1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Smiyan S, Dyadyk O, Kvasnitska O, Makhovska O, Antiuk Z, Bidovanets T, Komorovsky R. Management of granulomatosis with polyangiitis complicated by intestinal perforation and pancytopenia: a case report and literature review. Rheumatol Int 2024; 44:1369-1379. [PMID: 38627280 DOI: 10.1007/s00296-024-05586-5] [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: 01/20/2024] [Accepted: 03/13/2024] [Indexed: 06/15/2024]
Abstract
Granulomatosis with polyangiitis is a systemic vasculitis. While the classic triad typically comprises otorhinolaryngologic, pulmonary, and renal manifestations, it is essential to recognize that granulomatosis with polyangiitis can affect any organ. Furthermore, reports have documented less common sites of involvement, such as the gastrointestinal tract. In this case-based review, we focus on a case of granulomatosis with polyangiitis presenting with intestinal perforation and the added challenge of concurrent pancytopenia.A 25-year-old female was diagnosed with granulomatosis with polyangiitis, with her clinical course progressing from joint pain to severe multi-organ involvement, including gastrointestinal complications. Treatment challenges emerged with the development of pancytopenia. While this may not directly result from granulomatosis with polyangiitis, it introduced an additional layer of complexity and delayed the induction of remission with immunosuppressants. Despite initial stabilization, an unexpected jejunal perforation occurred, requiring surgical intervention and subsequent postoperative care. The case underscores the complex nature of granulomatosis with polyangiitis and its potential complications. A literature search yielded discrete relevant cases in the context of our patient's intricate presentation, which has been summarized.We highlight the complexities in diagnosing and managing granulomatosis with polyangiitis-related complications, especially in uncommon presentations, and emphasize the importance of a personalized approach to patient care in these circumstances.
Collapse
Affiliation(s)
- Svitlana Smiyan
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine
| | - Olena Dyadyk
- Department of Morphology, Clinical Pathology and Forensic Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Oksana Kvasnitska
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine
| | | | - Zhanna Antiuk
- Department of Rheumatology, Ternopil Regional Hospital, Ternopil, Ukraine
| | - Taras Bidovanets
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine
| | - Roman Komorovsky
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine.
| |
Collapse
|
3
|
Thiel J, Schmidt FM, Lorenzetti R, Troilo A, Janowska I, Nießen L, Pfeiffer S, Staniek J, Benassini B, Bott MT, Korzhenevich J, Konstantinidis L, Burgbacher F, Dufner AK, Frede N, Voll RE, Stuchly J, Bakardjieva M, Kalina T, Smulski CR, Venhoff N, Rizzi M. Defects in B-lymphopoiesis and B-cell maturation underlie prolonged B-cell depletion in ANCA-associated vasculitis. Ann Rheum Dis 2024:ard-2024-225587. [PMID: 38851295 DOI: 10.1136/ard-2024-225587] [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: 01/26/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES B-cell depletion time after rituximab (RTX) treatment is prolonged in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) compared with other autoimmune diseases. We investigated central and peripheral B-cell development to identify the causes for the defect in B-cell reconstitution after RTX therapy. METHODS We recruited 91 patients with AAV and performed deep phenotyping of the peripheral and bone marrow B-cell compartment by spectral flow and mass cytometry. B-cell development was studied by in vitro modelling and the role of BAFF receptor by quantitative PCR, western blot analysis and in vitro assays. RESULTS Treatment-naïve patients with AAV showed low transitional B-cell numbers, suggesting impaired B-lymphopoiesis. We analysed bone marrow of treatment-naïve and RTX-treated patients with AAV and found reduced B-lymphoid precursors. In vitro modelling of B-lymphopoiesis from AAV haematopoietic stem cells showed intact, but slower and reduced immature B-cell development. In a subgroup of patients, after RTX treatment, the presence of transitional B cells did not translate in replenishment of naïve B cells, suggesting an impairment in peripheral B-cell maturation. We found low BAFF-receptor expression on B cells of RTX-treated patients with AAV, resulting in reduced survival in response to BAFF in vitro. CONCLUSIONS Prolonged depletion of B cells in patients with AAV after RTX therapy indicates a B-cell defect that is unmasked by RTX treatment. Our data indicate that impaired bone marrow B-lymphopoiesis results in a delayed recovery of peripheral B cells that may be further aggravated by a survival defect of B cells. Our findings contribute to the understanding of AAV pathogenesis and may have clinical implications regarding RTX retreatment schedules and immunomonitoring after RTX therapy.
