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Shirish Sangle - One of the best experts on this subject based on the ideXlab platform.
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Livedo reticularis and pregnancy morbidity in patients negative for antiphospholipid antibodies
2016Co-Authors: Shirish Sangle, D P D’cruz, G. R. V. HughesAbstract:pregnancy morbidity, additional to the known risks asso-ciated with the presence of antiphospholipid antibodies (aPL). Objective: To determine the prevalence of pregnancy related morbidity in patients with widespread Livedo reticularis who are persistently negative for aPL. Patients and methods: 52 patients with widespread Livedo reticularis were studied: 31 fulfilled ACR criteria for SLE, 21 had a lupus-like illness; all were negative for aPL. All patients had Livedo (racemosa or reticularis type) on their extremities, trunk, and/or buttocks. Result: 33 (63%) patients had pregnancy related morbidity. 22 patients had up to 9 miscarriages, 15 patients had.3 miscarriages, 2 had 2 miscarriages, 4 had a fetal death (.10 weeks), 17 had pre-eclampsia, and 4 patients had premature delivery. 19 patients had no pregnancy relate
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Livedo Reticularis: An Enigma.
The Israel Medical Association journal : IMAJ, 2015Co-Authors: Shirish Sangle, David D'cruzAbstract:Livedo reticularis is a common cutaneous manifestation of APS and may be a prognostic marker of more severe disease. It is associated with arterial and venous thrombosis and pregnancy morbidity irrespective of the presence of antiphospholipid antibodies. Recent results suggest the possibility of an association with accelerated atherosclerosis in patients with Livedo. Given the similarities between APS and Livedo (aPL negative), experts in this field believe that Livedo may represent the so-called seronegative antiphospholipid syndrome, although the exact relationship of Livedo with seronegative APS remains to be elucidated. LV may present as painful cutaneous ulcers that are often difficult to treat. The underlying pathology involves prothrombotic as well as immunological processes with some overlap with APS. Treatment remains challenging and results are often variable.
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the prevalence of abnormal pulse wave velocity pulse contour analysis and ankle brachial index in patients with Livedo reticularis a controlled study
Rheumatology, 2013Co-Authors: Shirish Sangle, Akiko Tanikawa, Karen Schreiber, Marina Zakalka, David DcruzAbstract:Objective. To evaluate the prevalence of abnormal pulse wave velocity (PWV), pulse contour analysis (PCA) and abnormal anklebrachial pressure index (ABPI) in patients with Livedo reticularis (Livedo) and without Livedo. Methods. We recruited 74 patients, of whom 41 had Livedo: 16 APS, 9 APS with SLE and 16 with Livedo (negative for aPL or lupus). The other group of 33 patients without Livedo consisted of 10 APS, 8 APS with SLE and 15 with SLE only. Livedo was diagnosed and confirmed by a dermatologist. PWV was assessed in fasting patients by the Micro Medical PulseTrace analyser using a 4 MHz continuous-wave directional Doppler probe and digital PCA was analysed by Micro Medical PulseTrace by the same operator. Chisquare with Yates’s correction was used for comparing results. Results. The median age of the Livedo patients was 46 (2971) years and of the non-Livedo patients was 45 (2568) years. Abnormal values of PWV in 10/41 (24.40%), ABPI in 4/41 (9.8%) and PCA in 10/41 (24.40%) patients were observed in the Livedo group and in the non-Livedo group abnormal values of PWV in 1/33 (P4 0.025), ABPI in 0/33 (P = NS) and PCA in 5/33 (P = NS) were observed.
