SHORT REPORTS

No evidence of misdiagnosis in patients with multiple sclerosis and repeated positive anticardiolipin antibody testing based on magnetic resonance imaging and long term follow-up

M Liedorp¹, E Sanchez², I M W van Hoogstraten³, B M E von Blomberg³, F Barkhof², C H Polman¹ and J Killestein¹

¹ Department of Neurology, MS Centre Amsterdam, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands
² Department of Radiology, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands
³ Department of Clinical Pathology, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands

Correspondence to:
Dr Joep Killestein, Department of Neurology, MS Centre Amsterdam, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB, Amsterdam, the Netherlands; j.killestein{at}vumc.nl

Objective: To determine whether patients with definite multiple sclerosis (MS) and repeated positive anticardiolipin antibody (aCL Ab) testing fulfil the recently updated criteria for the antiphospholipid syndrome (APS). Also, to determine if these patients form a separate subgroup in terms of long term follow-up and MRI characteristics.

Design: A blinded case control study comparing MRI patterns between aCL Ab positive and negative MS patients with a clinical follow-up of 7 years.

Participants: 8 (5.6%; male:female ratio 2:6; 6 relapsing–remitting subtype, 1 primary progressive subtype and 1 neuromyelitis optica (NMO)) of 143 consecutive patients with definite MS or NMO (71% relapsing–remitting, 18% secondary progressive and 6% primary progressive disease course; 4% NMO) showed repeated positive aCL Ab testing.

Setting: Outpatient clinic of a tertiary MS centre in the Netherlands.

Results: All eight aCL Ab positive patients had levels below 40 MPL/GPL units, with the majority of intervals between tests of at least 12 weeks. After follow-up, none of the patients fulfilled the criteria for APS. No specific MRI features were present compared with 24 matched aCL Ab negative patients.

Conclusions: No aCL Ab positive MS patient fulfilled the criteria for APS, arguing against a possible misdiagnosis or coexistence.

Abbreviations: aCL Ab, anticardiolipin antibody; APS, antiphospholipid syndrome; MS, multiple sclerosis; NMO, neuromyelitis optica; OCB, oligoclonal bands

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