Collapse
Affiliation(s)
- Jens Thiel
- Division of Rheumatology and Clinical Immunology, Medical University of Graz, Graz, Austria
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Franziska M Schmidt
- Division of Clinical and Experimental Immunology, Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Raquel Lorenzetti
- Division of Rheumatology and Clinical Immunology, Medical University of Graz, Graz, Austria
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Arianna Troilo
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Iga Janowska
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Lena Nießen
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sophie Pfeiffer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Julian Staniek
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Bruno Benassini
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marei-Theresa Bott
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jakov Korzhenevich
- Division of Clinical and Experimental Immunology, Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Lukas Konstantinidis
- Department of Orthopedics and Trauma Surgery, University of Freiburg, Freiburg im Breisgau, Germany
| | - Frank Burgbacher
- Department of Orthopedics and Trauma Surgery, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ann-Katrin Dufner
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Natalie Frede
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Centre of Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Stuchly
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Marina Bakardjieva
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Tomas Kalina
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Cristian Roberto Smulski
- Medical Physics Department, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bariloche, Argentina
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Division of Clinical and Experimental Immunology, Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Centre of Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- CIBSS - Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| |
Collapse
|
4
|
Wanner M, Frischhut N, Uprimny C, Löffler-Ragg J, Böckle B, Schmuth M, Nguyen VA. Schmerzhafte rötlich‐livide subkutane Knoten. J Dtsch Dermatol Ges 2024; 22:860-863. [PMID: 38857088 DOI: 10.1111/ddg.15410_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/26/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Marina Wanner
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Nina Frischhut
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Christian Uprimny
- Universitätsklinik für Nuklearmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Judith Löffler-Ragg
- Universitätsklinik für Innere Medizin II Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Barbara Böckle
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Matthias Schmuth
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Van Anh Nguyen
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| |
Collapse
|
5
|
Wanner M, Frischhut N, Uprimny C, Löffler-Ragg J, Böckle B, Schmuth M, Nguyen VA. Painful reddish-livid subcutaneous nodules. J Dtsch Dermatol Ges 2024; 22:860-863. [PMID: 38724252 DOI: 10.1111/ddg.15410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/26/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Marina Wanner
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Nina Frischhut
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Christian Uprimny
- Universitätsklinik für Nuklearmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Judith Löffler-Ragg
- Universitätsklinik für Innere Medizin II Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Barbara Böckle
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Matthias Schmuth
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Van Anh Nguyen
- Universitätsklinik für Dermatologie, Venerologie und Allergologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Österreich
| |
Collapse
|
6
|
Chalkia A, Jayne D. ANCA-associated vasculitis-treatment standard. Nephrol Dial Transplant 2024; 39:944-955. [PMID: 37947275 DOI: 10.1093/ndt/gfad237] [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: 09/04/2023] [Indexed: 11/12/2023] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are characterized by small-vessel necrotizing inflammation, and prior to the advent of immunosuppressive therapy frequently had a fatal outcome. Treatment has transformed AAV into a relapsing/remitting disease with increased drug-related toxicities and organ damage. The use of glucocorticoids, cyclophosphamide and immunosuppressives (including azathioprine, mycophenolate and methotrexate) was optimized through a sequence of clinical trials establishing a standard of care against which subsequent targeted therapies could be developed. Improved understanding of pathophysiology has supported the development of B-cell depletion and complement inhibition in granulomatosis with polyangiitis and microscopic polyangiitis, and interleukin 5 inhibition for eosinophilic granulomatosis with polyangiitis, leading to the approval of newer agents for these conditions. There has been an increased attention on minimizing the adverse effects of treatment and on understanding the epidemiology of comorbidities in AAV. This review will focus on recent evidence from clinical trials, especially with respect to glucocorticoids, avacopan, plasma exchange, rituximab and mepolizumab, and their interpretation in the 2022 management recommendations by the European League of Associations of Rheumatology.
