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Ge Y, Zhu J, Yang G, Liu K, Yu X, Sun B, Zhang B, Yuan Y, Zeng M, Wang N, Xing C, Mao H. Clinical characteristics and outcome of double-seropositive patients with anti-glomerular basement membrane antibodies and anti-neutrophil cytoplasmic antibodies. Int Immunopharmacol 2024; 138:112607. [PMID: 38981222 DOI: 10.1016/j.intimp.2024.112607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To explore the clinical characteristics of double-seropositive patients (DPPs) with anti-glomerular basement membrane (Anti-GBM) antibodies and anti-neutrophil cytoplasmic antibodies (ANCA). METHODS We collected patients with both ANCA and anti-GBM positive glomerulonephritis who were hospitalized in the Department of Nephrology at the First Affiliated Hospital of Nanjing Medical University from January 2010 to August 2022. Retrospective analysis of the baseline clinical characteristics of patients and follow-up to explore relevant factors affecting renal and patient survival. RESULTS A total of 386 patients, including 69 ANCA negative anti-GBM glomerulonephritis patients, 296 anti-GBM negative ANCA associated vasculitis (AAV) patients, and 21 DPPs were enrolled in this study. Among the 21 DPPs aged 68.0 years (59.5, 74.0), there were 11 males and 10 females. The median serum creatinine at diagnosis was 629.0 (343.85, 788.75) μmol/L, and the median eGFR (CKD-EPI) was 7.58 (4.74, 13.77) mL/min. Fifteen cases (71.4 %) underwent initial RRT. After a follow-up of 40.0 (11.0, 73.0) months, 13 out of 21 DPPs (61.9 %) received maintenance RRT, while 49 out of 69 (71.0 %) ANCA negative anti-GBM-GN patients and 124 out of 296 (41.9 %) anti-GBM negative AAV patients received maintenance RRT (P < 0.001). Kaplan-Meier survival analysis showed that DPPs and ANCA negative anti-GBM-GN patients were more likely to progress to ESRD than anti-GBM negative AAV patients (P = 0.001). Among the 21 patients with DPPs, renal survival was significantly better in patients with better initial renal function, including those who did not receive initial RRT (P = 0.003), with lower serum creatinine levels (Cr < 629.0 μmol/L, P = 0.004) and higher eGFR levels (eGFR ≥ 7.60 ml/min, P = 0.005) than those with poor initial renal function. At the end of follow-up, 14 out of 21 DPPs (66.7 %) survived. Survival analysis showed no significant difference among patients in DPPs group, ANCA negative anti-GBM-GN group, and anti-GBM negative AAV group. CONCLUSIONS DPPs and ANCA negative anti-GBM-GN patients were more likely to progress to ESRD than anti-GBM negative AAV patients. In DPPs, the poor renal function at diagnosis might be a risk factor associated with poor renal survival.
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Affiliation(s)
- Yifei Ge
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Jinxing Zhu
- Pulmonary and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Guang Yang
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Kang Liu
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xiangbao Yu
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Bin Sun
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Bo Zhang
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Yanggang Yuan
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ming Zeng
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ningning Wang
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Changying Xing
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
| | - Huijuan Mao
- Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
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Hijikata Y, Kawabata K, Tsukamoto S, Ito S, Ando S, Bandai K, Watanabe M, Hosono M. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography revealed the course of granulocyte-colony stimulating factor-associated aortitis: A case report. Radiol Case Rep 2024; 19:3949-3951. [PMID: 39050642 PMCID: PMC11266861 DOI: 10.1016/j.radcr.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024] Open
Abstract
A 72-year-old man with diffuse large B-cell lymphoma underwent fluorine-18 fluorodeoxyglucose (FDG) PET/CT, revealing lymphoma lesions and no evidence of aortitis. The patient received chemotherapy and was treated with granulocyte colony-stimulating factor (G-CSF) for neutropenia. During chemotherapy, the patient underwent PET/CT again, revealing FDG accumulation and wall thickening at the aortic arch, which suggested aortitis. The patient was only experiencing fatigue. G-CSF-associated aortitis was suspected, and the original G-CSF was switched to another G-CSF while continuing chemotherapy. Three months later, the third round of PET/CT showed that FDG accumulation and wall thickening of the aortic arch vanished. PET/CT may be useful for not only the diagnosis but follow-up of G-CSF-associated aortitis. Radiologists should recognize incidental aortitis on PET/CT in patients receiving G-CSF administration.
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Affiliation(s)
- Yoichiro Hijikata
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kazuna Kawabata
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Suzune Tsukamoto
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Shunsuke Ito
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Saya Ando
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kazuhiro Bandai
- Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Mitsumasa Watanabe
- Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
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Rathmann J, Mohammad AJ. Classification Criteria for ANCA Associated Vasculitis - Ready for Prime Time? Curr Rheumatol Rep 2024; 26:332-342. [PMID: 38913291 DOI: 10.1007/s11926-024-01154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize the evolution and recent developments in the classification of ANCA associated vasculitis (AAV) and to summarize evaluations of the 2022 ACR/EULAR classification criteria of AAV in several cohorts. RECENT FINDINGS The classification of AAV has been a field of controversy for some time. The parallel existence of classification criteria and disease definitions produced some overlap in classification, leading to challenges when comparing different cohorts. The 2022 ACR/EULAR classification criteria derived from the largest study ever conducted in vasculitis account for significant changes in vasculitis classification with the integration of ANCA and modern imaging. These criteria show good performance compared to previous ones but also raise questions as ANCA serotypes have substantial impact on classification. In addition, there are some discrepancies with earlier agreed histopathological features of AAV disease phenotypes. During the last 35 years, several sets of classification criteria have evolved to facilitate epidemiologic studies and clinical trials in AAV. While some of these criteria have been in use for many years, they were criticized due to either not using ANCA or not integrating surrogate markers for vasculitis but also due to overlapping when used in parallel. The long-awaited new ACR/EULAR criteria for AAV were published in 2022 and are the result of a large international study, introducing for the first time ANCA and modern imaging in the classification of AAV. Though the criteria show good performance, they bring several other challenges with practical application.
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Affiliation(s)
- Jens Rathmann
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden.
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine University of Cambridge, Cambridge, UK
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Kojima M, Shibata M, Tomita S, Ueda R, Kasai R, Yamamoto E, Ban A, Suzuki S, Maruyama S. Recurrent localized fever caused by cryoglobulinemic vasculitis following hemodialysis: A case report. CEN Case Rep 2024:10.1007/s13730-024-00923-w. [PMID: 39102128 DOI: 10.1007/s13730-024-00923-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024] Open
Abstract
Post-dialysis fever is commonly reported in patients undergoing hemodialysis (HD). However, it is often challenging to identify the underlying cause owing to the wide variety of potential factors that can lead to fever. In this case, a 66-year-old Japanese man experienced recurrent fever after HD treatment. Initially, antibiotics were prescribed to treat pneumonia, but it was later discovered that the pneumonia was an alveolar hemorrhage caused by cryoglobulinemic vasculitis. It is believed that cryoglobulin was sensitized by cold exposure owing to the dialysate temperature, which resulted in fever being experienced only after HD. Although treatment for vasculitis required prednisolone and rituximab, simple plasma exchange and a dialysate temperature of 37.5 °C dramatically suppressed the occurrence of post-dialysis fever. Cryoglobulinemia should be considered as a potential cause of fever, as it may be a common occurrence in patients undergoing HD and could be overlooked as a possible cause of localized fever following HD treatment.
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Affiliation(s)
- Mitsuharu Kojima
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan.
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Maki Shibata
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan
| | - Saori Tomita
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan
| | - Reina Ueda
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan
| | - Rina Kasai
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan
| | - Eriko Yamamoto
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan
| | - Ayako Ban
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan
| | - Satoshi Suzuki
- Department of Nephrology, Kainan Hospital, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, 498-8502, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
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Xie W, Xiao S, Li X, Huang J, Zhang Z. Cardiovascular and cerebrovascular outcomes in anti-neutrophil cytoplasmic antibody-associated vasculitis: A systematic review with meta-analysis. Autoimmun Rev 2024:103587. [PMID: 39098514 DOI: 10.1016/j.autrev.2024.103587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE To quantify the magnitude of the risk of total and type-specific cardiovascular and cerebrovascular diseases (CCVD) in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). METHOD Searches of PubMed, Embase, and the Cochrane Library were conducted. Observational studies were included if they reported data on CCVD in AAV patients. Pooled risk ratios (RR) with 95% confidence intervals were calculated. RESULT Fourteen studies met the inclusion criteria, comprising 20,096 AAV patients (over 46,495 person-years) with 5757 CCVD events. Compared with non-vasculitis population, AAV patients showed an 83% increased risk of incident CCVD (1.83 [1.37-2.45]; n = 10), 48% for coronary artery disease (1.48 [1.26-1.75]; n = 9), and 56% for cerebrovascular accident (1.56 [1.22-1.99]; n = 9). For type-specific CCVD, the risks of myocardial infarction, stroke, heart failure were increased by 67% (1.67 [1.29-2.15]; n = 6), 97% (1.97 [1.19-3.25]; n = 8) and 72% (1.72 [1.28-2.32]; n = 4), whereas there was only a trend toward a higher risk of angina pectoris (1.46 [0.90-2.39]; n = 2), and ischemic stroke (1.88 [0.86-4.12]; n = 4). Subgroup analyses by AAV type found significantly increased CCVD risk in both granulomatosis with polyangiitis (1.87 [1.29-2.73]; n = 7) and microscopic polyangiitis (2.93 [1.58-5.43]; n = 3). In three studies reporting impact of follow-up period after AAV diagnosis, the CCVD risk was significantly higher in the first two years after diagnosis than the subsequent follow-up (2.23 [2.00-2.48] vs. 1.48 [1.40-1.56]; p < 0.01). Significant heterogeneity existed in the main analyses. CONCLUSION This meta-analysis demonstrates that AAV is associated with increased risks of overall and type-specific CCVD, especially within two years after AAV diagnosis.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
| | - Shiyu Xiao
- Department of Gastroenterology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
| | - Xiaoyuan Li
- Department of Nephrology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
| | - Jing Huang
- Department of Nephrology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China.
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Quartuccio L, Treppo E, De Martino M, Pillon M, Perniola S, Bruno D, Isola M, Gremese E. Faster steroid-free remission with tocilizumab compared to methotrexate in giant cell arteritis: a real-life experience in two reference centres. Intern Emerg Med 2024:10.1007/s11739-024-03722-4. [PMID: 39093541 DOI: 10.1007/s11739-024-03722-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
Glucocorticoids (GCs) are still the mainstay of treatment of giant cell arteritis (GCA). Although GCs are highly effective in GCA, the high burden of toxicity of GCs as well as the disease relapse during GC tapering is well documented. To compare the efficacy and rapidity of TCZ and MTX as steroid-sparing agents in a real-life cohort of GCA patients. A retrospective analysis was conducted including patients with newly diagnosed GCA from the Rheumatology Units of Udine and Rome. The inclusion criterion was the treatment with TCZ or MTX as first steroid-sparing drug. 112 GCA patients (81 females) with a median age of 70 (IQ 65-75) years were collected. Thirty-one out of 112 (27.7%) patients were treated with TCZ (162 mg/week), while 81/112 (72.3%) patients received MTX (up to 20 mg/week) as a GC-sparing agent. At month 6 after GCA onset, 5/31 (16.1%) patients in TCZ group and none in MTX group were in GC-free sustained remission (p value = 0.001). Similarly, at month 12, 64.5% (20/31) and 11.1% (9/81) of patients were in sustained GC-free remission in TCZ and MTX group, respectively (p value <0.001). At month 24 of follow-up, at least one relapse of the disease occurred in 7/31 (22.6%) in TCZ-treated and 28/81 (34.6%) in MTX-treated patients, respectively (p value = 0.22). TCZ allowed a faster discontinuation of steroid therapy than MTX in GCA patients, without increasing the risk of relapse.
