with new hope for migraine sufferers, and improved statistics for stroke and miscarriage. 

Take Home Bullet Points 

 With successful aPL testing in the future: 

  • Young heart attacks will be reduced and there will be protection against stroke 
  • Stillbirths could be reduced by 50% 
  • APS may be a model for accelerated forms of atheroma 

 References 

  1.  Malaviya AN, Marouf R, Al-Jarallah K, et al. Hughes syndrome: a common problem in Kuwait hospitals. Br J Rheumatol. 1996;35(11):1132-1136. 
  2. Bakshi J, Stevens R. Rituximab therapy for recurrent thromboembolic disease in antiphospholipid syndrome. Lupus. 2013;22(8):865-867. 
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