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Maisons V, Ramdani Y, Hankard A, Messiaen C, Jannot AS, Sautenet B, Halimi JM, Maillot F, Pillebout É, Audemard-Verger A. New insights into epidemiological data and impact of the COVID-19 pandemic on IgA vasculitis in children and adults: a French nationwide cohort. Rheumatol Int 2023; 43:1791-1798. [PMID: 37438546 DOI: 10.1007/s00296-023-05387-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
IgA vasculitis (IgAV) is a small size vasculitis for which epidemiologic data are strikingly lacking, especially about the adult form. Additionally, the COVID-19 pandemic seems to have profoundly modified the incidence of this disease. Here, we aimed to establish some relevant epidemiological data in both pediatric and adult IgAV. We performed an observational study using a national database called "BNDMR" on IgAV, which gathers patients managed in the French network of experts on rare diseases. We primarily performed descriptive statistics over the 2010-2022 period. Then, we compared the North-South geographical areas, the seasonality, and the impact of COVID-19 with that of other patients reported in the same centers. We collected data from 1988 IgAV patients. The sex ratio was 1.57 for adults and 1.05 for children. The annual incidence in 2021 was 0.06 for 100,000 adults and 0.50 for 100,000 children. Compared with other diseases reported into the BNDMR, IgAV was more common in the South than in the North of France (OR 4.88 [4.17-5.74] in adults and OR 1.51 [1.35-1.68] in children). IgAV was also observed more frequently in winter and autumn. Strikingly, we observed a decrease in incidence during the COVID-19 pandemic period in children (OR 0.62 [0.47-0.81]). Our study provides both new insights and confirmations of IgAV epidemiological data: winter and autumn seasonality, more pronounced male predominance in adults, decreasing incidence of pediatric IgAV during the COVID-19 pandemic and increasing incidence in the South of France.
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Affiliation(s)
- Valentin Maisons
- University of Tours, Tours, France.
- Department of Nephrology, Hopital Bretonneau, CHU Bretonneau, CHU de Tours, 2 boulevard Tonnellé, 37000, Tours, France.
- SPHERE INSERM U1246, Université de Tours, Université de Nantes, Tours, France.
| | - Yanis Ramdani
- University of Tours, Tours, France
- Department of Internal Medicine and Clinical Immunology, CHU Tours, Tours, France
| | | | - Claude Messiaen
- Banque Nationale de Données Maladies Rares (BNDMR), DSI-I&D, APHP, Paris, France
| | - Anne-Sophie Jannot
- Banque Nationale de Données Maladies Rares (BNDMR), DSI-I&D, APHP, Paris, France
| | - Bénédicte Sautenet
- University of Tours, Tours, France
- Department of Nephrology, Hopital Bretonneau, CHU Bretonneau, CHU de Tours, 2 boulevard Tonnellé, 37000, Tours, France
- SPHERE INSERM U1246, Université de Tours, Université de Nantes, Tours, France
| | - Jean-Michel Halimi
- University of Tours, Tours, France
- Department of Nephrology, Hopital Bretonneau, CHU Bretonneau, CHU de Tours, 2 boulevard Tonnellé, 37000, Tours, France
| | - François Maillot
- University of Tours, Tours, France
- Department of Internal Medicine and Clinical Immunology, CHU Tours, Tours, France
| | | | - Alexandra Audemard-Verger
- University of Tours, Tours, France
- Department of Internal Medicine and Clinical Immunology, CHU Tours, Tours, France
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Strübing F, Laurich A, Weiss C, Schönberg S, Kneser U, Sadick M. Performance of a vascular anomaly center: a retrospective analysis of 461 cases over seven years. Acta Radiol 2022; 64:1712-1717. [PMID: 36226366 DOI: 10.1177/02841851221130869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular malformations are rare diseases that are best managed in multidisciplinary vascular anomaly centers (VAC). So far, there are few published data on the logistic structure, patient allotment, and internal workflow in an interdisciplinary VAC. PURPOSE To demonstrate the referral structure and patient allotment in a European VAC. MATERIAL AND METHODS A retrospective cohort study was conducted. All patients treated in the VAC since its establishment in April 2014 until June 2020 were identified. A total of 461 patients were included in this study. RESULTS Most often, a venous malformation was diagnosed (49.9%), followed by arteriovenous malformations (8.7%) and syndromal vascular malformations (8.2%). Only 45.1% of referral diagnoses were correct. Of referrals, 35.1% were internal on-campus references, 28.0% were external references through physicians in private practice, and 19.7% came via external cooperating hospitals. Of the patients, 17.1% were self-admissions without a referral. CONCLUSION The most important referring clinics are internal medicine, pediatric, and vascular surgery. A substantial proportion of referrals came from private practices. Recruiting these cooperation partners should be considered a high priority when establishing a new VAC. The rate of misdiagnosis is high, and more education of fellow clinicians is urgently needed. Therefore, patients with vascular malformations should be referred to and treated in dedicated centers for vascular anomalies.