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Affiliation(s)
- Luca Quartuccio
- Rheumatology Division, Department of Medicine (DMED), University of Udine, Udine, Italy.
| | - Elena Treppo
- Rheumatology Division, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Maria De Martino
- Institute of Statistics, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Maria Pillon
- Rheumatology Division, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Simone Perniola
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Bruno
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Miriam Isola
- Institute of Statistics, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Elisa Gremese
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Hamsho S, Dumirieh S, Sleiay M, AlBaroudi D, Alshekh MA, Alahmad M. Pauci-immune necrotizing glomerulonephritis in a 24-year-old female with negative ANCA antibodies: A rare case report. Clin Case Rep 2024; 12:e9258. [PMID: 39104733 PMCID: PMC11299074 DOI: 10.1002/ccr3.9258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/26/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024] Open
Abstract
Key Clinical Message Pauci-immune necrotizing glomerulonephritis (PING) is a small vessel renal vasculitis usually associated with the presence of antineutrophil cytoplasmic antibodies (ANCA) against myeloperoxidase or proteinase. A small proportion of PING patients do not have ANCA antibodies. Abstract A condition known as Pauci-immune necrotizing glomerulonephritis, or PING for short, is a type of kidney inflammation that affects small blood vessels. This condition is typically linked with the existence of certain antibodies, specifically antineutrophil cytoplasmic antibodies or ANCA, which target myeloperoxidase or proteinase. However, it's worth noting that a minor percentage of individuals diagnosed with PING do not possess these ANCA antibodies. A 24-year-old woman with no previous medical history arrived at the ER due to various symptoms including joint pain, fever, difficulty swallowing, and shortness of breath. Despite multiple symptoms suggesting systemic lupus erythematosus (SLE), this diagnosis was ruled out based on the EULAR/ACR 2019 classification criteria and laboratory tests. Other potential diagnoses such as rheumatoid arthritis (RA) and eosinophilic garnulomatosis with polyaniitis (EGPA) were also excluded based on respective criteria. The patient was treated with a 3-day course of methylprednisolone, followed by prednisolone, which improved her creatinine levels. Subsequent tests for P-ANCA and C-ANCA were negative. A kidney biopsy confirmed necrotizing glomerulonephritis, consistent with pauci-immune vasculitis. A bronchoscopy revealed bleeding and hemorrhage in her lungs, but bacterial culture analysis was negative. The patient was given piperacillin, tazobactam, and vancomycin for septic coverage, as well as intravenous immunoglobulin (IVIg), which led to symptom improvement.
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Affiliation(s)
- Suaad Hamsho
- Rheumatology Department, Faculty of medicineDamascus UniversityDamascusSyria
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Galassi L, Lerva G, Passolunghi D, Marchetto G, Pozzi MR, Tolva VS. Acute aortoiliac thrombosis and mitral valve regurgitation as acute onset of eosinophilic granulomatosis with polyangiitis in a 26-year-old patient. J Vasc Surg Cases Innov Tech 2024; 10:101515. [PMID: 38873328 PMCID: PMC11170480 DOI: 10.1016/j.jvscit.2024.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/09/2024] [Indexed: 06/15/2024] Open
Abstract
We present a rare case of eosinophilic granulomatosis with polyangiitis (EGPA), involving a 26-year-old woman with a history of asthma and nasal polyps. The patient presented with acute aortoiliac thrombosis and mitral insufficiency, which was successfully treated with thrombolysis, aortic thromboendarterectomy, and valve replacement. Peripheral hypereosinophilia with eosinophilic infiltration of the heart led to the diagnosis of antineutrophilic cytoplasmic antibody-negative EGPA. Treatment with prednisone and mepolizumab was started, resulting in a positive outcome. This case showcases an unusual manifestation of EGPA with large size vessel involvement and requiring surgical and pharmacological treatment. It also highlights the importance of early detection for timely intervention and an improved prognosis.
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Affiliation(s)
- Luca Galassi
- School of Vascular and Endovascular Surgery, University of Milan, Milan, Italy
| | - Giulia Lerva
- School of Vascular and Endovascular Surgery, University of Milan, Milan, Italy
- Vascular and Endovascular Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | - Valerio Stefano Tolva
- Vascular and Endovascular Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Kudraszew E, Nowakowska-Płaza A, Wroński J, Płaza M, Wisłowska M. Cranial and extracranial manifestations of giant cell arteritis: a single-center observational study. Rheumatol Int 2024; 44:1529-1534. [PMID: 38739222 PMCID: PMC11222253 DOI: 10.1007/s00296-024-05608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Giant cell arteritis (GCA) presents two major phenotypes - cranial (cGCA) and extracranial (exGCA). exGCA may be overlooked. The study aimed to compare the clinical characteristics between cGCA and exGCA. METHODS Electronic medical records of patients treated between January 2015 and July 2023 at the Department of Rheumatology were searched for the diagnosis of GCA. The clinical characteristics of patients with cGCA, exGCA, and overlapping GCA manifestations were compared. RESULTS Out of 32 patients with GCA, 20 had cGCA, 7 had exGCA, and 5 had overlap manifestations. The groups did not differ significantly in demographics, clinical signs/symptoms, or laboratory test results. Importantly, the combined group of patients with exGCA and overlap GCA had a statistically significant delay in initiating treatment (median 12 weeks) compared to patients with cGCA (median 4 weeks; p = 0.008). CONCLUSION Our study confirmed the insidious nature of exGCA, which lacks distinctive clinical symptoms and consequently leads to delayed treatment.
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Affiliation(s)
- Emilia Kudraszew
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, Warsaw, 02-637, Poland
| | - Anna Nowakowska-Płaza
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, Warsaw, 02-637, Poland
| | - Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, Warsaw, 02-637, Poland.
| | - Mateusz Płaza
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Małgorzata Wisłowska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, Warsaw, 02-637, Poland
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10
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Masiak A, Jassem E, Dębska-Ślizień A, Bułło-Piontecka B, Kowalska B, Chmielewski M. Co-existence of ANCA-associated vasculitides with immune-mediated diseases: a single-center observational study. Rheumatol Int 2024; 44:1521-1528. [PMID: 38914775 PMCID: PMC11222238 DOI: 10.1007/s00296-024-05631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Antineutrophil cytoplasmic antibody-associated vasculitides (AAV) is a group of systemic necrotizing small vessel autoimmune diseases, with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) being the two most common. The co-existence of AAV with different immune-mediated diseases (autoimmune disesases - AID) might affect the clinical presentation of the primary disease. The purpose of the study was to assess the co-existence of AAV with AID and to investigate whether it affects the characteristics and the course of AAV. METHODS A retrospective single-center study was performed to identify patients with a diagnosis of MPA or GPA and concomitant AID, and to investigate their clinical features and characteristics. The group consisted of consecutive unselected AAV patients treated at a large university-based hospital, since 1988 with follow-up until 2022. RESULTS Among 284 patients diagnosed either with GPA (232) or MPA (52), 40 (14,1%) had co-existing AIDs. The most frequent were: Hashimoto thyroiditis (16 cases), rheumatoid arthritis (8 cases), followed by psoriasis (6 cases), pernicious anemia (3 cases), and alopecia (3 cases). Patients with autoimmune comorbidities had a significantly longer time between the onset of symptoms and the diagnosis (26 vs. 11 months, p < 0.001). Laryngeal involvement (20.0% vs. 9.0%, p = 0,05), peripheral nervous system disorders (35.0% vs. 13.9%, p < 0.001), and neoplasms (20.0% vs. 8.6%, p = 0,044) were more common in patients with AID comorbidities, compared to subjects without AID. In contrast, renal involvement (45.0% vs. 70.9%, p = 0.001) and nodular lung lesions (27.5% vs. 47.5%, p = 0.044) were significantly less frequent in patients with co-morbidities. Following EUVAS criteria, patients with autoimmune co-morbidities had a generalized form of the disease without organ involvement (52.5% vs. 27.2%, p = 0.007), while the others had a higher percentage of generalized form with organ involvement (38.3% vs. 20.0%, p = 0.007). CONCLUSIONS The coexistence of AAV with different autoimmune diseases is not common, but it might affect the clinical course of the disease. Polyautoimmunity prolonged the time to diagnosis, but the AAV course seemed to be milder. Particular attention should be paid to the increased risk of cancer in these patients. It also seems reasonable that AAV patients should receive a serological screening to exclude the development of overlapping diseases.
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Affiliation(s)
- Anna Masiak
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland.
| | - Ewa Jassem
- Department of Pulmonology and Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdańsk, Poland
| | - Barbara Bułło-Piontecka
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdańsk, Poland
| | - Bożena Kowalska
- Department of Otolaryngology, Medical University of Gdansk, Gdańsk, Poland
| | - Michał Chmielewski
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
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Zhang P, Yan SJ, Hu J, Liu HP, Xia W, Yang M, Kuang QH, Shi KL, Fu MZ, Gao CL, Xia ZK. Clinical outcomes and clinico-pathological correlations in children with MPO-ANCA-associated glomerulonephritis showing renal arteritis. J Investig Med 2024; 72:511-521. [PMID: 38594222 DOI: 10.1177/10815589241248073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
The aim of this study was to evaluate the clinical features, pathological characteristics, and prognosis in myeloperoxidase (MPO)-antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AAGN) with renal arteritis. The study involved 97 children from five pediatric clinical centers with MPO-AAGN who exhibited distinct clinical features. The patients were divided into AAGN-A+ and AAGN-A-, based on the presence or absence of arteritis, and the disparities in clinical, histopathological characteristics, and prognosis between the two groups was evaluated. In contrast to the AAGN-A- group, the children in the AAGN-A+ group exhibited more pronounced clinical symptoms and renal pathological injury. Arteritis positively moderately correlated with the serum creatinine, interleukin-6, urinary neutrophil gelatinase-associated lipocalin, negatively moderately correlated with serum complement C3. The renal survival rate in the AAGN-A+ group was significantly poorer than AAGN-A- group (χ2 = 4.278, p = 0.039). Arteritis showed a good predictive value for end-stage kidney disease (ESKD), and C3 deposition, ANCA renal risk score and arteritis were independent risk factors for the development of ESKD in children with MPO-AAGN. Arteritis is a significant pathological change observed in children with MPO-AAGN, and the formation of arteritis may be related to the inflammatory response and activation of the complement system.
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Affiliation(s)
- Pei Zhang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shi-Jun Yan
- Department of Pediatrics, Qinhuai Medical District, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jian Hu
- Department of Pediatrics, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Hai-Peng Liu
- Department of Emergency, Xuzhou Children's Hospital, Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Wei Xia
- Department of Pediatric Nephrology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Yang
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qian-Huining Kuang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kai-Li Shi
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Meng-Zhen Fu
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Chun-Lin Gao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zheng-Kun Xia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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12
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Wang RX, Newman SA. Urticarial Vasculitis. Immunol Allergy Clin North Am 2024; 44:483-502. [PMID: 38937011 DOI: 10.1016/j.iac.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Urticarial vasculitis is a rare autoimmune disorder characterized by persistent edematous papules and plaques on the skin that last longer than 24 hours, often accompanied by systemic symptoms such as joint pain and fever. Unlike common urticaria, this condition involves inflammation of small blood vessels, leading to more severe and long-lasting skin lesions with a tendency to leave a bruiselike appearance. Diagnosis is challenging and may require a skin biopsy. Associated with underlying autoimmune diseases, treatment involves managing symptoms with medications such as antihistamines and corticosteroids, addressing the immune system's dysfunction, and treating any concurrent autoimmune conditions.
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Affiliation(s)
- Ruth X Wang
- Department of Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Sabrina A Newman
- Department of Dermatology, University of Colorado School of Medicine, Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop 8127, Aurora, CO 80045, USA.
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13
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Monghal V, Puéchal X, Smets P, Vandergheynst F, Michel M, Diot E, Ramdani Y, Moulinet T, Dhote R, Hautcoeur A, Lelubre C, Dominique S, Lebourg L, Melboucy S, Wauters N, Carlotti A, Cachin F, Ebbo M, Jourde-Chiche N, Iudici M, Aumaitre O, Andre M, Terrier B, Trefond L. Large-vessel involvement in ANCA-associated vasculitis: A multicenter case-control study. Semin Arthritis Rheum 2024; 67:152475. [PMID: 38810568 DOI: 10.1016/j.semarthrit.2024.152475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) primarily affects small vessels. Large-vessel involvement (LVI) is rare. We aimed to describe the characteristics of LVI, to identify associated risk factors, and to describe its therapeutic management. METHODS This multicenter case-control (1:2) study included patients with AAV according to the ACR/EULAR classification and LVI as defined by the Chapel Hill nomenclature, together with controls matched for age, sex, and AAV type. RESULTS We included 26 patients, 15 (58 %) of whom were men, with a mean age of 56.0 ± 17.1 years. The patients had granulomatosis with polyangiitis (n = 20), or microscopic polyangiitis (n = 6). The affected vessels included the aorta (n = 18; 69 %) supra-aortic trunks (n = 9; 35 %), lower-limb arteries (n = 5; 19 %), mesenteric arteries (n = 5; 19 %), renal arteries (n = 4; 15 %), and upper-limb arteries (n = 2; 8 %). Imaging showed wall thickening (n = 10; 38 %), perivascular inflammation (n = 8; 31 %), aneurysms (n = 5; 19 %), and stenosis (n = 4; 15 %). Comparisons with the control group revealed that LVI was significantly associated with neurological manifestations (OR=3.23 [95 % CI: 1.11-10.01, p = 0.03]), but not with cardiovascular risk factors (OR=0.70 [95 % CI: 0.23-2.21, p = 0.60]), or AAV relapse (OR=2.01 [95 % CI: 0.70-5.88, p = 0.16]). All patients received corticosteroids, in combination with an immunosuppressant in 24 (92 %), mostly cyclophosphamide (n = 10, 38 %) or rituximab (n = 9, 35 %). CONCLUSION Regardless of distinctions based on vessel size, clinicians should consider LVI as a potential manifestation of AAV, with the aorta commonly affected. The risk of developing LVI appears to be greater for clinical phenotypes of AAV with neurological involvement. Standard AAV treatment can be used to manage LVI.
