For antiphospholipid syndrome patients, lab results don’t always paint the full picture

Patients with APS have concerns about their ability to function normally, even when their blood work and clinical visits appear normal.

5:00 AM

Author | Valerie Goodwin

doctor talking to patient in clinic with blue shirt
Getty Images

Antiphospholipid syndrome is an autoimmune disease that preferentially affects women. Patients with APS are typically given different medications to reduce their risk of blood clotting and help normalize lab values such as platelet count. Despite this, patients sometimes internally feel that they are not doing as well as the numbers are showing.

APS is characterized by persistently positive antiphospholipids antibodies in the setting of adverse obstetric events or dangerous blood clots. Patients may be diagnosed with “primary APS” when APS is the main autoimmune disease or “secondary APS” when the is APS diagnosis is paired with Lupus.

A study conducted by University of Michigan Medicine titled “Predictors and Interrelationship of Patient-Reported Outcomes in Antiphospholipid Syndrome: A Cross-Sectional Study” published in the American College of Rheumatology’s ACR Open, researchers found that many patients perceived their physical and cognitive function to be less than optimal.

Patients with APS have many self-reported symptoms that impact on different dimensions on their quality of life. However, they do not routinely receive opportunities to explain these impacts in a way that can be connected to APS. It is even rarer for these patient reports to be systematically studied on a large scale. More often APS is studied from the perspective of the physician. Here, the authors used validated patient-reported outcomes measures to ask how patients viewed their health in a systematic and consistent way.

One hundred and thirty-nine APS patients at University of Michigan Health were each given three questionnaires upon arrival to an appointment with their APS physician. The questionnaires asked APS patients to rate their physical function, cognitive function, and pain intensity.

The study found that roughly half of patients had a physical function score of less than 45, suggesting at least mild self-perceived impairment in how one is able to carry out their day-to-day physical activity. Another important domain, cognitive function, is often not assessed from a patient self-report perspective. A pioneering effort in this study was to systematically assess the relationship between cognitive function and the quality of life. While the cognitive function questionnaires have not previously been deployed as widely as those for physical function (limiting a deep understanding of score interpretations), a quarter of patients with primary APS were assigned a cognitive score of less than 40, suggesting at least moderate self-perceived impairment in this area.

Interestingly, impairments in self-reported physical function and cognitive function, as well as higher pain intensity, were not only associated with clinical markers suggestive of more severe disease, but also with potentially modifiable lifestyle factors such as obesity and smoking status.

Unexpectedly, patients taking drugs typically prescribed for mental health, such as selective serotonin reuptake inhibitors, also reported worse physical and cognitive function and higher pain intensity. Struggles with mental health are common in patients with unpredictable autoimmune diseases like APS, although the impacts of mental health and associated medications have only rarely been studied in this condition.

“The next step is to study this all longitudinally to see how these numbers hold up over time,” said Julia Weiner, an undergraduate student and researcher working with Jason Knight M.D., Ph.D., an associate professor of rheumatology and internal medicine and supervisor of the lab. “Distributing a questionnaire that focuses specifically on depression and SSRI use alongside assessing impairments in cognitive function is also likely to help us gain a better understanding of how these symptoms and associated medications impact APS patients.”

As another next step, Weiner hopes to administer the Montreal Objective Cognitive Assessment, a standard way to objectively score cognitive function, to a larger volume of patients who also complete questionnaires. This can help the team understand how well self-perceived cognitive function predicts actual cognitive performance.

Overall, the Michigan Medicine team is very enthusiastic about finding more ways to incorporate patients into all aspects of their research, from providing their perceptions of their disease (as in this study), to study design, to study interpretation. “Patients and researchers will have to partner together if we are ever going to achieve the ultimate goal of a cure for APS,” said Weiner.

Additional Authors: Julia K. Weiner, Tristan Smith, Claire K. Hoy, Cyrus Sarosh, Jacqueline A. Madison, Amala Ambati, Ajay Tambralli, Noah Peters, Corinne Packel, Kelsey Gockman, Yu Zuo, Emily N. Briceño, Vivek Nagaraja (Mayo Clinic Scottsdale), and Jason S. Knight.

Paper cited: “Predictors and Interrelationship of Patient-Reported Outcomes in Antiphospholipid Syndrome: A Cross-Sectional Study,” American College of Rheumatology’s ACR OpenDOI: 10.1002/acr2.1151

Live your healthiest life: Get tips from top experts weekly. Subscribe to the Michigan Health blog newsletter

Headlines from the frontlines: The power of scientific discovery harnessed and delivered to your inbox every week. Subscribe to the Michigan Health Lab blog newsletter

Like Podcasts? Add the Michigan Medicine News Break on SpotifyApple Podcasts or anywhere you listen to podcasts.

More Articles About: Depression Mental Health Assessment chronic pain Lupus Mental Health All Research Topics Rounds
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories white coats hanging and one swinging off hanger with purple haze over them and sunshine peeking through
Health Lab
Who feels ready for residency?
Helen Morgan, M.D., of Michigan Medicine, authored a study that surveyed obstetric and gynecology residents to determine who feels prepared for the transition from medical school to residency.
cell phone with brain on screen in blue with blue background
Health Lab
Mental health apps may help those waiting for care, study finds
People with depression, anxiety and even suicidal thoughts can wait weeks for a mental health appointment, but a new study shows mobile apps and activity trackers might help during the wait.
close up photo of yellow pills lined up on a bright blue matt
Health Lab
New drug candidate blocks resistance to cancer therapies
A team of researchers at the University of Michigan Health Rogel Cancer Center has designed a molecule that impairs signaling mediated by two key drivers of cancer therapy resistance.
rat in blue with yellow bright brain with blue abstract background
Health Lab
Diabetes and weight loss drugs could be enhanced, shows study in mice
A network of proteins found in the central nervous system could be harnessed to increase the effectiveness, and reduce the side effects, of diabetes and weight-loss drugs such as Ozempic and Mounjaro, according to research from the University of Michigan Life Sciences Institute. 
doctor with patient talking
Health Lab
Considering the patient’s perspective in inducible laryngeal obstruction care
Exploring the main topic of concern patients have when it comes to the results of their treatment for inducible laryngeal obstruction can help to increase effective treatment methods.
two women, one older one younger, looking concerned listening to a provider across from them with back to camera
Health Lab
Many breast cancer survivors don't receive genetic testing, despite being eligible
As cancer treatment and survivorship care relies more on understanding the genetic make up of an individual’s tumor, a study from the University of Michigan Health Rogel Cancer Center finds that many breast cancer survivors who meet criteria for genetic counseling and testing are not receiving it.