Book Review

The Antiphospholipid Syndrome

N Engl J Med 1997; 336:1684June 5, 1997

Article

The Antiphospholipid Syndrome
Edited by Ronald A. Asherson, Ricard Cervera, Jean-Charles Piette, and Yehuda Shoenfeld. 339 pp., illustrated. Boca Raton, Fla., CRC Press, 1996. $149.95. ISBN: 0-8493-9423-6

The antiphospholipid-antibody syndrome is enigmatic for several reasons. Until recently, there was no standardized definition of the syndrome. The associated antibodies (lupus anticoagulant and anticardiolipin antibody) can come and go in a given patient, and experts differ about which tests should be performed. It is clear that the antibodies are associated with clinical complications such as thromboembolism, thrombocytopenia, and loss of pregnancy, but it is unclear whether the antibodies actually cause these complications. Most daunting for clinicians is the paucity of controlled clinical trials of treatments for the syndrome.

The editors have assembled a group of internationally recognized authors, who have written a highly successful book. It has three parts, focusing on the epidemiologic and pathophysiologic aspects of the antiphospholipid-antibody syndrome; clinical and laboratory features; and management and prognosis.

The book is comprehensive and well referenced. It has comprehensive sections on basic science and clinical research. It highlights areas of controversy and deficiencies in our knowledge, as well as problems facing clinicians for which the need for clinical trials is dire. There are many clear and concise tables and relevant radiographs and photographs. To avoid confusion in terminology, there is consistency in terms and definitions throughout the text — a remarkable achievement, given the controversy and divergence of expert opinions over what constitutes the antiphospholipid-antibody syndrome and which tests best define it.

The book opens with a chapter that gives historical perspective and explains some of the early confusion in defining the syndrome, notably about why a substance that is an in vitro inhibitor of clotting should cause thrombotic rather than bleeding complications. The confusion was amplified by the term lupus anticoagulant — a misnomer because not only do many (if not most) patients with the antibody not have systemic lupus erythematosus, but in vivo the antibody is associated with thrombotic complications.

Particularly informative are the chapters on the detection of antiphospholipid antibodies and animal models of the antiphospholipid-antibody syndrome. The former provides an update on the importance of β₂-glycoprotein I as a target antigen for antiphospholipid antibodies and a comprehensive review of proposed mechanisms of action of antiphospholipid antibodies. The latter summarizes how animal models have improved our understanding of the antiphospholipid-antibody syndrome and point to the antibodies as the cause of complications such as recurrent spontaneous abortion.

The second part of the book, which deals with clinical and laboratory aspects of the antiphospholipid-antibody syndrome, is generally well done, particularly the chapter on renal manifestations. The last part of the book, on management and prognosis, contains a very practical chapter on the management of venous and arterial thrombosis and a nice closing chapter about new perspectives in the study and treatment of the disease.

Jeffrey Ginsberg, M.D.
McMaster University, Hamilton, ON L8N 3Z5, Canada

Citing Articles (1)

Citing Articles

1. 1

   Gerald B. Zelenock, James C. Stanley, Roy A. More, Lazar J. Greenfield, Charles J. Shanley, Lloyd A. Jacobs. (1997) Differential Clinical Workloads Among Faculty at a Major Academic Health Center. Annals of Surgery 226:3, 336-347
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