Collapse
Affiliation(s)
- Aglaia Chalkia
- Department of Medicine, University of Cambridge, Cambridge, UK
- Nephrology Department, Hippokration General Hospital, Athens, Greece
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
7
|
Konda R, Rajasekaran A, Rizk DV. Antineutrophil cytoplasmic antibody-associated vasculitis. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00167. [PMID: 38785128 DOI: 10.1097/mnh.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW This review focuses on latest developments in managing antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV), a systemic autoimmune condition characterized by inflammation and necrosis of small blood vessels due to circulating autoantibodies that target neutrophilic granules. RECENT FINDINGS Our understanding of AAV pathogenesis has evolved in the past decades highlighting the central pathogenic roles of autoantibodies and complement activation. In parallel, the appreciation for glucocorticoid toxicity has led the research on crucial steroid-sparing therapeutic alternatives. Complement inhibitors (like avacopan) that have emerged are associated with better preservation of kidney function in AAV patients with severe kidney impairment. The role of plasma-exchange (PLEX) was revisited in updated guidelines that recommended its potential use in the context of diffuse alveolar hemorrhage associated hypoxia and severe kidney involvement, particularly with a serum creatinine level above 3.4 mg/dl. The ANCA Kidney Risk Score risk prediction and Glucocorticoid Toxicity Index score aid in identifying high-risk patients and individualizing management plans. SUMMARY Kidney involvement in AAV requires prompt diagnosis and initiation of immunosuppression to prevent irreversible nephron loss. Newer therapeutic targets are on the horizon and offer hope for personalized treatment strategies.
Collapse
Affiliation(s)
- Raghunandan Konda
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | |
Collapse
|
8
|
Charnaya O, Kruglyakova J, Jacob B, Arend LJ. Clinicopathological characteristics of pediatric ANCA-associated glomerulonephritis. Pediatr Nephrol 2024:10.1007/s00467-024-06406-5. [PMID: 38780769 DOI: 10.1007/s00467-024-06406-5] [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: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and glomerulonephritis is uncommon in children. We sought to characterize the histological and clinical features of the disease and report on risk factors for adverse outcomes in a pediatric cohort. METHODS Retrospective single-center cohort of all pediatric (< 20 years) patients diagnosed with ANCA-associated glomerulonephritis (AAGN) by kidney biopsy between 2002 and 2022 at Johns Hopkins University. Histological and clinical features were extracted from the medical record. Clinical, laboratory, and histological findings were analyzed to determine the association with kidney failure (KF) and/or death. RESULTS A total of 17 patients were identified (GPA n = 7, MPA = 10) with a median age of 15 years (IQR 12-17) at presentation, a slight female predominance (59%), with seven patients reaching the composite outcome of death (n = 1) or kidney failure (n = 6). There was no difference in presenting clinical symptoms or extra-renal manifestations between the two groups. Univariable Cox regression identified several factors associated with an increased hazard of endpoint including the degree of global or segmental sclerosis, interstitial fibrosis and tubular atrophy (IFTA), C3 and C1q staining, presence of subendothelial deposits, and proteinuria. Multivariable regression was not performed due to the small sample size. We saw a trend towards increased utilization of plasma exchange and a decrease in cyclophosphamide utilization in the more recent era. There was no association between treatment modality and outcome. CONCLUSIONS Pediatric AAGN is a rare disease associated with significant morbidity. We identified glomerulosclerosis and IFTA on histology, and proteinuria on initial presentation as risk factors for KF/death.