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Affiliation(s)
- V Monghal
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - X Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université Paris Cité, Paris, France
| | - P Smets
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - F Vandergheynst
- General Internal Medicine Department, Erasme University Hospital, Brussels, Belgium
| | - M Michel
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, AP-HP, Université Paris-Est Créteil, Créteil, France
| | - E Diot
- Service de Médecine Interne Immunologie Clinique, CHU de Tours, F-37032 Tours, France
| | - Y Ramdani
- Service de Médecine Interne Immunologie Clinique, CHU de Tours, F-37032 Tours, France
| | - T Moulinet
- Systemic and Autoimmune Rare Diseases, Nancy University Hospital, UMR 7365, IMoPA, Lorraine University, CNRS, Vandoeuvre-lès-Nancy, France
| | - R Dhote
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - A Hautcoeur
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - C Lelubre
- Department of Internal Medicine, CHU-Charleroi Marie-Curie, 6042 Charleroi, Belgium
| | - S Dominique
- CHU Rouen, Department of Pulmonology, F-76000 Rouen, France
| | - L Lebourg
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France
| | - S Melboucy
- Service de médecine interne et polyvalente, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100, Saint-Quentin, France
| | - N Wauters
- General Internal Medicine Department, Erasme University Hospital, Brussels, Belgium
| | - A Carlotti
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, 75014, Paris, France
| | - F Cachin
- Service de Médecine Nucléaire, Centre Jean PERRIN, Clermont-Ferrand, France
| | - M Ebbo
- Département de Medecine Interne, CHU Timone, AP-HM, Aix Marseille Université, France
| | - N Jourde-Chiche
- Aix-Marseille Université, Faculté des Sciences Médicales et Paramédicales, C2VN, INRA 1260, INSERM 1263, AP-HM Hôpital de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - M Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université Paris Cité, Paris, France
| | - O Aumaitre
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France; Université Clermont Auvergne Inserm U1071, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), USC-INRA 2018, Clermont-Ferrand, France
| | - M Andre
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France; Université Clermont Auvergne Inserm U1071, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), USC-INRA 2018, Clermont-Ferrand, France
| | - B Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université Paris Cité, Paris, France
| | - L Trefond
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France; Université Clermont Auvergne Inserm U1071, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), USC-INRA 2018, Clermont-Ferrand, France.
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Tateyama K, Umemoto S, Iwano S, Hirano T, Suzuki M. Sinonasal manifestations of granulomatosis with polyangiitis: A retrospective analysis. Auris Nasus Larynx 2024; 51:625-630. [PMID: 38626696 DOI: 10.1016/j.anl.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/12/2024] [Accepted: 04/02/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE This study aimed to examine the characteristics of nasal and imaging findings of sinonasal lesions in granulomatosis with polyangiitis (GPA) patients and how these lesions change over time in both the active and remission phases of the disease. METHODS We retrospectively reviewed GPA patients with sinonasal lesions who were followed up at our department between January 2005 and December 2020. The following data were collected: age, sex, symptoms at initial presentation, anti-neutrophil cytoplasmic antibody (ANCA) type, and histopathological, nasal (initial and follow-up), and imaging (initial and follow-up) findings. RESULTS This study included 17 patients with GPA aged 30 to 79 years. Computed tomography (CT) of the sinuses showed mucosal thickening in 16 patients, bone thickening in 12, bone destruction in 4, and an orbital invasion mass in 3 at the time of diagnosis. After initiating treatment, mucosal thickening of the sinuses improved in 3 of 16 patients and remained unchanged in 13. Bone thickening at the time of diagnosis remained unchanged in 10 of 12 patients and worsened in 2; 1 patient displayed newly developed bone thickening. Destructive nasal findings on CT were positive for proteinase 3-ANCA. CONCLUSIONS Our study revealed that mucosal thickening, bone thickening, bone destruction, and orbital invasion mass were major CT findings in patients with GPA. Intranasal findings such as granulations, crusting, and necrosis were seen in the active phase; moreover, saddle nose, loss of turbinate, and nasal septal perforation were subsequently seen in the course of the disease. Sinonasal findings of GPA vary depending on the disease stage and period.
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Affiliation(s)
- Kaori Tateyama
- Department of Otolaryngology Head and Neck Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Shingo Umemoto
- Department of Otolaryngology Head and Neck Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Shohei Iwano
- Department of Otolaryngology Head and Neck Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takashi Hirano
- Department of Otolaryngology Head and Neck Surgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Masashi Suzuki
- Department of Otolaryngology Head and Neck Surgery, Oita University Faculty of Medicine, Oita, Japan
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15
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Elahi T, Ahmed S, Mubarak M, Ahmed E. Clinicopathological characteristics and renal outcomes of adult patients with pauci-immune necrotizing glomerulonephritis according to ANCA status. Clin Rheumatol 2024; 43:2669-2678. [PMID: 38954279 DOI: 10.1007/s10067-024-07047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Pauci-immune necrotizing glomerulonephritis (PING) is commonly associated with the presence of antineutrophilic cytoplasmic antibodies (ANCAs) but a significant number of patients do not have these antibodies. The significance of ANCA-negativity in the context of Berden's classification of PING is not known. METHODS A retrospective analysis was conducted on all patients with histopathological diagnosis of idiopathic PING irrespective of ANCA status diagnosed between January 1998 to December 2018 and followed up at renal clinic for > 12 months. All biopsies were reclassified by Berden's classification. Clinicopathological characteristics and renal outcomes of ANCA-positive and ANCA-negative patients were compared. RESULTS Out of 134 patients, 66 (49.5%) were ANCA-negative. The mean age was 34.76 ± 13.3 years. Compared with the ANCA-positive patients, ANCA-negative patients had significantly greater prevalence of nephrotic-range proteinuria (74.23% Vs 57.9%, P = 0.036) with less extra-renal manifestations (P < 0.05)). On histology, focal and crescentic classes dominated with less number of globally sclerosed glomeruli (2.7% Vs 5.07%, P = 0.02) and more mesangial proliferation (22.7% Vs 4.41%, P = 0.002) in the ANCA-negative group, whereas sclerotic was predominant in the ANCA-positive group (P = 0.05). More patients achieved complete and partial recovery in ANCA-negative patients (42.4% Vs 20.5%, P < 0.05) with better renal survival (27.27% Vs 16.17%, log-rank test: P = 0.03) and less patient mortality (13.63% vs 30.8%, log-rank test: P = 0.04) at 2 years. CONCLUSION Our study confirms high prevalence of ANCA negativity among our cohort and this group presents with isolated renal involvement with better renal and patient survival. The ANCA-positive group showed significantly more patients in the sclerotic class, lower 2-year renal survival, and higher 2-year mortality as compared to the ANCA-negative group. However, the complete and partial responses to treatment were significantly better in the ANCA-negative group. Key Points • This study shows a high prevalence of ANCA negativity in cases of PING in Pakistani population, as almost half of patients in this study did not have these antibodies. • This negativity is more prevalent in the Asian populations but its significance in the context of Berden's classification of PING is unknown. • ANCA-negative group exhibited less severe phenotype and better outcomes compared with ANCA-positive group.
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Affiliation(s)
- Tabassum Elahi
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road Near Civil Hospital, Karachi, 74200, Pakistan.
| | - Saima Ahmed
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road Near Civil Hospital, Karachi, 74200, Pakistan
| | - Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road near Civil Hospital, Karachi, 74200, Pakistan
| | - Ejaz Ahmed
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road Near Civil Hospital, Karachi, 74200, Pakistan
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16
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Liu Y, Feng Y, Kong X, Wei Y, Zhan M, Wang J, Dai X, Wang L, Ma L, Chen H, Jiang L. A microRNA sponge, LINC02193, promotes neutrophil activation by upregulating ICAM1 and is correlated with ANCA-associated vasculitis. Rheumatology (Oxford) 2024; 63:2295-2306. [PMID: 37963065 DOI: 10.1093/rheumatology/kead605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To investigate the pathogenic role and underlying mechanisms of long noncoding RNAs (lncRNAs) in ANCA-associated vasculitis (AAV). METHODS RNA-sequencing (RNA-seq) was applied to screen the expression profile of lncRNAs in peripheral leukocytes from five AAV patients and five healthy controls (HC). Candidate lncRNAs were preliminarily verified in peripheral leukocytes from 46 AAV patients and 35 HC by qRT-PCR. Then, the identified LINC02193 was further validated in peripheral neutrophils from 67 AAV patients, 45 HC and 64 disease controls. Correlation between LINC02193 levels and disease activity was analysed. Then, a loss-of-function study was conducted to investigate the role of LINC02193 in neutrophils activation. Furthermore, bioinformatics analysis, dual luciferase reporter and RNA immunoprecipitation assays were performed to explore the mechanism of LINC02193 regulating neutrophils activation. RESULTS A total of 467 upregulated and 412 downregulated lncRNAs were identified in AAV patients. From the top five upregulated lncRNAs, an elevation of LINC02193 was validated in a larger sample of AAV patients, and positively correlated with disease activity. Knockdown of LINC02193 inhibited reactive oxygen species and nitric oxide production, neutrophil extracellular traps release and adhesion to endothelial cells of differentiated human promyelocytic leukaemia HL-60 cells, whereas overexpression of ICAM1 counteracted these effects. Mechanistic analysis demonstrated that LINC02193 acted as an miR-485-5p sponge to relieve the repressive effect of miR-485-5p on ICAM1, thus promoting ICAM1 expression. CONCLUSION LINC02193, a novel lncRNA identified in AAV, could function as competing endogenous RNAs for miR-485-5p to promote ICAM1 expression and neutrophils activation, suggesting its potential as a therapeutic target of AAV.
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Affiliation(s)
- Yun Liu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Yifan Feng
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Yuanyuan Wei
- Shanghai Key Laboratory of Bioactive Small Molecules, State Key Laboratory of Medical Neurobiology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Minglang Zhan
- Department of Rheumatology, Xiamen Hospital, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Jinghua Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Xiaojuan Dai
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Li Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
- Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, PR China
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17
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Amsler J, Everts-Graber J, Martin KR, Roccabianca A, Lopes C, Tourneur L, Mocek J, Karras A, Naccache JM, Bonnotte B, Samson M, Hanslik T, Puéchal X, Terrier B, Guillevin L, Néel A, Mouthon L, Witko-Sarsat V. Dysregulation of neutrophil oxidant production and interleukin-1-related cytokines in granulomatosis with polyangiitis. Rheumatology (Oxford) 2024; 63:2249-2258. [PMID: 37947315 DOI: 10.1093/rheumatology/kead578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Neutrophils play a key role in ANCA-associated vasculitis, both as targets of autoimmunity and as facilitators of vascular damage. In granulomatosis with polyangiitis (GPA), the data regarding the production of reactive oxygen species (ROS) in neutrophils are unclear. Further, recent data suggests that ROS production could have an anti-inflammatory effect through the regulation of inflammasomes and IL-1-related cytokines. We aimed to analyse ROS production in neutrophils from patients with GPA and investigate its association with IL-1-related cytokines and the autoantigen PR3. METHODS Seventy-two GPA patients with disease flare were included in the NEUTROVASC prospective cohort study. ROS production in whole blood of patients with active GPA was evaluated and compared with that in the same patients in remission or healthy controls. Associations between ROS production, PR3 membrane expression on neutrophils, serum levels of IL-1-related cytokines as well as inflammasome-related proteins were analysed. RESULTS We observed a robust defect in ROS production by neutrophils from patients with active GPA compared with healthy controls, independent of glucocorticoid treatment. Serum levels of IL-1-related cytokines were significantly increased in GPA patients, particularly in patients with kidney involvement, and levels of these cytokines returned to normal after patients achieved remission. Further, inflammasome-related proteins were significantly dysregulated in the cytosol of neutrophils as well as the serum from GPA patients. CONCLUSION Our data suggests that ROS production and regulation of inflammasomes in neutrophils from patients with GPA are disturbed and may be a potential therapeutic target. TRIAL REGISTRATION ClinicalTrials.gov, https://www.clinicaltrials.gov, NCT01862068.