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the point prevalence of an abnormal ankle brachial index in antiphospholipid antibody negative patients with Livedo reticularis a controlled study
Annals of the Rheumatic Diseases, 2008Co-Authors: Shirish Sangle, G. R. V. Hughes, C Christodoulou, S Paul, David DcruzAbstract:Livedo reticularis (Livedo) is characterised by reticular cyanotic cutaneous discolouration surrounding a pale central area. Physiological Livedo, also known as cutis marmorata, is common in young women on exposure to cold. Pathological Livedo is characterised by a fixed broken pattern, which is occasionally associated with ulceration. Livedo is frequently seen in antiphospholipid (Hughes) syndrome (APS), and appears to be associated with a worse prognosis.1 A number of patients have recently been described who have many features of APS including thrombosis, Livedo and pregnancy morbidity in the absence of antiphospholipid antibodies (aPL).2 Our aim was to assess the prevalence and …
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Livedo reticularis and pregnancy morbidity in patients negative for antiphospholipid antibodies
Annals of the rheumatic diseases, 2005Co-Authors: Shirish Sangle, D P D'cruz, G. R. V. HughesAbstract:Background: Livedo may be an independent risk factor for pregnancy morbidity, additional to the known risks associated with the presence of antiphospholipid antibodies (aPL). Objective: To determine the prevalence of pregnancy related morbidity in patients with widespread Livedo reticularis who are persistently negative for aPL. Patients and methods: 52 patients with widespread Livedo reticularis were studied: 31 fulfilled ACR criteria for SLE, 21 had a lupus-like illness; all were negative for aPL. All patients had Livedo (racemosa or reticularis type) on their extremities, trunk, and/or buttocks. Result: 33 (63%) patients had pregnancy related morbidity. 22 patients had up to 9 miscarriages, 15 patients had .3 miscarriages, 2 had 2 miscarriages, 4 had a fetal death (.10 weeks), 17 had pre-eclampsia, and 4 patients had premature delivery. 19 patients had no pregnancy related morbidity. Overall morbidity was similar in the patients with lupus and lupus-like disease. Conclusion: Pregnancy related morbidity in lupus is known to be associated with the presence of aPL. This study suggests that pregnancy loss may also be independently associated with widespread Livedo reticularis in patients who are aPL negative. A larger study is needed.
G. R. V. Hughes - One of the best experts on this subject based on the ideXlab platform.
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Livedo reticularis and pregnancy morbidity in patients negative for antiphospholipid antibodies
2016Co-Authors: Shirish Sangle, D P D’cruz, G. R. V. HughesAbstract:pregnancy morbidity, additional to the known risks asso-ciated with the presence of antiphospholipid antibodies (aPL). Objective: To determine the prevalence of pregnancy related morbidity in patients with widespread Livedo reticularis who are persistently negative for aPL. Patients and methods: 52 patients with widespread Livedo reticularis were studied: 31 fulfilled ACR criteria for SLE, 21 had a lupus-like illness; all were negative for aPL. All patients had Livedo (racemosa or reticularis type) on their extremities, trunk, and/or buttocks. Result: 33 (63%) patients had pregnancy related morbidity. 22 patients had up to 9 miscarriages, 15 patients had.3 miscarriages, 2 had 2 miscarriages, 4 had a fetal death (.10 weeks), 17 had pre-eclampsia, and 4 patients had premature delivery. 19 patients had no pregnancy relate
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the point prevalence of an abnormal ankle brachial index in antiphospholipid antibody negative patients with Livedo reticularis a controlled study
Annals of the Rheumatic Diseases, 2008Co-Authors: Shirish Sangle, G. R. V. Hughes, C Christodoulou, S Paul, David DcruzAbstract:Livedo reticularis (Livedo) is characterised by reticular cyanotic cutaneous discolouration surrounding a pale central area. Physiological Livedo, also known as cutis marmorata, is common in young women on exposure to cold. Pathological Livedo is characterised by a fixed broken pattern, which is occasionally associated with ulceration. Livedo is frequently seen in antiphospholipid (Hughes) syndrome (APS), and appears to be associated with a worse prognosis.1 A number of patients have recently been described who have many features of APS including thrombosis, Livedo and pregnancy morbidity in the absence of antiphospholipid antibodies (aPL).2 Our aim was to assess the prevalence and …
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Livedo reticularis and pregnancy morbidity in patients negative for antiphospholipid antibodies
Annals of the rheumatic diseases, 2005Co-Authors: Shirish Sangle, D P D'cruz, G. R. V. HughesAbstract:Background: Livedo may be an independent risk factor for pregnancy morbidity, additional to the known risks associated with the presence of antiphospholipid antibodies (aPL). Objective: To determine the prevalence of pregnancy related morbidity in patients with widespread Livedo reticularis who are persistently negative for aPL. Patients and methods: 52 patients with widespread Livedo reticularis were studied: 31 fulfilled ACR criteria for SLE, 21 had a lupus-like illness; all were negative for aPL. All patients had Livedo (racemosa or reticularis type) on their extremities, trunk, and/or buttocks. Result: 33 (63%) patients had pregnancy related morbidity. 22 patients had up to 9 miscarriages, 15 patients had .3 miscarriages, 2 had 2 miscarriages, 4 had a fetal death (.10 weeks), 17 had pre-eclampsia, and 4 patients had premature delivery. 19 patients had no pregnancy related morbidity. Overall morbidity was similar in the patients with lupus and lupus-like disease. Conclusion: Pregnancy related morbidity in lupus is known to be associated with the presence of aPL. This study suggests that pregnancy loss may also be independently associated with widespread Livedo reticularis in patients who are aPL negative. A larger study is needed.