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Affiliation(s)
- Felix Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Annette Laurich
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics and Data Processing, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
| | - Stefan Schönberg
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
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Walker AM, Patel RR, Vandergriff T, Savory S. COVID-19 associated immunoglobulin A vasculitis in an adult. JAAD Case Rep 2022; 30:35-37. [PMID: 36320660 PMCID: PMC9613799 DOI: 10.1016/j.jdcr.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Key Words
- ALT, Alanine transaminase
- AST, aspartate aminotransferase
- COVID-19
- CRP, C-reactive protein
- DIF, direct immunofluorescence
- ED, Emergency Department
- ESR, Erythrocyte sedimentation rate
- ESRD, end-stage renal disease
- H&E, Hematoxylin and eosin
- HSP, Henoch-Schönlein purpura
- Henoch-Schönlein purpura
- IgA vasculitis
- IgA, Immunoglobulin A
- PCR, polymerase chain reaction
- vasculitis
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Affiliation(s)
| | | | | | - Stephanie Savory
- Correspondence to: Stephanie Savory, MD, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd. Dallas, TX 75390-9069
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Kelly BG, Stratton DB, Mansour I, Tanriover B, Culpepper KS, Curiel-Lewandrowski C. Navigating the initial diagnosis and management of adult IgA vasculitis: A review. JAAD Int 2022; 8:71-78. [PMID: 35721303 PMCID: PMC9204729 DOI: 10.1016/j.jdin.2022.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background IgA vasculitis in adults has not been thoroughly studied. This has left a practice gap related to the management and follow-up of a population that is at an increased risk of comorbidities and potentially poor outcomes. For this reason, it is important to synthesize evidence from the current literature because this can help direct the movement for more robust studies to clarify best practice recommendations. Objective We sought to create a narrative review for the practicing dermatologist when diagnosing and leading the care of IgA vasculitis in adult patients. Methods A broad literature search was performed with a focus on articles that were published after the introduction of the most updated European Alliance of Associations for Rheumatology/Pediatric Rheumatology International Trials Organization/Pediatric Rheumatology European Society criteria. Results The characteristics and management guidelines for IgA vasculitis in adults have been refined, although more rigorous studies are needed to develop best practice recommendations. Limitations Because of the lack of sufficient randomized controlled trials on IgA vasculitis in adults, this narrative review is composed of mostly observational, descriptive studies. Conclusion Adults with IgA vasculitis are at an increased risk of complicated disease course, necessitating formal diagnostic assessment and clear-cut follow-up recommendations to manage and prevent poor health outcomes related to various comorbidities.
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Affiliation(s)
- Brenna G. Kelly
- Division of Dermatology, University of Arizona, Tucson, Arizona
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Iyad Mansour
- Division of Nephrology, University of Arizona, Tucson, Arizona
| | - Bekir Tanriover
- Division of Nephrology, University of Arizona, Tucson, Arizona
| | - Keliegh S. Culpepper
- Division of Dermatology, University of Arizona, Tucson, Arizona
- Dermpath Diagnostics, Tucson, Arizona
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona
- Correspondence to: Clara Curiel-Lewandrowski, MD, Division of Dermatology, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724.
