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Öner N, Çelikel E, Tekin ZE, Güngörer V, Kurt T, Tekgöz PN, Sezer M, Karagöl C, Coşkun S, Kaplan MM, Polat MC, Acar BÇ. Intravenous immunoglobulin therapy in immunoglobulin A vasculitis with gastrointestinal tract involvement. Clin Exp Med 2023; 23:1773-1782. [PMID: 36441440 DOI: 10.1007/s10238-022-00950-w] [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: 09/16/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the outcomes of patients who received intravenous immunoglobulin (IVIG) for immunoglobulin A vasculitis (IgAV) with gastrointestinal (GI) tract involvement, and to determine the differences between the groups that responded to IVIG and those that did not. METHODS This retrospective study comprised 152 patients with IgAV between 2018 and 2022. Sixty-five patients (43%) had GI tract involvement. Patients with IgAV-GI involvement who had been treated with IVIG were evaluated. Patients were classified with IgAV according to the 2008 Ankara-EULAR/PRINTO/PRES. Their demographics, presentation, and management are reported. RESULTS Twelve (7 boys/5 girls) of these patients were treated with IVIG. The median age was 90.1 (31-177) months. The mean follow-up period was 30.6 ± 9.9 months. All patients had skin involvement, joint involvement (arthralgia or arthritis), and abdominal pain. All 12 patients were given steroids (30 mg/kg/day pulse methylprednisolone for 3-7 days, followed by 2 mg/kg/day steroids) before IVIG. Nine patients received cyclophosphamide treatment (four before IVIG and five after IVIG). Complete remission was achieved in 5 of the patients with IVIG. Four patients were diagnosed with IgAV concomitant familial Mediterranean fever, and colchicine treatment was initiated. CONCLUSIONS IVIG may be used in steroids and/or immunosuppressive drug resistant IgAV. It can be considered as a treatment option, especially in patients with multi-organ/system involvement, comorbid inflammatory diseases such as familial Mediterranean fever, and in patients with IgAV-GI tract involvement resistant to standard treatment in the advanced pediatric age group.
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Affiliation(s)
- Nimet Öner
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey.
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Zahide Ekici Tekin
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Vildan Güngörer
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Tuba Kurt
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Pakize Nilüfer Tekgöz
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Müge Sezer
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Cüneyt Karagöl
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Serkan Coşkun
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Melike Mehveş Kaplan
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Merve Cansu Polat
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Banu Çelikel Acar
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
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Theofilis P, Vordoni A, Koukoulaki M, Vlachopanos G, Kalaitzidis RG. Overview of infections as an etiologic factor and complication in patients with vasculitides. Rheumatol Int 2022; 42:759-770. [PMID: 35165771 PMCID: PMC8853270 DOI: 10.1007/s00296-022-05100-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Panagiotis Theofilis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Aikaterini Vordoni
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Maria Koukoulaki
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Georgios Vlachopanos
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece.
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Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia. Rheumatol Ther 2021; 8:877-888. [PMID: 33895983 PMCID: PMC8217357 DOI: 10.1007/s40744-021-00307-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To describe the incidence, risk factors and long-term outcomes in children hospitalised with septic arthritis (SA) in Western Australia (WA). Methods We extracted state-wide longitudinally linked administrative health data for patients aged < 16 years with a first diagnostic code of 711.X (ICD9-CM) and M00.X (ICD10-AM) in WA in the period 1990–2010. Annual incidence rates (AIR) per 100,000 with 95% confidence intervals (CIs), prior conditions during a median lookback period of 63.2 [interquartile range (IQR) 19.8–117.1] months and outcomes, including standardised mortality rates (SMR), during a median follow-up of 10 years are reported. Results A total of 891 patients [62% male, median age 6.4 (IQR 1.9–10.6) years with 34% aged < 3 years] were admitted for SA during the observation period. The overall AIR (per 100,000) was 9.85 (95% CI 4.79–14.41), and was higher in Indigenous Australians [34.9 vs. 5.5 (non-Indigenous), p < 0.001] and in males [11.9 vs. 7 (females), p < 0.01]; AIR showed no temporal or seasonal variation. Knees (43.9%), hips (34.6%) and ankles (13.3%) were most frequently