Y Shoenfeld - One of the best experts on this subject based on the ideXlab platform.
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Livedo Reticularis as a Criterion for Antiphospholipid Syndrome
Clinical Reviews in Allergy & Immunology, 2007Co-Authors: Elias Toubi, Y ShoenfeldAbstract:Many consensus meetings were organized in an attempt to improve the present criteria for antiphospholipid syndrome (APS) classification. In this regard, a high prevalence of antiphospholipid antibodies in systemic lupus erythematosus patients was reported in association with the presence of Livedo reticularis (LR). In these studies, the association between LR, migraine, and the development of thrombosis (strokes, valvular dysfunctions) was evident. During the last decade, it was strongly suggested that many clinical symptoms (LR, valvular dysfunctions) or laboratory features (thrombocytopenia) should be considered as “minor criteria” for APS. The inclusion of these clinical symptoms in the criteria for APS classification could become of additive value especially when they exist together in one patient. This review summarizes the data that question or support this idea.
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use of intravenous immunoglobulin in Livedo vasculitis
Clinical and Experimental Rheumatology, 2000Co-Authors: Howard Amital, Y Levy, Y ShoenfeldAbstract:We describe a 36-year-old woman with Livedo vasculitis (atrophie blanche) lasting for 15 years. After the failure of numerous therapeutic modalities the patient was treated with intravenous immunoglobulin. Significant resolution of the cutaneous lesions was seen with a concomitant alleviation of pain. To the best of our knowledge this is the first patient with Livedo vasculitis described in the medical literature ever to be treated with IVIG and to achieve a successful outcome.
Elias Toubi - One of the best experts on this subject based on the ideXlab platform.
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Livedo Reticularis as a Criterion for Antiphospholipid Syndrome
Clinical Reviews in Allergy & Immunology, 2007Co-Authors: Elias Toubi, Y ShoenfeldAbstract:Many consensus meetings were organized in an attempt to improve the present criteria for antiphospholipid syndrome (APS) classification. In this regard, a high prevalence of antiphospholipid antibodies in systemic lupus erythematosus patients was reported in association with the presence of Livedo reticularis (LR). In these studies, the association between LR, migraine, and the development of thrombosis (strokes, valvular dysfunctions) was evident. During the last decade, it was strongly suggested that many clinical symptoms (LR, valvular dysfunctions) or laboratory features (thrombocytopenia) should be considered as “minor criteria” for APS. The inclusion of these clinical symptoms in the criteria for APS classification could become of additive value especially when they exist together in one patient. This review summarizes the data that question or support this idea.
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Livedo reticularis is a marker for predicting multi-system thrombosis in antiphospholipid syndrome
Clinical and experimental rheumatology, 2005Co-Authors: Elias Toubi, Ilan Krause, Abigail Fraser, Shaul Lev, Ljudmila Stojanovich, Jozef Rovensky, Miri Blank, Yehuda ShoenfeldAbstract:Objective Livedo reticularis (LR) is a skin vasculopathy that has been frequently described in patients with anti-phospholipid syndrome (APS) and reported to be present in association with valvular heart pathology and strokes (i.e. Sneddon’s syndrome). Methods In a cohort of APS patients we investigated the possible association of LR with various clinical aspects of APS such as pregnancy morbidity, central nervous system (CNS) and cardiac manifestations. Results Livedo reticularis was found in 50/308 (16%) of APS patients, and there was a significant association with cerebrovascular accidents (CVA), migraines and epilepsy (p = 0.01, 0.002, and 0.02 respectively). A similar association was also detected between LR, and the presence of cardiac valve thickening and vegetations (p = 0.001). No association with venous thrombosis, recurrent fetal loss, IUGR or toxemia was found. Conclusion Livedo reticularis is a frequent cutaneous manifestation in patients with APS. Its high association with cardiac and CNS thrombosis may suggest that LR-APS patients compose a subset at higher risk for thrombosis, and thus may require a closer follow-up and a more aggressive anticoagulation.