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Affiliation(s)
- Jennifer Amsler
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Judith Everts-Graber
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katherine R Martin
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Inflammation Division, WEHI, and Department of Medical Biology, University of Melbourne, Parkville, Australia
| | - Arnaud Roccabianca
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Chloé Lopes
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Léa Tourneur
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Julie Mocek
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Marc Naccache
- Department of Pulmonology-Allergology-Thoracic Oncology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Bernard Bonnotte
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - Maxime Samson
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - Thomas Hanslik
- Service de Médecine Interne, Hôpital Ambroise-Paré, AP-HP, Boulogne Billancourt, France
| | - Xavier Puéchal
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Benjamin Terrier
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Loïc Guillevin
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Antoine Néel
- Service de Médecine Interne, CHU Nantes, Nantes, France
- CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Luc Mouthon
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Véronique Witko-Sarsat
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
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Romich E, Banerjee S, Amudala N, Chou S, Li R, Lee H, Cohen N, Merkel PA, Rhee RL. Patient-Reported Sinonasal Symptoms and Risk of Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Care Res (Hoboken) 2024; 76:1099-1108. [PMID: 38523260 PMCID: PMC11288776 DOI: 10.1002/acr.25329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Relapses are frequent and difficult to predict in antineutrophil cytoplasmic antibody-associated vasculitis (AAV), resulting in long-term use of immunosuppression. Although sinonasal disease is associated with relapse of AAV, detailed characterization of sinonasal symptoms is lacking. Using a patient-reported outcome, the 22-item SinoNasal Outcome Test (SNOT-22), we investigated the relationship between sinonasal symptoms and disease activity in AAV. METHODS This was a prospective, longitudinal study of individual with AAV and healthy individuals. Relapse was defined as a Birmingham Vasculitis Activity Score for Wegner's Granulomatosis score >0. Higher SNOT-22 scores indicate worse symptoms. Generalized estimating equation and Cox proportional hazard models evaluated the association between SNOT-22 and relapse. RESULTS There were 773 visits (106 active disease visits) from 168 patients with AAV and 51 controls. Median SNOT-22 at remission was higher in AAV versus controls (20 vs 5; P < 0.001) and higher during active disease versus remission (P < 0.001). In all AAV, and particularly within granulomatosis with polyangiitis, higher SNOT-22 scores were observed months to years before relapse and were associated with increased risk of relapse (hazard ratio 2.7, 95% confidence interval 1.2-6.2; P = 0.02). Similar findings were seen when examining patients with versus without sinonasal disease and after removing relapses limited to the ear, nose, and throat. CONCLUSION A patient-reported outcome measure of sinonasal disease, the SNOT-22, not only changes with disease activity in AAV, but also is associated with a higher risk of relapse within two years. These findings support the possibility that the SNOT-22 score may enhance prediction of relapse and that persistent sinonasal disease may be important in the pathophysiology of relapse.
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Affiliation(s)
| | | | | | - Sherry Chou
- University of Pennsylvania, Philadelphia, PA
| | - Ruolan Li
- University of Pennsylvania, Philadelphia, PA
| | - Hongzhe Lee
- University of Pennsylvania, Philadelphia, PA
| | - Noam Cohen
- University of Pennsylvania, Philadelphia, PA
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19
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Qi X, Yang J, Jin H, Xiao Y, Wang Y, Zhang Y. Clinical characteristics and risk factors of connective tissue disease complicated with bronchiectasis and pulmonary infection. APMIS 2024; 132:571-580. [PMID: 38798084 DOI: 10.1111/apm.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 05/03/2024] [Indexed: 05/29/2024]
Abstract
The clinical data from 118 CTD patients with bronchiectasis were collected and categorized into two groups: pulmonary infection present (n = 67) and absent (n = 51), for comparative analysis of characteristics and risk factors. Then, we analyzed and compared their demographics, disease characteristics, and risk factors for infection. Among the whole cohort (n = 118), the incidence of pulmonary infections was 56.78%. The occurrence of rheumatoid arthritis, systemic lupus erythematosus, and vasculitis was found to be associated with an increased risk of pulmonary infection. Sputum culture identified Pseudomonas aeruginosa and Klebsiella pneumoniae as the predominant pathogens in the infected group. Notably, symptoms such as joint pains (p = 0.018) and morning stiffness (p = 0.017) were significantly more common in the infected group compared to the noninfected group. Moreover, our findings revealed that elevated levels of C-reactive protein and complement C3, along with bronchial expansion observed on high-resolution computed tomography (HRCT), were significant independent factors in the infection group. Conversely, pulmonary interstitial changes identified through HRCT (OR: 0.135, 95% CI: 0.030-0.612, p = 0.009) were significantly associated with the non-infection group. Overall, this study provides valuable insights into managing CTD patients with bronchiectasis, emphasizing early detection and tailored approaches to prevent and treat pulmonary infections for better outcomes.
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Affiliation(s)
- Xuan Qi
- Department of Rheumatism and immunology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiaying Yang
- Department of Rheumatism and immunology, Zhenjiang First People's Hospital, Zhenjiang, China
| | - Hongtao Jin
- Department of Rheumatism and immunology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuran Xiao
- Department of Rhrumatism, Anguo City Hospital of Traditional Chinese Medicine, Anguo, China
| | - Ying Wang
- Department of Cardiology, Dingzhou people's hospital, Dingzhou, China
| | - Yiqing Zhang
- Department of Rheumatism and immunology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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20
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Oyama S, Yamashita H, Yamaji M, Kobayashi T, Kubota A, Shimizu J, Takemura T, Kaneko H. Muscular polyarteritis nodosa with fasciitis and upper extremity involvement. Rheumatol Adv Pract 2024; 8:rkae088. [PMID: 39099571 PMCID: PMC11297502 DOI: 10.1093/rap/rkae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- Setsuko Oyama
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Misa Yamaji
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toshiaki Kobayashi
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Jun Shimizu
- Department of Neurology, The University of Tokyo, Tokyo, Japan
- Department of Physical Therapy, Tokyo University of Technology, Tokyo, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Hiroshi Kaneko
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
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21
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Sun H, Liu L, Wang G, Kong W, Zhong Y, Yi L, Zou Y. Comparison of different doses of Tripterygium glycosides treating in IgA vasculitis nephritis: A Bayesian network meta-analysis. Heliyon 2024; 10:e34329. [PMID: 39114002 PMCID: PMC11305250 DOI: 10.1016/j.heliyon.2024.e34329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Background Tripterygium glycosides (TG) is extracted from the roots of Tripterygium wilfordii Hook F (Lei gong teng, a traditional Chinese medicine). It is widely used in China to treat immunoglobulin A vasculitis nephritis (IgAVN), which is a common secondary glomerular disease. As there are no guidelines for the rational application of TG, we performed this study to evaluate the efficacy and safety of different doses of TG and to determine the optimal treatment for IgAVN. Methods Ten databases were searched from their inception to April 2023 for randomised controlled trials (RCTs) using TG, TG combined with glucocorticoids (GC), or TG combined with traditional Chinese medicine (TCM) to treat IgAVN. A network meta-analysis was performed following the protocol (CRD42023401645). Results Forty-four eligible RCTs involving 3402 patients were included. For effective rate, TG 1.5 mg/kg/d (TG1.5) + TCM was ranked as the best intervention, followed by TG 1.0 mg/kg/d (TG1.0) + TCM, TG1.5, TG1.0+GC, TG1.0, TCM, GC, and routine treatment (RT). TG1.0+TCM ranked best in reducing recurrence, followed by TG1.0+GC, GC, TG1.5, and RT. Compared with TG1.0, TG1.0+TCM and TG1.5+TCM effectively reduced liver injury events. Compared with TG1.5, TG1.5+TCM and TG1.0+TCM effectively reduced leukopenia events. No significant differences in the reduction of gastrointestinal events were observed between the interventions. Subgroup analyses explored the effects of the participants' age. The intervention rankings of the outcomes generally remained consistent. Only a small difference was observed in gastrointestinal events. TCM was the best treatment for reducing gastrointestinal events in paediatric patients. Conclusions The results showed a positive correlation between dose and efficacy, whereas no relationship was found between dose and adverse events. TCM can boost the efficacy and reduce adverse events when combined with TG. In conclusion, we consider TG1.5+TCM as the best treatment for IgAVN. However, further research is required to confirm these findings.
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Affiliation(s)
- Hui Sun
- Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- No. 1 Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Lijia Liu
- Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- No. 1 Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Gang Wang
- Zou's Nephrology Medicine Intangible Cultural Heritage Inheritance Studio, Nanjing Boda Nephrology Hospital, Nanjing, Jiangsu, China
| | - Wei Kong
- Department of Nephrology, Nanjing Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yu Zhong
- Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Lan Yi
- Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yanqin Zou
- Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Zou's Nephrology Medicine Intangible Cultural Heritage Inheritance Studio, Nanjing Boda Nephrology Hospital, Nanjing, Jiangsu, China
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22
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Falde SD, Lal A, Cartin-Ceba R, Mertz LE, Fervenza FC, Zand L, Koster MJ, Warrington KJ, Lee AS, Aslam N, Abril A, Specks U. Treatment of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Diffuse Alveolar Hemorrhage With Avacopan. ACR Open Rheumatol 2024. [PMID: 39077977 DOI: 10.1002/acr2.11726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/10/2024] [Accepted: 06/30/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVE Avacopan, an activated complement factor 5 receptor antagonist, has been approved as adjunct therapy for severe active antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Current evidence supports the management of AAV presenting with diffuse alveolar hemorrhage (DAH) by administering glucocorticoids combined with either rituximab or cyclophosphamide in addition to supportive care. The role of avacopan in patients with DAH as a primary severe disease manifestation of AAV has not been well established. Furthermore, concerns remain regarding timely access to avacopan, the best glucocorticoid tapering regimen, and long-term efficacy and safety of the drug. We sought to identify clinical features and outcomes of patients presenting with DAH secondary to AAV who received avacopan in addition to glucocorticoids and rituximab or cyclophosphamide. METHODS We performed a retrospective cohort study of all consecutive patients presenting with DAH as part of active severe granulomatosis with polyangiitis or microscopic polyangiitis. Demographic and clinical characteristics were collected at presentation and follow-up. RESULTS Fifteen patients met inclusion criteria and were observed for a median time of 17 weeks (interquartile range [IQR] 6-37 weeks) after initiation of avacopan. Patients were predominantly female and White, had never smoked, and were a median age of 66 years (IQR 52-72 years) at diagnosis. The majority had newly diagnosed severe AAV with renal involvement. Three patients progressed to respiratory failure. The timing of avacopan introduction and patterns of glucocorticoid tapers varied widely in this cohort. Two serious adverse events related to infection were observed, including one opportunistic infection leading to the patient's death, although neither was directly attributed to avacopan administration. CONCLUSION We describe the clinical course of patients who presented with the severe AAV disease manifestation of DAH and received avacopan as adjunct therapy. Most patients achieved remission during follow-up, and adverse events, including infection, were observed.
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Affiliation(s)
| | - Amos Lal
- Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | | | | | | | - Andy Abril
- Mayo Clinic Jacksonville, Jacksonville, Florida
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23
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Kapoor M, Reddel SW. Ways to think about vasculitic neuropathy. Curr Opin Neurol 2024:00019052-990000000-00185. [PMID: 39046107 DOI: 10.1097/wco.0000000000001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Vasculitis as a pathomechanism for neuropathy can be isolated to the peripheral nervous system, a part of a systemic autoimmune condition or a component of another syndrome. This review aims to discuss the broad range of diagnoses in which vasculitic neuropathy can be encountered, highlight the progress in imaging techniques in identifying vasculitis, and the new drugs developed for other autoimmune diseases that may be applied to neurological conditions. RECENT FINDINGS Advances in imaging modalities, ultrasound, MRI and FDG-PET scanning for neuromuscular applications has redefined many aspects of vasculitic neuropathies. The benefit of dividing vasculitides by vessel size is becoming less absolute as diagnostic approaches advance. MRI and FDG-PET are widely used in diagnosis, defining extent of involvement of disease and monitoring. In neuralgic amyotrophy, the identification of hourglass-like constrictions on imaging has changed the treatment paradigm to include surgical interventions. These diagnostic approaches are supported by new immunomodulating and immunosuppression techniques. SUMMARY Vasculitic neuropathies are a broad group of conditions with a range of causes and associations. Increased use of imaging techniques impacts our traditional definitions and classifications. The growth in treatment options for other autoimmune conditions are likely to infiltrate the neurological landscape.