affected, with Staphylococci predominant (49%) in patients with positive cultures (41.5%). Prior infection(s) (40.4%) and respiratory disease (7%) were the main pre-existing morbidities. Median hospital stay was 4.0 (IQR 2–8) days, with 1.9% requiring admission to the intensive care unit and 10.4% requiring readmission within 30 days. During follow-up, 26 patients (3.1%) developed osteomyelitis, nine patients were diagnosed with osteoarthrosis (1.1%) and five patients (0.6%) underwent joint replacement. Female patients developed other serious infections more often than male patients (40.5 vs. 27.1%, p < 0.01), as well as other comorbidities (Charlson Comorbidity Index > 0: 34.6 vs. 27.2%, p = 0.02), including diabetes (4.2 vs. 0%; p = 0.001), cardiovascular events (4.2 vs 1.4%, p = 0.002) and chronic arthritis (1 vs. 0%, p = 0.05). The crude mortality rate was low (0.3%), with 99.4% survival at 180 months and no increase in the SMR. Conclusions The incidence of SA in children in WA did not change over the 20-year observation period. SA did not lead to excess mortality, but bone and joint complications developed in 5% of patients. The high propensity to comorbid conditions in this young cohort suggests an underlying role of comorbidity in SA development. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00307-x. As more children are living with complex and chronic conditions, we investigated whether children in Western Australia (WA) have become more prone to joint infections. During a 20-year observation period we collected health data for all children admitted to any hospital in the state with an infected joint and recorded their health outcomes. We found that joint infection occurs in nearly ten out of 100,000 children each year, but we saw no change in the frequency over time. We did observe higher rates in Indigenous children (35/100,000) than in non-indigenous children (6/100,000) but found no noticeable influence of the seasons on the frequency of joint infections. Knees, hips and ankles were most often affected, and 15% had additional bone infection. Children needed to be treated in hospital for 4–5 days, and only a small minority (1.2%) were so ill they needed intensive care. Joint infections led to chronic, long-term complications in about 5% of patients, but we found no evidence that joint infections increased the risk of death compared to children in the general population.
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Nossent J, Raymond W, Keen HI, Preen D, Inderjeeth C. Morbidity and mortality in adult-onset IgA vasculitis: a long-term population-based cohort study. Rheumatology (Oxford) 2021; 61:291-298. [PMID: 33779729 DOI: 10.1093/rheumatology/keab312] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES With sparse data available, we investigated mortality and risk factors in adults with IgAV. METHODS Observational population-based cohort study using state-wide linked longitudinal health data for hospitalised adults with IgAV (n = 267) and matched comparators (n = 1080) between 1980-2015. Charlson comorbidity index (CCI) and serious infections (SI) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from WA Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRR) and hazard ratio (HR) for survival were assessed. RESULTS During 9.9 (±9.8) years lookback patients with IgAV accrued higher CCI scores (2.60 vs1.50 p < 0.001) and had higher risk of SI (OR 8.4, p < 0.001), not fully explained by CCI scores. During 19 years follow-up, the rate of death in Patients with IgAV (n = 137) was higher than in comparators (n = 397) (MRR 2.06, CI 1.70-2.50, p < 0.01) and the general population (SMRR 5.64, CI 4.25, 7.53, p < 0.001). Survival in IgAV was reduced at five (72.7 vs. 89.7%) and twenty years (45.2% vs. 65.6%) (both p < 0.05). CCI (HR1.88, CI:1.25 - 2.73, p = 0.001), renal failure (HR 1.48, CI: 1.04 - 2.22, p = 0.03) and prior SI (HR 1.48, CI:1.01 - 2.16, p = 0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, p = 0.02) was significantly more frequent in patients with IgAV. CONCLUSIONS Premorbid comorbidity accrual appears increased in hospitalized patients with IgAV and predicts premature death. As comorbidity does not fully explain the increased risk of premorbid infections or the increased mortality due to infections in IgAV, prospective studies are needed.
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Affiliation(s)
- Johannes Nossent
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, The University of Western Australia
| | - Warren Raymond
- Rheumatology Group, School of Medicine, The University of Western Australia
| | - Helen Isobel Keen
- Rheumatology Group, School of Medicine, The University of Western Australia.,Dept. Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David Preen
- School of Population and Global Health, The University of Western Australia
| | - Charles Inderjeeth
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, The University of Western Australia
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