Jean-charles Piette - One of the best experts on this subject based on the ideXlab platform.
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sneddon syndrome with or without antiphospholipid antibodies a comparative study in 46 patients
Medicine, 1999Co-Authors: Camille Francès, Thomas Papo, B Wechsler, J L Laporte, Valerie Biousse, Jean-charles PietteAbstract:: Sneddon syndrome is characterized by the association of Livedo reticularis and cerebral ischemic arterial events (stroke or transient ischemic attack). Reported prevalence of antiphospholipid antibodies is highly variable. We conducted this study to compare the clinical and pathologic features of patients with Sneddon syndrome according to the presence or absence of antiphospholipid antibodies. Forty-six consecutive patients with Sneddon syndrome were analyzed. All were examined by the same dermatologist who classified the Livedo of the trunk according to the regularity of the fishnet reticular pattern and according to the thickness of the fishnet reticular pattern (> or = 10 mm = large; < 10 mm = fine). Skin biopsies were systematically performed, from both the center and the violaceous netlike pattern in 38 patients. Antiphospholipid antibodies-positive Sneddon syndrome was defined by the presence of lupus anticoagulant or abnormal titers of anticardiolipin antibodies on repeated determinations. Group I consisted of 27 antiphospholipid antibodies-negative patients and Group II, of 19 antiphospholipid antibodies-positive patients. All patients except I in Group II had irregular Livedo reticularis. Large Livedo racemosa was more frequently observed in Group I (89%) than in Group II (21%, p < 0.001). On skin biopsy, arteriolar obstruction was detected in only 8 patients (4 in each group). The following parameters were not statistically different between the 2 groups: gender, mean age at detection of Livedo, mean age at first clinical cerebral event, hypertension, Raynaud phenomenon, patients with extracerebral and extracutaneous arterial or arteriolar thrombosis or stenosis, patients with venous thrombosis, and women with 2 fetal losses or more. In contrast, seizures (11% in Group I versus 37% in Group II, p < 0.05), mitral regurgitation on echocardiogram (19% versus 53%, p = 0.02), and thrombocytopenia < 150,000/muL (0% versus 42%, p < 0.005) were more frequently observed in Group II. The number of events per year of follow-up was lower with antiplatelet therapy (0.08 versus 0.5) in Group I, but was not different with anticoagulation (0.056 versus 0.06). Antiphospholipid antibodies-negative and -positive patients with Sneddon syndrome belong to close but different subsets of Sneddon syndrome.
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prevalence of anti endothelial cell antibodies in patients with sneddon s syndrome
Journal of The American Academy of Dermatology, 1995Co-Authors: Camille Francès, Jean-charles Piette, Le M Tonqueze, K V Salohzin, L A Kalashnikova, P Godeau, E L Nasonov, P YouinouAbstract:Abstract Background : Sneddon's syndrome consists of widespread Livedo reticularis and ischemic cerebral manifestations. Its pathogenesis remains unclear. Endothelial cells could be the primary target tissue. Objective : Our aim was to determine the prevalence of anti-endothelial cell antibodies (AECA) in a large series of patients with Sneddon's syndrome. The results were compared with those of three groups of control subjects: 39 patients with active periarteritis nodosa, 20 patients hospitalized for stroke without Livedo, and 28 healthy persons. Methods : AECA were detected with enzyme-linked immunosorbent assay with hybrid cells (EA.hy926) before and after absorption on epithelial cells (A 5498) to avoid false positivity from antibodies reacting with membranous epithelial antigens. Results : Twenty-two patients with Sneddon's syndrome had AECA (35%). Of the control subjects, 11 patients with active periarteritis nodosa (28%), 1 of 20 patients with a recent stroke without Livedo, and no healthy persons had AECA. Conclusion : AECA were frequently found in patients with Sneddon's syndrome, in contrast to the patients with stroke without Livedo. The clinical significance and involvement of these antibodies in the pathogenesis of endothelial lesions in Sneddon's syndrome remain to be ascertained.