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Affiliation(s)
- Mahima Kapoor
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Centre, Melbourne, Victoria
| | - Stephen W Reddel
- ANZAC Research Institute, Central Clinical School, University of Sydney, Sydney, Australia
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24
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Alba MA, Kermani TA, Unizony S, Murgia G, Prieto-González S, Salvarani C, Matteson EL. Relapses in giant cell arteritis: Updated review for clinical practice. Autoimmun Rev 2024; 23:103580. [PMID: 39048072 DOI: 10.1016/j.autrev.2024.103580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/20/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Abstract
Giant cell arteritis (GCA), the most common primary vasculitis in adults, is a granulomatous systemic vasculitis usually affecting the aorta and its major branches, particularly the carotid and vertebral arteries. Although remission can be achieved in most patients with GCA using high-dose glucocorticoids (GC), relapses are frequent, occurring in >40% of GC-only treated patients, mostly during the first two years after diagnosis. Relapsing courses lead to high GC exposure, increasing the risk of treatment-related adverse effects. Although tocilizumab is an efficacious GC-sparing therapy that allows increased sustained remission and reduced cumulative GC doses, relapses are common after drug discontinuation. This narrative review examines the most relevant features of relapses in GCA, including its definition, classification, frequency, clinical, laboratory, and imaging characteristics, chronology, probable pathophysiology, and predictive factors. In addition, we discuss treatment options for relapsing patients and the effect of relapses on patient outcomes.
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Affiliation(s)
- Marco A Alba
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
| | - Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sebastian Unizony
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Murgia
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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25
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Baalbaki H, Dubé D, Ross C, Ducharme-Bénard S, Hussein S, Meunier RS, Pagnoux C, Makhzoum JP. Optic Nerve Sheath Measurement on Ultrasound: A Novel Diagnostic Test for Giant Cell Arteritis. ACR Open Rheumatol 2024. [PMID: 39037898 DOI: 10.1002/acr2.11729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE Optic nerve sheath enhancement on magnetic resonance imaging has been reported in patients with giant cell arteritis (GCA), with or without visual manifestations. Whether similar findings can be documented on ultrasound is unknown. Optic nerve ultrasound is a point-of-care, easy to learn, rapid, and noninvasive technique. This study aims to investigate whether optic nerve sheath diameter (ONSD) measured on ultrasound is useful in the diagnosis of active, new-onset GCA. METHODS A single-center, diagnostic accuracy study was performed from June to November 2022 on consecutive eligible patients referred for suspected GCA. Optic nerve ultrasound was performed on both eyes. The ONSD (includes the optic nerve and its sheath) and optic nerve diameter (OND) were measured 3 mm behind the ocular globe. The presence or absence of GCA was confirmed clinically 6 months later. Multivariable linear regression, adjusting for age and sex, was used to determine the association between optic nerve ultrasound measures and final GCA diagnosis. RESULTS Thirty participants were enrolled, including nine participants with a final diagnosis of GCA. Mean ± SD ONSD was 5.98 ± 1.17 mm in patients with GCA and 4.02 ± 0.99 mm in patients without GCA. Mean ONSD was greater by 1.26 mm in patients with GCA (95% confidence interval 0.30-2.21 mm, P = 0.01) compared with those without GCA, adjusting for age and sex. Mean ± SD OND was 2.97 ± 0.46 mm in patients with GCA and 2.47 ± 0.58 mm in patients without GCA. There was no evidence of an association between GCA diagnosis and OND. CONCLUSION Patients with GCA had a significantly greater ONSD on ultrasound than patients without GCA. Optic nerve ultrasound may represent a novel, rapid, bedside diagnostic test for GCA. A large prospective study is required to confirm these findings and evaluate whether ONSD can be used as a disease activity biomarker in GCA.
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Affiliation(s)
- Hussein Baalbaki
- Vasculitis Clinic, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - David Dubé
- Vasculitis Clinic, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Carolyn Ross
- Vasculitis Clinic, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | | | - Samer Hussein
- Vasculitis Clinic, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | | | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jean-Paul Makhzoum
- Vasculitis Clinic, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
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Chung J, Yoon T, Do H, Park YB, Lee SW. Circulating Malondialdehyde Is a Potential Biomarker for Predicting All-Cause Mortality during Follow-Up by Reflecting Comprehensive Inflammation at Diagnosis in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1182. [PMID: 39064611 PMCID: PMC11278744 DOI: 10.3390/medicina60071182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/07/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: To investigate whether circulating malondialdehyde (cMDA) at diagnosis could contribute to reflecting cross-sectional comprehensive inflammation or vasculitis activity and further predicting all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Materials and Methods: This study included 78 patients with AAV. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were collected as indices reflecting cross-sectional comprehensive inflammation, whereas the Birmingham vasculitis activity score (bVAS), and the five-factor score (FFS) were reviewed as AAV-specific indices. All-cause mortality was considered to be a poor outcome during follow-up. cMDA was measured from stored sera. Results: The median age of the 78 patients (32 men and 46 women) was 63.0 years. The median BVAS, FFS, ESR, and CRP were 5.0, 0, 24.5 mm/h, and 3.4 mg/L, respectively. Six patients died during the median follow-up duration based on all-cause mortality at 26.7 months. At diagnosis, cMDA was significantly correlated with cross-sectional ESR but not with BVAS or FFS. Compared to patients with cMDA < 221.7 ng/mL, those with cMDA ≥ 221.7 ng/mL at diagnosis exhibited an increased relative risk (RR 12.4) for all-cause mortality and further showed a decreased cumulative patient survival rate. Cox analyses revealed that cMDA ≥ 221.7 ng/mL (hazard ratio 24.076, p = 0.007) exhibited an independent association with all-cause mortality during follow-up in patients with AAV. Conclusions: cMDA at diagnosis may be a potential biomarker for predicting all-cause mortality during follow-up by reflecting comprehensive inflammation at diagnosis in patients with AAV.
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Affiliation(s)
- Jihye Chung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.C.); (Y.-B.P.)
| | - Taejun Yoon
- Department of Medical Science, BK21 Plus Project, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Hyunsue Do
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Republic of Korea;
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.C.); (Y.-B.P.)
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.C.); (Y.-B.P.)
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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27
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Zhang H, Yan D, Wei Y, He Y, Chang J, Zhang W. Case Report: two cases of anti-neutrophil cytoplasmic antibody-associated vasculitis involving large vessels. Front Cardiovasc Med 2024; 11:1434734. [PMID: 39091355 PMCID: PMC11291234 DOI: 10.3389/fcvm.2024.1434734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of systemic diseases caused by a combination of many factors, including genetics, environment, and immunity. AAV is characterized by predominantly small-vessel involvement and has a variety of clinical manifestations. Small-vessel lesions of the kidneys and lungs are common, and lesions of medium-sized arteries may also present, but the involvement of large arteries and their primary branches is very rare. This report delineates two instances of AAV with large arterial involvement, one case presenting with lesions of the aortic valve and the other with lesions of the pulmonary artery. The first case involved a 57-year-old man with no underlying diseases. Transthoracic echocardiography showed thickening of the left and right coronary valves of the aortic valve with enhanced echogenicity, moderate echogenic masses were seen on both valve leaflets, and the leaflets had restricted opening and poor closure. Blood tests showed positive perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) and anti-myeloperoxidase (MPO) antibodies. The patient's aortic valve thickening virtually disappeared after treatment with hormones combined with immunosuppressive agents. The second case involved a 60-year-old woman whose transthoracic echocardiography and CT (computed tomography) angiography of the pulmonary arteries showed wall thickening of the main pulmonary artery and the proximal left and right pulmonary arteries, leading to luminal stenosis. Blood tests showed positive cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA) and anti-proteinase 3 (PR 3) antibodies. The patient's pulmonary artery wall thickening reduced after receiving hormones in combination with immunosuppression but she died of heart failure during subsequent treatment. The patient had been diagnosed with tuberculosis six months earlier and had been poorly treated with anti-tuberculosis therapy. The involvement of large arteries in AAV is a rare and critical condition with rapid progression and a high mortality rate. Early recognition of this type of AAV and aggressive immunosuppressive therapy may facilitate the reversal of the vascular lesion and a reduction in the risk of patient death.
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Affiliation(s)
- Hanyu Zhang
- Department of Medical Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Dingfang Yan
- Department of Medical Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yuehua Wei
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yun He
- Department of Medical Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Junjie Chang
- Department of Medical Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Wenjun Zhang
- Department of Medical Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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28
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Abdulazim DO, Fadel MR, Yassin BM, Magdy M, Eissa BM. Ocular Damage Index, Ocular Pain and Subjective Visual Rating in Patients with Behçet's Uveitis: A Study of Impact on Health-Related Quality of Life. Ocul Immunol Inflamm 2024:1-8. [PMID: 39012760 DOI: 10.1080/09273948.2024.2375020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE The aim of our study is to assess subjective disease burden parameters (SVR and OP) as well as objective ones (BCVA and ODI) as predictors of HRQoL in Egyptian patients with BD uveitis. METHODS Ninety-six patients with BD uveitis were recruited in this cross-sectional study from the Rheumatology Department, Cairo University Hospital. HRQoL was assessed using RAND-36 item health survey 1.0, subjective visual rating (SVR) was measured on a 6-point Likert scale. Ocular pain (OP) was rated on a numeric rating scale. The Ocular Damage Index (ODI) was calculated using the ocular domain of the BD damage index. Linear regression was performed to determine predictors of HRQoL metrics. RESULTS SVR predicted Vitality (β = 0.15, p = 0.004), Emotional Well-being (EW) (β = 0.13, p = 0.005), General Health (β = 0.18, p = 0.012) and Mental Component Summary (β = 0.22, p = 0.002). OP predicted Social Function (β = -3.18 p < 0.001), General Health (β = -1.55, p = 0.004), Physical Component Summary (β = -2.00, p = 0.007) and Mental Component Summary (β = -1.53, p = 0.005). BCVA predicted Physical Function (β = 31.1, p = 0.02) and Emotional Well-being (β = 7.94, p = 0.01). ODI failed to predict any HRQoL metrics. ODI was independent predictor of legal blindness adjusted for uveitis duration and severity. Legally blind patients had worse HRQoL metrics than patients with better vision. CONCLUSION In BD uveitis patients, subjective disease burden parameters were more informative about HRQoL metrics than objective ones. Longitudinal studies are needed to elucidate the utility of ODI as an outcome measure in BD uveitis. PRECIS In Behcet's uveitis patients, health-related quality of life was related to visual outcome, ocular pain, and subjective visual rating. Ocular damage was an independent predictor of legal blindness, adjusted for uveitis duration and severity.
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Affiliation(s)
- Dina O Abdulazim
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mariam Raouf Fadel
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Bassant Mahmoud Yassin
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Magdy
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Basma M Eissa
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
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Guillevin L. [Anti-Neutrophil Cytoplasmic Antigens (ANCA)-associated vasculitis: Current therapeutics]. Biol Aujourdhui 2024; 218:19-24. [PMID: 39007773 DOI: 10.1051/jbio/2024001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Indexed: 07/16/2024]
Abstract
ANCA-associated vasculitis brings together three diseases, granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. This group of diseases has benefited over the last 3 decades from major therapeutic advances both in terms of therapeutic strategies and availability of new drugs, mainly for targeted therapies. Treatments, whether conventional or not, include an induction phase followed by a maintenance phase. Induction treatment today poses few problems. It is essentially based on the combination of corticosteroids and rituximab or cyclophosphamide. Remission is achieved in less than 6 months and maintenance treatment, preventing relapses, is then started. We showed that the best maintenance treatment was rituximab, surpassing the efficacy of methotrexate or azathioprine. During this phase, corticosteroid therapy is stopped or given at a very small dose. In Eosinophilic Granulomatosis with Polyangiitis (GEPA), the strategy is slightly different and there is a lack of prospective trials to demonstrate the benefits of rituximab or mepolizumab (anti-IL5) in inducing remission. Regarding maintenance treatment, prolonged corticosteroid therapy (orally and/or inhaled) is often necessary to control asthmatic disease. Only mepolizumab has shown its ability to prevent relapses and reduce the dose of corticosteroids controlling asthma. The current questions posed by maintenance treatment are its duration which could be variable and adapted to the risk of relapse and the risks induced by prolonged immunosuppression, particularly infectious.
