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Hyperferritinemia is Associated with Serologic Antiphospholipid Syndrome in SLE Patients

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Abstract

Ferritin may play a direct role on the immune system. We sought to determine if elevated levels of ferritin in lupus patients correlate with disease activity and organ involvement in a large cohort. Ferritin levels (gender and age adjusted) were assessed in 274 lupus serum samples utilizing the LIASON Ferritin automated immunoassay method. Significant disease activity was determined if European Consensus Lupus Activity Index (ECLAM) > 2 or Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) > 4. Utilizing an EXCEL database, we compared elevated ferritin levels to manifestations grouped by organ involvement, serology, and previous therapy. The patients were predominantly female (89%), median age was 37 years old, and disease duration was 10.6 ± 7.7 years. Hyperferritinemia was found in 18.6% of SLE patients. Compared to subjects with normal ferritin levels, a significantly greater proportion of patients with hyperferritinemia had thrombocytopenia (15.4% vs. 33.3%, p = 0.003) and lupus anticoagulant (11.3% vs. 29.0%, p = 0.01). Additionally, compared to normoferritinemic subjects, hyperferritinemic subjects had significantly higher total aCL (99.7 ± 369 vs. 30.9 ± 17.3 GPI, p = 0.02) and aCL IgM antibody levels (75.3 ± 357.4 vs. 9.3 ± 10.3 GPI, p = 0.02), and marginally lower aCL IgG antibody levels (9.2 ± 4.9 vs. 9.7 ± 3.9 GPI, p = 0.096). While the ECLAM score significantly correlated with hyperferritinemia (p = 0.04), the SLEDAI score was marginally associated with hyperferritinemia (p = 0.1). Serositis was marginally associated with hyperferritinemia, but not with other manifestations. An association with serologic APS was encountered. Hyperferritinemia was associated with thrombocytopenia, lupus anticoagulant, and anti-cardiolipin antibodies suggest that it may be an early marker for secondary antiphospholipid syndrome in SLE patients.

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Authors and Affiliations

  1. Departments of Medicine C, Wolfson Medical Center, Tel-Aviv, Israel

    Gisele Zandman-Goddard

  2. Departments of Medicine B, Wolfson Medical Center, Tel-Aviv, Israel

    Hedi Orbach

  3. Zabludowicz Center for Autoimmune Diseases & Department of Medicine B, Sheba Medical Center, Tel-Aviv, Israel

    Nancy Agmon-Levin & Miri Blank

  4. Epidemiology Unit, Wolfson Medical Center, Tel-Aviv, Israel

    Mona Boaz

  5. Department of Medicine D, Meir Medical Center, Kfar Saba, Israel

    Howard Amital

  6. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Gisele Zandman-Goddard, Nancy Agmon-Levin, Howard Amital, Miri Blank & Yehuda Shoenfeld

  7. University of Debrecen, Debrecen, Hungary

    Zoltan Szekanecz & Gabriella Szucs

  8. National Institute of Rheumatic Diseases, Piestany, Slovak Republic

    Josef Rovensky

  9. National Institute of Rheumatology and Physiology, Budapest, Hungary

    Emese Kiss

  10. DiaSorin S.p.A., Saluggia, Italy

    Nadia Corocher

  11. Division of Rheumatology, University of Padova, Padova, Italy

    Andrea Doria

  12. Bezhanijska Kosa University Medical Center, Belgrade, Serbia

    Ljudmila Stojanovich

  13. University of Milan, Milan, Italy

    Francesca Ingegnoli & Pier Luigi Meroni

  14. University Clinical Center Ljubljana, Ljubljana, Slovenia

    Blaz Rozman

  15. Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    Jesus Gomez-Arbesu

  16. Zabludowicz Center for Autoimmune Diseases & Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel

    Yehuda Shoenfeld

Authors
  1. Gisele Zandman-Goddard
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  2. Hedi Orbach
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  3. Nancy Agmon-Levin
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  4. Mona Boaz
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  6. Zoltan Szekanecz
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  9. Emese Kiss
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  12. Ljudmila Stojanovich
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  13. Francesca Ingegnoli
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  17. Miri Blank
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  18. Yehuda Shoenfeld
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Correspondence to Gisele Zandman-Goddard.

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Zandman-Goddard, G., Orbach, H., Agmon-Levin, N. et al. Hyperferritinemia is Associated with Serologic Antiphospholipid Syndrome in SLE Patients. Clinic Rev Allerg Immunol 44, 23–30 (2013). https://doi.org/10.1007/s12016-011-8264-0

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