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Neumann T. [Update on immunoglobulin A vasculitis]. Z Rheumatol 2022; 81:305-312. [PMID: 35303751 PMCID: PMC8932091 DOI: 10.1007/s00393-022-01162-z] [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] [Accepted: 12/30/2021] [Indexed: 11/18/2022]
Abstract
Die Immunglobulin-A-Vaskulitis (IgAV) ist eine systemische Vaskulitis der kleinen Gefäße mit Ig(Immunglobulin)A-Immunkomplexbildung und einem breiten Spektrum klinischer Konstellationen. Typische Manifestationen sind Purpura, Arthralgien oder Arthritiden, Enteritis und Glomerulonephritis. Die IgAV ist die häufigste Vaskulitis im Kindesalter mit meist unkompliziertem und selbstlimitierendem Verlauf. Erwachsene erkranken deutlich seltener an einer IgAV, wobei die Verläufe insbesondere bei renaler oder gastrointestinaler Manifestation komplizierter sind. Verschiedene Trigger der IgAV, darunter Infektionen, wurden beschrieben, wobei eine gestörte Glykosylierung von IgA1 mit konsekutiver Freilegung von Bindungsstellen für Autoantikörper die pathophysiologische Voraussetzung für die Vaskulitis ist. Therapeutische Strategien mit Immunsuppressiva sind bisher mit geringer Evidenz unterlegt, berücksichtigen die Schwere der Organmanifestationen und orientieren sich an den Empfehlungen zur Behandlung anderer Vaskulitiden der kleinen Gefäße. Benigne Verläufe werden symptomatisch behandelt. Die langfristige Prognose der IgAV ist von der renalen Manifestation beeinflusst.
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Affiliation(s)
- Thomas Neumann
- Klinik für Rheumatologie, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Schweiz. .,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz.
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Audemard-Verger A, Pillebout E. [Who can pretend knowing how to treat adult IgA vasculitis? What are the futures challenges?]. Rev Med Interne 2021; 43:1-2. [PMID: 34776278 DOI: 10.1016/j.revmed.2021.10.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Affiliation(s)
- A Audemard-Verger
- Service de Médecine Interne et d'Immunologie Clinique, CHRU de Tours, Tours, France; Université de Tours, Tours, France.
| | - E Pillebout
- Service de Néphrologie, Hôpital Saint Louis, AP-HP, France
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Taoka M, Ochi N, Mimura A, Ichiyama N, Nagasaki Y, Nakagawa N, Nakanishi H, Yamane H, Oshiro Y, Monobe Y, Takigawa N. IgA Vasculitis in a Lung Cancer Patient During Chemoradiotherapy. Ther Clin Risk Manag 2021; 17:571-575. [PMID: 34113114 PMCID: PMC8184282 DOI: 10.2147/tcrm.s308771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/20/2021] [Indexed: 01/07/2023] Open
Abstract
A 72-year-old man with locally advanced lung squamous cell carcinoma experienced red purpura on the lower legs and hematuria when the disease progressed during definitive chemoradiotherapy. He had renal dysfunction and proteinuria. Biopsy specimens of the skin lesion and kidney revealed immunoglobulin A vasculitis. Potential causes such as paraneoplastic syndrome and cancer treatment have been proposed. The administration of steroids rapidly improved the symptoms. The presentation of immunoglobulin A vasculitis is accompanied by malignancies. Clinicians should keep this syndrome in mind, even during curative-intent treatment.
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Affiliation(s)
- Masataka Taoka
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Ayaka Mimura
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Naruhiko Ichiyama
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Yasunari Nagasaki
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Nozomu Nakagawa
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Hidekazu Nakanishi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Hiromichi Yamane
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Yoshiyuki Oshiro
- Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan
| | - Yasumasa Monobe
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Nagio Takigawa
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
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