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Affiliation(s)
- Loïc Guillevin
- Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
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30
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Xu H, Wu Z, Zhao Y, Hu C, Li P, Deng C, Li L, Bai Y, Song N, Luo J, Feng F, He C, Li Y, Zhang S. Antineutrophil cytoplasmic antibody is an independent risk factor in rheumatoid arthritis-associated interstitial lung disease. Clin Chim Acta 2024; 561:119845. [PMID: 38969087 DOI: 10.1016/j.cca.2024.119845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES This study aimed to investigate the clinical relevance of antineutrophil cytoplasmic antibody (ANCA) in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). METHODS Detailed clinical records of rheumatoid arthritis (RA) patients who underwent ANCA screening tests were collected. ANCA measurements were determined by indirect immunofluorescence assay (IIF) and enzyme-linked immunosorbent assay (ELISA). Clinical characteristics were compared between ANCA-positive and ANCA-negative groups, and multivariable logistic models were used to evaluate the independent association of ANCA with ILD in RA patients. RESULTS The prevalence of ANCA by IIF was significantly higher in RA-ILD patients compared to those with RA without ILD (31.7 % vs. 19.5 %, p < 0.001). RA-ILD patients positive for ANCA exhibited elevated levels of inflammatory markers and greater disease activity, and showed more severe impairment of lung function compared to ANCA-negative RA-ILD patients. Multivariable logistic regression analysis revealed an independent association of ANCA, especially pANCA, with RA-ILD. ANCA specificities for BPI, elastase, and cathepsin-G were found in 15.6 % of RA-ILD patients; the specificities for most others remain unknown. CONCLUSIONS The findings suggest a potential role for ANCA/pANCA in stratifying the risk of RA and provide supplementary information to the existing clinically available assays. This additional information may be valuable in identifying RA patients who require further investigations for RA-ILD, such as high-resolution computed tomography (HRCT). These results emphasize the potential clinical relevance of ANCA in the context of RA-ILD.
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Affiliation(s)
- Honglin Xu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ziyan Wu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chaojun Hu
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Li
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuiwen Deng
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijun Li
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yina Bai
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Song
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinmei Luo
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Futai Feng
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chengmei He
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yongzhe Li
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Shulan Zhang
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Liu S, Xu M, Zhao X, Yang J, Zhang W, Chen Y. Ocular manifestations in ANCA-associated vasculitis: a comprehensive analysis from Chinese medical centers. Clin Rheumatol 2024:10.1007/s10067-024-07034-y. [PMID: 39002071 DOI: 10.1007/s10067-024-07034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION This study aimed to explore ocular manifestations in ANCA-associated vasculitis (AAV), focusing on granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), and microscopic polyangiitis (MPA) and to examine the associations with laboratory parameters and other systemic manifestations. METHODS This retrospective study reviewed data from 533 AAV patients across two major Chinese medical centers from January 2016 to November 2023. Data including diagnosis, cranial manifestations of disease, ocular complications, and laboratory parameters were analyzed. Univariate and multivariable logistic regression analyses assessed associations across disease manifestations. Machine learning models were also utilized to predict the risk of retinal/eye involvement in AAV patients. RESULTS Among 533 patients (210 GPA, 217 MPA, 99 EGPA, and 7 unclassified AAV), ocular complications were observed in 20.64% of them, with a distribution of 36.67% in GPA, 7.37% in MPA, and 18.18% in EGPA. The most common ocular manifestations included scleritis and retro-orbital mass/dacryocystitis, which were notably prevalent in GPA patients. Retinal involvement was observed in 9.09% of EGPA cases. The machine learning models yielded that eosinophil percentage (EOS%), high-sensitivity C-reactive protein (hsCRP), and CD4 + T cell/CD8 + T cell ratio (T4/T8) can predict retinal involvement. Furthermore, the white blood cell, EOS%, APTT, IgA, hsCRP, PR3-ANCA, and T4/T8 can predict eye involvement. CONCLUSION Ocular manifestations are a prevalent complication across all forms of AAV. Predictive models developed through machine learning offer promising tools for early intervention and tailored patient care. This necessitates a multidisciplinary approach, integrating rheumatology and ophthalmology expertise for optimal patient outcomes.
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Affiliation(s)
- Shulin Liu
- Department of Ophthalmology, Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Xu
- Department of Ophthalmology, Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenfei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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32
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Bloom JL, Wu EY. Update on antineutrophil cytoplasmic autoantibody vasculitis in children. Curr Opin Rheumatol 2024:00002281-990000000-00124. [PMID: 38990100 DOI: 10.1097/bor.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
PURPOSE OF REVIEW Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is often organ- or life-threatening in children and impacts them during important periods of psychosocial and physical development. This review covers recent advances in the pathophysiology, diagnosis, management, and outcomes of AAV in children and highlights the ongoing need for funding and increased research collaboration. RECENT FINDINGS Recent work has improved our understanding of AAV disease pathogenesis, potentially identifying new biomarkers and therapeutic targets. Collaborative clinical studies have also highlighted the variable manifestations in children and identified potential factors associated with poorer outcomes. Consensus-based treatment guidelines are also appearing, but clinical trials are still essential to better understanding treatment efficacy and safety in children affected by AAV. New, validated outcome measures, including those that are patient-reported, will facilitate these much-needed clinical trials in pediatric AAV. SUMMARY There is a continued need for more rigorous study in pediatric AAV, however, there is certainly excitement with the increase in recent research relevant to the pediatric population.
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Affiliation(s)
- Jessica L Bloom
- University of Colorado, Department of Pediatrics, Division of Rheumatology, Denver, Colorado
| | - Eveline Y Wu
- University of North Carolina at Chapel Hill, Department of Pediatrics, Division of Rheumatology
- University of North Carolina at Chapel Hill, Department of Pediatrics, Division of Allergy/Immunology, Chapel Hill, North Carolina, USA
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Kim TH, Son Y, Lee H, Lee K, Lee H, Park J, Kim S, Smith L, Lee S, Jeong YD, Jo H, Udeh R, Pizzol D, Kang J, Yon DK. Biomarkers and Related Factors for the Diagnosis, Risk of Coronary Artery Lesions, and Resistance to Intravenous Immunoglobulin in Kawasaki Disease: An Umbrella Review of Meta-Analyses. Pediatr Cardiol 2024:10.1007/s00246-024-03563-0. [PMID: 38980324 DOI: 10.1007/s00246-024-03563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/22/2024] [Indexed: 07/10/2024]
Abstract
Kawasaki disease (KD) is a self-limited febrile disease predominantly affecting infants and children under 5 years old. Coronary artery lesions (CAL) are a prevalent complication, highlighting the necessity for swift diagnosis and treatment. A comprehensive review of biomarkers applicable for the diagnosis and treatment of Kawasaki disease (KD) in clinical settings is imperative. To provide a comprehensive review and analysis of biomarkers for diagnosis of KD, incidence of CAL, and intravenous immunoglobulin (IVIG) resistance. The data included in our study were sourced from searches conducted in PubMed/MEDLINE, Embase, EBSCO, and Google Scholar until March 15, 2024. Studies investigating the association with KD or evaluating diagnostic value were included in our study. Eligibility was independently assessed by two authors, with conflicts resolved through discussion. Data extraction was performed by 2 independent authors, following Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guideline. Data were pooled using a random-effects model. We assess biomarkers relevant to KD, categorizing them into three groups: diagnostic, associated with CAL incidence, and linked to IVIG resistance. For studies focusing solely on association, we present standardized mean differences (SMD). For those reporting sensitivity and specificity as diagnostic measures, we calculate the diagnostic odds ratio (DOR) to compare their efficacy. We identified 14 meta-analyses on biomarkers related to KD. 11 biomarkers exhibited diagnostic value for KD, while 21 were associated with its progression. Four biomarkers, including non-coding RNAs (DOR, 19.35 [95% CI, 13.58-27.56]), Serum ferritin (DOR, 24.90 [11.67-53.12]), N terminal proBNP (DOR, 21.03 [9.03-49.00]), and micro RNAs (DOR, 45.28 [6.30-325.52]), have significant diagnostic value for the diagnosis of KD. Seven biomarkers showed significant association with the incidence of CAL. Twenty biomarkers were for the prediction of IVIG resistance, including prognostic nutritional index (DOR, 7.72 [95% CI, 2.37-25.09]), non-coding RNAs (DOR, 14.63 [3.24-66.14]), neutrophil to lymphocyte ratio (DOR, 6.62 [4.05-10.81]), platelet to lymphocyte ratio (DOR, 3.30 [2.10-5.19]), and C reactive protein (DOR, 6.58 [3.69-11.74]). Based on the evidence, we have proposed various biomarkers associated with KD. Our aim is for these biomarkers to have wide applicability in both diagnostic and therapeutic settings.
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Affiliation(s)
- Tae Hyeon Kim
- Department of Medicine, Kyung Hee University, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yejun Son
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Kyeongmin Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Sooji Lee
- Department of Medicine, Kyung Hee University, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yi Deun Jeong
- Department of Medicine, Kyung Hee University, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyesu Jo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Raphael Udeh
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, Australia
| | - Damiano Pizzol
- Health Unit Eni, Maputo, Mozambique
- Health Unit Eni, San Donato Milanese, Italy
| | - Jiseung Kang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 149 13th Street, Room 4140, Charlestown, Boston, MA, USA.
- Division of Sleep Medicine, Department of Anesthesia, Harvard Medical School, Boston, MA, USA.
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University, Seoul, South Korea.
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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Kurashina JI, Shimojima Y, Kishida D, Ichikawa T, Uehara T, Sekijima Y. Multiple lymphadenopathies in eosinophilic granulomatosis with polyangiitis: Differentiating from IgG4-related lymphadenopathy. Mod Rheumatol Case Rep 2024; 8:318-322. [PMID: 38661295 DOI: 10.1093/mrcr/rxae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
We report a case of eosinophilic granulomatosis with polyangiitis in a 75-year-old man who developed mononeuritis multiplex and purpura in the lower legs concomitantly presenting with lymphadenopathies. Biopsied lymph node tissue pathologically demonstrated fibrinoid necrotising vasculitis with perivascular eosinophil infiltration, resulting in eosinophilic granulomatosis with polyangiitis diagnosis. Additionally, abundant immunoglobulin (Ig) G4-positive plasma cell infiltration exhibiting >70% IgG4/IgG ratio, without storiform pattern fibrosis and obliterative phlebitis, was observed in the biopsied lymph node. Clinical improvement was observed after corticosteroid therapy. IgG4-related lymphadenopathy has been defined as a distinct clinical category regardless of fulfilling IgG4-related disease classification criteria. However, some autoimmune diseases, including eosinophilic granulomatosis with polyangiitis, can develop lymphadenopathy pathologically similar to IgG4-related lymphadenopathy.
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Affiliation(s)
- Jun-Ichi Kurashina
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
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Kawaguchi R, Usagawa H, Miyawaki Y, Oiwa H. A case of eosinophilic granulomatosis with polyangiitis associated with diffuse alveolar haemorrhage: A case report and case-based review. Mod Rheumatol Case Rep 2024; 8:398-403. [PMID: 38676913 DOI: 10.1093/mrcr/rxae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/29/2024]
Abstract
A 76-year-old man with bronchial asthma was admitted for respiratory failure and bloody sputum. A significant drop in haemoglobin and multiple consolidations supported clinical diagnosis of diffuse alveolar haemorrhage (AH). Myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was positive and urinalysis suggested glomerulonephritis. Based on eosinophilia, sinusitis, peripheral nerve involvement, and leukocytoclastic vasculitis, he was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) associated with AH. Our case-based review suggested that male predominance (65%), high positivity for ANCA (88%), and a high frequency of renal involvement (45%) may be characteristic of AH in EGPA. Although AH is rare in EGPA, we should be aware of this life-threatening complication.
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Affiliation(s)
- Rira Kawaguchi
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hirohisa Usagawa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshia Miyawaki
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Oiwa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Sofue H, Kida T, Hirano A, Omura S, Kadoya M, Nakagomi D, Abe Y, Takizawa N, Nomura A, Kukida Y, Kondo N, Yamano Y, Yanagida T, Endo K, Hirata S, Matsui K, Takeuchi T, Ichinose K, Kato M, Yanai R, Matsuo Y, Shimojima Y, Nishioka R, Okazaki R, Takata T, Ito T, Moriyama M, Takatani A, Miyawaki Y, Ito-Ihara T, Yajima N, Kawaguchi T, Fujioka K, Fujii W, Seno T, Wada M, Kohno M, Kawahito Y. Optimal dose of intravenous cyclophosphamide during remission induction therapy in ANCA-associated vasculitis: A retrospective cohort study of J-CANVAS. Mod Rheumatol 2024; 34:767-774. [PMID: 37801552 DOI: 10.1093/mr/road099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/19/2023] [Accepted: 09/09/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To identify the optimal dose of intravenous cyclophosphamide (IVCY) for induction therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis. METHODS We retrospectively assessed patients with antibody-associated vasculitis who received IVCY every 2-3 weeks during the remission induction phase. The associations of the IVCY dose with infection-free survival and relapse-free survival were analysed using a Cox regression model. We compared patients in three categories: very low-dose (VLD), low-dose (LD), and conventional dose (CD) (<7.5 mg/kg, 7.5-12.5 mg/kg, and >12.5 mg/kg, respectively). The non-linear association between IVCY dose and the outcomes was also evaluated. RESULTS Of the 80 patients (median age 72 years), 12, 42, and 26 underwent the VLD, LD, and CD regimens, respectively, of whom 4, 3, and 7 developed infection or died. The adjusted hazard ratios for infection or death were 4.3 (95% confidence interval (CI) 0.94-19.8) for VLD and 5.1 (95% CI 1.21-21.3) for CD, compared with LD. We found the hazard ratio for infection or death increased when the initial IVCY dose exceeded 9 mg/kg. Relapse-free survival did not differ clearly. CONCLUSION Low-dose IVCY (7.5-12.5 mg/kg) may result in fewer infections and similar relapse rates compared with the conventional regimen (>12.5 mg/kg).