Collapse
Affiliation(s)
- Olga Charnaya
- Department of Pediatrics, Johns Hopkins School of Medicine, 200 N. Wolfe St., Room 3061, Baltimore, MD, 21287, USA.
| | - Jacqueline Kruglyakova
- Department of Pediatrics, Johns Hopkins School of Medicine, 200 N. Wolfe St., Room 3061, Baltimore, MD, 21287, USA
| | - Binil Jacob
- Medical School for International Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Mountain Area Health Education Center, Asheville, NC, USA
| | - Lois J Arend
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
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] [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.
Collapse
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
| | - Michele 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.
| |
Collapse
|
10
|
Kaymakci MS, Elfishawi MM, Langenfeld HE, Hanson AC, Crowson CS, Bois MC, Ghaffar U, Koster MJ, Specks U, Warrington KJ. Large vessel involvement in antineutrophil cytoplasmic antibody-associated vasculitis. Rheumatology (Oxford) 2024; 63:1682-1689. [PMID: 37672018 DOI: 10.1093/rheumatology/kead467] [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: 06/08/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES ANCA-associated vasculitis (AAV) is currently categorized under the small vessel vasculitides. There is limited knowledge about large vessel involvement in AAV (L-AAV), mainly described in case reports and small series. L-AAV can involve temporal arteries (TA-AAV), aorta (A-AAV), and periaortic soft tissue (PA-AAV). We sought to characterize the features of patients with L-AAV. METHODS Patients older than 18 years at diagnosis of TA-AAV, A-AAV and PA-AAV seen at the Mayo Clinic, Rochester between 1 January 2000 and 31 December 2021 were identified through a proprietary medical text search algorithm. Patients were included if diagnosed with L-AAV, fulfilled 2022 ACR/EULAR classification criteria for GPA, MPA or EGPA, had positive ANCA test results, and had more than one outpatient or inpatient visit. RESULTS The study cohort consists of 36 patients with L-AAV. Of those, 23 had p-ANCA and/or MPO-ANCA, and 13 had c-ANCA and/or PR3-ANCA. Mean (s.d.) age at AAV diagnosis was 63.4 (12.79) years; 20 (56%) were male. Seventeen patients had TA-AAV, 10 had A-AAV and 9 had PA-AAV. Most patients (n = 25, 69%) were diagnosed with large vessel vasculitis and AAV within a 1-year timespan. Twenty-five (69%) patients had histopathological confirmation of AAV diagnosis in a location other than temporal artery, aorta or periaortic soft tissue. Glucocorticoids (36/36), rituximab (19/36) and methotrexate (18/36) were the most frequent treatments. CONCLUSION This is the largest single-centre cohort of patients with L-AAV to date. AAV can involve large arteries, albeit infrequent. AAV-targeted therapy should be considered in patients with L-AAV.
Collapse
Affiliation(s)
- Mahmut S Kaymakci
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohanad M Elfishawi
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew C Hanson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Umar Ghaffar
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Koster
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
11
|
Schönermarck U, Hellmich B, Csernok E. [Laboratory diagnostics for vasculitis beyond antineutrophil cytoplasmatic autoantibodies]. Z Rheumatol 2024; 83:283-296. [PMID: 38587633 DOI: 10.1007/s00393-024-01494-y] [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: 02/26/2024] [Indexed: 04/09/2024]
Abstract
The diagnosis of systemic vasculitis (SV) is a major clinical challenge due to the very different forms of presentation and requires an interdisciplinary approach. Targeted laboratory diagnostics support making the diagnosis, differential diagnosis and classification and are also a key component in the detection of active organ manifestations and treatment complications. The basic laboratory tests include the erythrocyte sedimentation rate (ESR), C‑reactive protein (CRP), blood count, serum creatinine, urinalysis, specific autoantibodies, complement, immunoglobulins, cryoglobulins and hepatitis B and C serology. Antineutrophil cytoplasmic autoantibodies (ANCA), antiglomerular basement membrane antibodies (anti-GBM antibodies) and anti-C1q antibodies are valuable laboratory markers for the diagnosis of the various forms of small vessel vasculitis. There are no specific laboratory tests for the diagnosis of medium and large vessel vasculitis. Despite advances in our understanding of the pathogenesis of vasculitis, no biomarkers have yet been identified that can be reliably used to guide treatment or that are useful in distinguishing vasculitis from other inflammatory diseases such as infections or treatment complications.