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Affiliation(s)
- Hideaki Sofue
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kida
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Aiko Hirano
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Omura
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masatoshi Kadoya
- Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daiki Nakagomi
- Department of Rheumatology, University of Yamanashi Hospital, Yamanashi, Japan
| | - Yoshiyuki Abe
- Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo, Japan
| | - Naoho Takizawa
- Department of Rheumatology, Chubu Rosai Hospital, Nagoya, Japan
| | - Atsushi Nomura
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Yuji Kukida
- Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan
| | - Naoya Kondo
- Department of Nephrology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan
| | - Takuya Yanagida
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan
| | - Koji Endo
- Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kiyoshi Matsui
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Yanai
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Matsuo
- Department of Rheumatology, Tokyo Kyosai Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryo Nishioka
- Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ryota Okazaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tomoaki Takata
- Division of Gastroenterology and Nephrology, Tottori University, Yonago, Japan
| | - Takafumi Ito
- Division of Nephrology, Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Mayuko Moriyama
- Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Ayuko Takatani
- Rheumatic Disease Center, Sasebo Chuo Hospital, Nagasaki, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiko Ito-Ihara
- The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kazuki Fujioka
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Wataru Fujii
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahiro Seno
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Wada
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Schindler V, Venhoff N. [Eosinophilic granulomatosis with polyangiitis: a review article]. Laryngorhinootologie 2024. [PMID: 38964344 DOI: 10.1055/a-2214-1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of ANCA-associated vasculitis (AAV) within the group of small vessel vasculitides. It is defined by vasculitis of small and medium-sized vessels with granulomatous inflammation and blood and tissue eosinophilia. Almost all patients have allergic symptoms with bronchial asthma and rhinosinusitis symptoms. Further clinical manifestations vary depending on the localisation, severity, and type of disease manifestation. Eosinophilic infiltration and inflammation may result in rhinosinusitis, pneumonitis, gastrointestinal involvement, and cardiomyopathy. The latter, in particular, is associated with a worse prognosis. As a necrotising pauci-immune small-vessel vasculitis, EGPA, similar to the other AAVs, can cause pulmonary infiltrates with alveolar haemorrhage, glomerulonephritis, cutaneous vasculitis with purpura as well as central and peripheral neurologic injuries. The presence of perinuclear ANCA (pANCA) with specificity against myeloperoxidase (MPO) is observed in approximately one-third of patients but is not specific to EGPA. MPO-ANCA-positive patients are more likely to have peripheral neurologic involvement and glomerulonephritis, whereas ANCA-negative patients are more likely to have cardiac and pulmonary involvement. What is frequently challenging in the clinical routine is to differentiate EGPA from the hypereosinophilic syndrome (HES). The therapeutic approach to EGPA depends on whether the severity of the disease is potentially organ or life-threatening. For severe forms of EGPA, acute therapy mainly includes glucocorticoids in combination with cyclophosphamide. Rituximab has come to be mentioned as an alternative treatment option in the guidelines. Various immunosuppressive therapies are available for remission maintenance. In EGPA without severe organ involvement, IL-5 blockade with mepolizumab is an approved treatment.
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Affiliation(s)
- Viktoria Schindler
- Klinik für Rheumatologie und Klinische Immunologie, Department Innere Medizin, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Klinik für Rheumatologie und Klinische Immunologie, Department Innere Medizin, Universitätsklinikum Freiburg, Freiburg, Germany
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Di Ludovico A, Rinaldi M, Lauriola F, Ciarelli F, La Bella S, Gualdi G, Chiarelli F, Bailey K, Breda L. The Diagnostic Role of Skin Manifestations in Rheumatic Diseases in Children: A Critical Review of Paediatric Vasculitis. Int J Mol Sci 2024; 25:7323. [PMID: 39000430 PMCID: PMC11242831 DOI: 10.3390/ijms25137323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
Skin lesions are frequently observed in children with rheumatic diseases, particularly in conditions such as IgA vasculitis (IgAV) and Kawasaki disease (KD). In paediatric vasculitis, the presence of skin lesions serves as an early indicator, emphasising the importance of timely diagnosis to prevent complications, such as cardiac or renal involvement. Conversely, autoinflammatory disorders like juvenile systemic lupus erythematosus (SLE) and juvenile dermatomyositis (DM) may manifest with cutaneous manifestations either at the onset of disease or during its progression. Identifying these skin lesions prior to the appearance of systemic symptoms offers an opportunity for early diagnosis and treatment, which has a positive influence on the outcomes. Additionally, it is noteworthy that specific rheumatological conditions, such as acute rheumatic fever (ARF) or oligoarticular or polyarticular forms of juvenile idiopathic arthritis (JIA), may exhibit occasional, but significant skin involvement, which is strongly correlated with an unfavourable prognosis. The assessment of skin is important in the holist approach to assessing patients for potentially systemic/multisystem disorder and helps distinguish discrete conditions.
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Affiliation(s)
- Armando Di Ludovico
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Marta Rinaldi
- Paediatric Department, Buckinghamshire Healthcare NHS Trust, Aylesbury-Thames Valley Deanery, Oxford HP21 8AL, UK
| | - Federico Lauriola
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Francesca Ciarelli
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Saverio La Bella
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Giulio Gualdi
- Dermatology Clinic, Department of Medicine and Aging Science, University G D’Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Chiarelli
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Kathryn Bailey
- Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Luciana Breda
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
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Gozzi L, Cozzi D, Zantonelli G, Giannessi C, Giovannelli S, Smorchkova O, Grazzini G, Bertelli E, Bindi A, Moroni C, Cavigli E, Miele V. Lung Involvement in Pulmonary Vasculitis: A Radiological Review. Diagnostics (Basel) 2024; 14:1416. [PMID: 39001306 PMCID: PMC11240918 DOI: 10.3390/diagnostics14131416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
Pulmonary vasculitis identifies a heterogeneous group of diseases characterized by inflammation, damage and necrosis of the wall of pulmonary vessels. The most common approach to classify vasculitis is according to etiology, therefore dividing them into primary and secondary, with a further sub-classification of primary vasculitis based on the size of the affected vessels (large, medium, and small). Pulmonary involvement is frequently observed in patients with systemic vasculitis and radiological presentation is not pathognomonic, but may vary between diseases. The main findings using high-resolution computed tomography (HRCT) include small vessel wall thickening, nodular lesions, cavitary lesions, reticular opacities, ground-glass opacities (GGO), consolidations, interlobular septal thickening, tracheobronchial stenosis, and aneurysmal dilatation of pulmonary arteries, with or without pleural effusion. Radiological diagnosis alone is difficult since signs and symptoms of lung vessel involvement are often non-specific and might overlap with other conditions such as infections, connective tissue diseases and neoplasms. Therefore, the aim of this review is to describe the most common radiological features of lung involvement in pulmonary vasculitis so that, alongside detailed clinical history and laboratory tests, a prompt diagnosis can be performed.
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Affiliation(s)
- Luca Gozzi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Zantonelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Caterina Giannessi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Simona Giovannelli
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Olga Smorchkova
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
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Collie MM, Chen DP, Hu Y, Blazek LN, Derebail VK, Wu EY, Jain K, Orzechowski N, Poulton CJ, Henderson CD, Falk RJ, Hogan SL. Examining the role of patient-reported external factors and risk of relapse in anti-neutrophilic cytoplasmic autoantibody vasculitis. FRONTIERS IN NEPHROLOGY 2024; 4:1404451. [PMID: 39015144 PMCID: PMC11249541 DOI: 10.3389/fneph.2024.1404451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/27/2024] [Indexed: 07/18/2024]
Abstract
The role of stressors, insect bites, and infections on disease relapse of ANCA vasculitis has yet to be entirely explored, with limited retrospective studies focused on disease onset from small participant cohorts. Our study analyzes longitudinal survey data from 2011-2022 to evaluate this perspective from a large ANCA vasculitis cohort. We collected surveys every three to six months to obtain information on self-reported psychological stressors and significant life events, insect bites, and infections throughout clinical disease. We defined cohorts as those who relapsed (Relapse Cohort) and controls as those who did not relapse (Remission Cohort) during the study period. Survey responses were retrospectively reviewed during a 15-month timeframe prior to relapse or during 15 months of remission and categorized by type of stress event, insect bite, and infections at every available 3-month interval. There were no significant differences in stress and insect bites between the relapse and remission cohorts. Patients who relapsed reported more frequent upper respiratory infections and other infections, such as those affecting the skin and eyes, but there were no significant differences in the incidence of pulmonary or urinary infections compared to the remission cohort. There was a significant difference in reported upper respiratory infections 9 to 15 months prior to the relapse date, indicating a remote history of infections as a potentially significant physical stressor that may contribute to disease relapse. More frequent patient-reported infections, specifically upper respiratory infections, may contribute to patient vulnerability to relapse. Counseling and close monitoring of patients after infectious symptoms could aid in earlier detection of disease flares. Future studies are essential to further understand the importance of distal risk factors and how they impact relapse.
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Affiliation(s)
- Mary M. Collie
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Dhruti P. Chen
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Yichun Hu
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Lauren N. Blazek
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Vimal K. Derebail
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Eveline Y. Wu
- Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Koyal Jain
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Nicole Orzechowski
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Caroline J. Poulton
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Candace D. Henderson
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Ronald J. Falk
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Susan L. Hogan
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
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Chung SA, Kermani TA. Improving on Intuition: Assessing Disease Activity in Takayasu Arteritis. Arthritis Care Res (Hoboken) 2024; 76:905-907. [PMID: 38433604 DOI: 10.1002/acr.25320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Sharon A Chung
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco
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Chandola S, Chopra K, Chawla R, Azad SV, Jana M, Bagri NK. Pediatric Behçet's disease masquerading as pulmonary malignancy. Int J Rheum Dis 2024; 27:e15262. [PMID: 39031015 DOI: 10.1111/1756-185x.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/22/2024]
Affiliation(s)
- Stuti Chandola
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Karan Chopra
- Department of Pediatrics, AIIMS, New Delhi, India
| | - Rohan Chawla
- Ophthalmology, Dr Rajendra Prasad Centre, AIIMS, New Delhi, India
| | | | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
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Sakabe M, Tobino K, Obata Y, Sogabe S, Uchida K, Murakami Y. Eosinophilic granulomatosis with polyangiitis developed during treatment with benralizmab for severe asthma: A case report and literature review. Respirol Case Rep 2024; 12:e01431. [PMID: 38988828 PMCID: PMC11233256 DOI: 10.1002/rcr2.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disorder characterized by necrotizing vasculitis, asthma, and eosinophilia. We report a case of EGPA that developed during benralizumab treatment for severe asthma and provide a literature review. A 79-year-old Japanese male with severe asthma presented with generalized purpura 4 months after initiating benralizumab treatment. He had reduced his oral prednisolone dose from 7.5 to 2 mg/day. Laboratory tests revealed eosinophilia, and skin biopsy showed vasculitis with eosinophilic infiltration. He was diagnosed with EGPA and treated with corticosteroids, azathioprine, and mepolizumab, which led to rapid improvement and sustained remission. Five cases of EGPA developing during benralizumab treatment have been reported, with onset ranging from 14 to 36 weeks after initiation. Clinicians should monitor for EGPA development in patients receiving benralizumab, particularly during oral corticosteroid reduction.
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Affiliation(s)
| | - Kazunori Tobino
- Department of Respiratory Medicine Iizuka Hospital Iizuka Japan
- Department of Respiratory Medicine Juntendo University, School of Medicine Bunkyo-Ku Japan
| | - Yumi Obata
- Department of Respiratory Medicine Iizuka Hospital Iizuka Japan
| | - Shota Sogabe
- Department of Respiratory Medicine Iizuka Hospital Iizuka Japan
| | - Kazuki Uchida
- Department of Respiratory Medicine Iizuka Hospital Iizuka Japan
| | - Yosuke Murakami
- Department of Respiratory Medicine Iizuka Hospital Iizuka Japan
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Liu L, Zhu Y, Lan J, Chu L, Li W, Xue C. Association between CBL gene polymorphism and susceptibility of microscopic polyangiitis in a Chinese population: A case-control analysis. Cytokine 2024; 179:156596. [PMID: 38669907 DOI: 10.1016/j.cyto.2024.156596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/06/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To assess whether Casitas B-lineage lymphoma (CBL) gene polymorphism influences the risk of microscopic polyangiitis (MPA) in Chinese populations. METHODS In total, 266 MPA patients and 297 healthy controls were recruited for a case-control study. Five CBL SNPs were genotyped using multiplex polymerase chain reaction and high-throughput sequencing. The relationship between SNPs and the risk of MPA under different genetic models was evaluated by SNPstats. SNP-SNP interaction was analyzed by generalized multifactor dimensionality reduction (GMDR). Finally, the association between CBL SNPs and treatment effects were assessed. RESULTS The results showed that CBL rs2276083 was associated with decreasing MPA risk under dominant (OR: 0.53; p = 0.014) and recessive models (OR: 0.52; p = 0.0034). Stratification analysis indicated that rs2276083 and rs2509671 in age < 60 years, rs2276083 in female or in Han population were protective factors for MPA. The CBL haplotype (A-A-G-C-T) was associated with an increased risk of MPA. GMDR suggested that CBL rs2276083, phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PI3KCA) rs1607237, and autophagy-related gene 7 (ATG7) rs7549008 might interact with each other in MPA development (p = 0.0107). CBL rs1047417 with AG genotype and rs11217234 with AG genotype had better clinical treatment effects than other two genotypes (p = 0.048 and p = 0.025, respectively). CONCLUSION The genetic polymorphism of CBL had a potential association with the risk of MPA and clinical treatment effects in Guangxi population in China.
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Affiliation(s)
- Liu Liu
- The Second Affiliated Hospital of Guangxi Medical University, Department of Nephrology, Nanning Guangxi, 530007, China; The First Affiliated Hospital, Department of Nephrology, Hengyang Medical School, University of South China, Hengyang Hunan, 421001, China
| | - Yan Zhu
- The First Affiliated Hospital, Department of Nephrology, Hengyang Medical School, University of South China, Hengyang Hunan, 421001, China
| | - Jingjing Lan
- The Second Affiliated Hospital of Guangxi Medical University, Department of Nephrology, Nanning Guangxi, 530007, China
| | - Liepeng Chu
- The Second Affiliated Hospital of Guangxi Medical University, Department of Nephrology, Nanning Guangxi, 530007, China
| | - Wei Li
- The Second Affiliated Hospital of Guangxi Medical University, Department of Nephrology, Nanning Guangxi, 530007, China
| | - Chao Xue
- The Second Affiliated Hospital of Guangxi Medical University, Department of Nephrology, Nanning Guangxi, 530007, China.
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Wölbing P, Dugas-Breit S, Hartschuh W, Toberer F. [Bronchial asthma and allergic rhinitis-The skin sample reveals a severe systemic disease]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:572-576. [PMID: 38502363 PMCID: PMC11224073 DOI: 10.1007/s00105-024-05323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
This article reports the case of a 30-year-old female patient who suffered for many years from initially unspecific symptoms, such as recurrent, nonallergic and noninfectious sinusitis, late-onset bronchial asthma and pronounced lymphadenopathy; however, the correct diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) could only be made by histological investigations after the appearance of skin symptoms. The EGPA is a severe systemic disease which, if left untreated, can cause multiple organ damage and even be fatal. With adequate treatment the disease is mild in more than 90% of cases and patients can even completely recover. By making the correct diagnosis, the patient could be successfully treated and the risk of late manifestations and subsequent damage with a potentially fatal outcome was reduced.
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Affiliation(s)
- Priscila Wölbing
- Hautklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Susanne Dugas-Breit
- Hautklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Wolfgang Hartschuh
- Hautklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
- Drs. Durani, Haut- und Laserzentrum Heidelberg, Heidelberg, Deutschland
| | - Ferdinand Toberer
- Hautklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
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Reggiani F, Stella M, Calatroni M, Sinico RA. Treatment strategies for ANCA-associated vasculitides: from standard protocols to future horizons. Expert Rev Clin Immunol 2024; 20:765-780. [PMID: 38445642 DOI: 10.1080/1744666x.2024.2326628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION ANCA-associated vasculitides (AAV), classified into granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis represent a group of disorders characterized by necrotizing vasculitis of small vessels, endothelial injury and tissue damage. The outcomes and prognosis of AAV have undergone significant changes with the introduction of glucocorticoids (GCs) and other immunosuppressants (cyclophosphamide, azathioprine, methotrexate, and mycophenolate mofetil). The enhanced understanding of pathogenesis has subsequently led to the incorporation into clinical practice of drugs targeting specific therapeutic targets. AREAS COVERED After an extensive literature search of Pubmed, Medline, Embase of the most recent evidence, we provide an overview of available treatments, highlighting how newer drugs have integrated into standard protocols. Our review also explores potential new therapeutic targets, including B cell depletion and inhibition, T cell inhibition, complement inhibition, and IL-5 and IgE inhibition. EXPERT OPINION There is hope that the new treatment targets currently under study in AAV may enable a faster and more lasting clinical response, ensuring the reduction of possible side effects from therapies. Moreover, numerous aspects necessitate further exploration in the future, such as tailoring of GCs, integration of GCs-sparing agents, efficacy of combination therapy, optimal maintenance therapy, to reduce organ-damage and improve quality of life.
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Affiliation(s)
- Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Stella
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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Jakes RW, Kwon N, Huynh L, Hwee J, Baylis L, Alfonso-Cristancho R, Du S, Khanal A, Duh MS, Terrier B. Burden of eosinophilic granulomatosis with polyangiitis in Europe. ERJ Open Res 2024; 10:00912-2023. [PMID: 39104949 PMCID: PMC11299011 DOI: 10.1183/23120541.00912-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/26/2024] [Indexed: 08/07/2024] Open
Abstract
Background and aims Real-world evidence characterising the burden of eosinophilic granulomatosis with polyangiitis (EGPA) in Europe is limited. The aim of this study was to characterise patients in a large European EGPA cohort. Methods This retrospective, non-interventional, longitudinal study (GSK ID: 214661) recruited cross-specialty physicians from France, Germany, Italy, Spain and the UK to conduct medical chart reviews for patients with a physician-confirmed diagnosis of EGPA. Patients were ≥12 years of age at diagnosis with ≥1 year of follow-up data from the first clinical visit with the physician (index date). Outcome measures collected from index date to end of follow-up included clinical manifestations and healthcare resource utilisation (HCRU). Results In total, 407 patient medical charts were reviewed by 204 physicians; median (interquartile range) duration of follow-up from index date was 2.2 (1.7-3.5) years. Most patients (73.5%) had asthma. Patients underwent multiple diagnostic assessments, and 74.9% received ≥3 different therapies between diagnosis and end of follow-up (98.8% oral corticosteroids, 63.9% immunosuppressive therapies, 45.5% biologics). During follow-up, 84.5% of patients experienced EGPA clinical manifestations; most were considered moderate or severe and commonly affected the lungs (55.8%; including lung infiltrates 25.8% and severe asthma 24.8%), ear, nose and throat (53.3%), and skin (41.8%). HCRU was substantial: 26.0% of patients made emergency department visits, 36.6% were hospitalised and 84.8% had outpatient visits. Conclusions These real-world data show that EGPA presents a substantial burden to patients and the healthcare system. Earlier and better differential diagnosis and appropriate treatment may help reduce incidence of clinical manifestations and HCRU.
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Affiliation(s)
| | - Namhee Kwon
- Clinical Sciences, Respiratory, GSK, London, UK
| | | | | | - Lee Baylis
- Global Medical Affairs, GSK, Durham, NC, USA
| | | | - Shawn Du
- Analysis Group, Inc., Boston, MA, USA
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Ergelen R, Kutluğ Ağaçkıran S, Direskeneli H, Alibaz-Oner F. Common femoral vein wall thickness measurement by Doppler ultrasonography is an accurate diagnostic test for Behçet's Disease both in supine and standing positions. Phlebology 2024; 39:388-392. [PMID: 38386018 DOI: 10.1177/02683555241235436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES We recently reported the first controlled Doppler ultrasonography (US) study demonstrating increased common femoral vein (CFV) thickness in Behçet's Disease (BD). Standard lower extremity venous Doppler US is performed in erect position. In order to confirm accuracy and applicability of method, we measured CFV thickness in both supine and standing positions in this study. METHOD We included sex and age-matched 42 BD patients and 41 healthy controls (HCs). After routine visits, bilateral CFV thickness was measured with Doppler US both in supine and standing positions. RESULTS Bilateral CFV thickness was significantly higher in BD than in HC. There were no statistically significant differences in measurements of CFV wall thickness between standing and supine positions in both groups. CONCLUSIONS CFV measurement by Doppler US is a new and non-invasive diagnostic tool for the diagnosis of BD. Our study confirmed that patient position does not affect CFV wall thickness measurement for diagnosis of BD.
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Affiliation(s)
- Rabia Ergelen
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Seda Kutluğ Ağaçkıran
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
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Borrelli S, Martire MS, Stölting A, Vanden Bulcke C, Pedrini E, Guisset F, Bugli C, Yildiz H, Pothen L, Elands S, Martinelli V, Smith B, Jacobson S, Du Pasquier RA, Van Pesch V, Filippi M, Reich DS, Absinta M, Maggi P. Central Vein Sign, Cortical Lesions, and Paramagnetic Rim Lesions for the Diagnostic and Prognostic Workup of Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200253. [PMID: 38788180 PMCID: PMC11129678 DOI: 10.1212/nxi.0000000000200253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of multiple sclerosis (MS) can be challenging in clinical practice because MS presentation can be atypical and mimicked by other diseases. We evaluated the diagnostic performance, alone or in combination, of the central vein sign (CVS), paramagnetic rim lesion (PRL), and cortical lesion (CL), as well as their association with clinical outcomes. METHODS In this multicenter observational study, we first conducted a cross-sectional analysis of the CVS (proportion of CVS-positive lesions or simplified determination of CVS in 3/6 lesions-Select3*/Select6*), PRL, and CL in MS and non-MS cases on 3T-MRI brain images, including 3D T2-FLAIR, T2*-echo-planar imaging magnitude and phase, double inversion recovery, and magnetization prepared rapid gradient echo image sequences. Then, we longitudinally analyzed the progression independent of relapse and MRI activity (PIRA) in MS cases over the 2 years after study entry. Receiver operating characteristic curves were used to test diagnostic performance and regression models to predict diagnosis and clinical outcomes. RESULTS The presence of ≥41% CVS-positive lesions/≥1 CL/≥1 PRL (optimal cutoffs) had 96%/90%/93% specificity, 97%/84%/60% sensitivity, and 0.99/0.90/0.77 area under the curve (AUC), respectively, to distinguish MS (n = 185) from non-MS (n = 100) cases. The Select3*/Select6* algorithms showed 93%/95% specificity, 97%/89% sensitivity, and 0.95/0.92 AUC. The combination of CVS, CL, and PRL improved the diagnostic performance, especially when Select3*/Select6* were used (93%/94% specificity, 98%/96% sensitivity, 0.99/0.98 AUC; p = 0.002/p < 0.001). In MS cases (n = 185), both CL and PRL were associated with higher MS disability and severity. Longitudinal analysis (n = 61) showed that MS cases with >4 PRL at baseline were more likely to experience PIRA at 2-year follow-up (odds ratio 17.0, 95% confidence interval: 2.1-138.5; p = 0.008), whereas no association was observed between other baseline MRI measures and PIRA, including the number of CL. DISCUSSION The combination of CVS, CL, and PRL can improve MS differential diagnosis. CL and PRL also correlated with clinical measures of poor prognosis, with PRL being a predictor of disability accrual independent of clinical/MRI activity.
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Affiliation(s)
- Serena Borrelli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maria Sofia Martire
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna Stölting
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Colin Vanden Bulcke
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edoardo Pedrini
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - François Guisset
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Céline Bugli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Halil Yildiz
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lucie Pothen
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sophie Elands
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vittorio Martinelli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan Smith
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven Jacobson
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Renaud A Du Pasquier
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vincent Van Pesch
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Massimo Filippi
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel S Reich
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martina Absinta
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pietro Maggi
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
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Kain R. [Renal involvement in systemic diseases]. PATHOLOGIE (HEIDELBERG, GERMANY) 2024; 45:261-268. [PMID: 38805092 PMCID: PMC11199298 DOI: 10.1007/s00292-024-01338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Diseases of the nonneoplastic renal parenchyma occur in the context of a number of disorders that affect the organism systemically and can thus represent a differential diagnosis for autoimmunological kidney diseases. PURPOSE Two common autoimmunologic diseases of the kidney, namely antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and systemic lupus erythematosus (SLE), are presented and put into context of the broader field of renal diseases. Novel diagnostic and therapeutic approaches are discussed. MATERIALS AND METHODS A review of the recent literature and an overview of the disease presentation are provided.
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Affiliation(s)
- Renate Kain
- Klinisches Institut für Pathologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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