Collapse
Affiliation(s)
- Ulf Schönermarck
- Medizinische Klinik und Poliklinik IV, Nephrologisches Zentrum, LMU Klinikum, Campus Großhadern, LMU München, Deutschland
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, Medius Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim-Teck, Deutschland
| | - Elena Csernok
- Klinik für Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, Medius Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim-Teck, Deutschland.
| |
Collapse
|
12
|
Sharma U, Rishi E, Rishi P, Gupta V, Raman R. Posterior segment manifestations of Takayasu arteritis: A narrative review. Indian J Ophthalmol 2024; 72:637-647. [PMID: 38648432 PMCID: PMC11168552 DOI: 10.4103/ijo.ijo_1346_23] [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: 05/24/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024] Open
Abstract
Ocular symptoms can be the presenting manifestation of Takayasu arteritis (TA) or could be indicative of disease reactivation. A review of published literature related to posterior segment manifestations of TA by using the keywords "Takayasu arteritis," "ophthalmic manifestations," "retina," "retinopathy," "ocular," "optic nerve," and "optic neuropathy" was performed. In total, 62 case reports and 12 case series were included. The majority of the articles were from Asia (n = 47, 64%). Females outnumbered males in the ratio of 7:1. The mean age of patients was 33 years (range: 8-78 years, SD: 13.5 years). In 58% (n = 41 out of 71) cases, ocular symptoms were the presenting manifestation of the underlying disease. Hypotensive retinopathy was found in 70% of eyes, and hypertensive retinopathy was found in 27%. The mean presenting visual acuity (VA) was +1.03 logMAR (range: -0.12 to 3, SD: 1.07), and at the final follow-up was +1.02 logMAR (range: -0.12 to 3, SD 1.17). VA improved in 34% (n = 29/86), remained stable in 45% (39/86), and worsened in 21% (18/86). The mean follow-up was 9 months (range: 0.5-204, SD: 16 months).
Collapse
Affiliation(s)
- Unnati Sharma
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Ekta Rishi
- Truhlsen Eye Institute, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Pukhraj Rishi
- Truhlsen Eye Institute, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
13
|
Cler SJ, Ogden MA, Farrell NF, Roland LT, Diffie CE, Schneider JS. When inflammation is not just inflammation-A review of systemic diseases of the nose and sinuses part 2: Granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis. Am J Otolaryngol 2024; 45:104207. [PMID: 38176206 DOI: 10.1016/j.amjoto.2023.104207] [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] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Chronic rhinosinusitis is a very common condition. Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (eGPA) are systemic diseases which can contribute to the development of chronic rhinosinusitis in select patients. OBJECTIVE Characterize the presenting features, diagnostic criteria, workup, and management of granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis as they are encountered in otolaryngology clinics. METHODS Full length manuscripts published 2000 or later were reviewed. A separate search was conducted for each disease. Pertinent clinical features related to sinonasal manifestations of GPA and eGPA were collected and reported in this review. RESULTS 467 references were discovered during literature review process. In total, 42 references for GPA and 35 references for eGPA were included in this review. CONCLUSION GPA and eGPA are vasculitis syndromes which commonly present in the context of multisystem disease. For GPA, pulmonary and renal disease are common; for eGPA a history of asthma is nearly ubiquitous. Sinonasal disease is a very common feature for both disease processes and may precede the development of systemic symptoms in many patients. Clinical work up and diagnosis is complex and generally requires multidisciplinary care. Treatment primarily consists of immunosuppressive agents, and a number of steroids, steroid sparing agents, and biologics have been shown to be effective. The role of sinus surgery includes tissue biopsy for diagnosis, functional surgery for symptom management in select cases, and reconstruction of cosmetic and functional defects.
Collapse
Affiliation(s)
- Samuel J Cler
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America.
| | - M Allison Ogden
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
| | - Nyssa Fox Farrell
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
| | - Lauren T Roland
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
| | - Colin E Diffie
- Washington University in St. Louis School of Medicine, Department of Medicine, Division of Rheumatology, United States of America
| | - John S Schneider
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
| |
Collapse
|
14
|
Casal Moura M, Zubidat D, Liebana MP, Sethi S, Soler MJ, Zand L, dos Santos FG, Nardelli L, Leon-Roman J, Sousa C, Warrington KJ, Specks U, Fervenza FC. Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease. Kidney Int Rep 2024; 9:1284-1297. [PMID: 38707835 PMCID: PMC11068975 DOI: 10.1016/j.ekir.2024.02.1431] [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: 10/03/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction A significant number of patients with antineutrophil cytoplasmic antibodies (ANCA)- associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still progress to end-stage kidney disease (ESKD, estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2) despite advances in remission-induction treatment. Methods This is a retrospective cohort study on myeloperoxidase (MPO)-ANCA or proteinase 3 (PR3)-ANCA positive patients with AAV (microscopic polyangiitis, MPA; or granulomatosis with polyangiitis, GPA) and eGFR <15 ml/min per 1.73 m2 or ESKD at presentation. Renal recovery, dialysis discontinuation, and persistence of ESKD after standard remission-induction, with or without the use of plasma exchange (PLEX) were analyzed. Results We analyzed 166 patients with biopsy-proven active AAV-GN and eGFR <15 ml/min per 1.73 m2 at the time of diagnosis. Patients received glucocorticoids with cyclophosphamide (CYC) (n = 84) or with rituximab (RTX) (n = 72) for remission-induction, and 49 received PLEX. The predictors of renal recovery were erythrocyte sedimentation rate, serum creatinine (SCr) at diagnosis, and minimal or mild chronicity changes. We further analyzed 71 patients who started dialysis with or without PLEX within 4 weeks of AAV-GN diagnosis. The predictors of dialysis discontinuation were minimal chronicity changes in kidney biopsy at diagnosis (odds ratio = 6.138; 95% confidence interval [CI]: 1.389-27.118; P = 0.017). Predictors of persistence of ESKD within 12 months included higher SCr at diagnosis (incidence rate ratio [IRR] = 1.086; 95% CI: 1.005-1.173; P = 0.037), and moderate (IRR = 3.797; 95% CI: 1.090-13.225; P = 0.036), or severe chronicity changes in kidney biopsy (IRR = 5.883; 95% CI: 1.542-22.439; P =0.009). Conclusion In our cohort, kidney recovery, dialysis discontinuation, and persistence of ESKD in patients with AAV-GN and eGFR <15 ml/min per 1.73 m2 depended on SCr and histologic findings on kidney biopsies at the time of diagnosis and was not affected by the addition of PLEX.
Collapse
Affiliation(s)
- Marta Casal Moura
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Dalia Zubidat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Marc Patricio Liebana
- Servicio de Nefrologia, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Jose Soler
- Servicio de Nefrologia, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Ladan Zand
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Fernanda G. dos Santos
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Luca Nardelli
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Juan Leon-Roman
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Servicio de Nefrologia, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Ciria Sousa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Kenneth J. Warrington
- Division of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Fernando C. Fervenza
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| |
Collapse
|
15
|
Vasi İ, Kardaş RC, Ekici M, Yıldırım D, Kaya B, Duran R, Karadeniz H, Güler AA, Küçük H, Göker B, Bilgen ŞA, Tufan A, Öztürk MA, Erden A. Assessment and comparison of the 2023 ACR/EULAR APS criteria with the revised Sapporo criteria. Int J Rheum Dis 2024; 27:e15175. [PMID: 38720575 DOI: 10.1111/1756-185x.15175] [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: 12/26/2023] [Revised: 03/02/2024] [Accepted: 04/21/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To analyze antiphospholipid antibody (aPL)-positive patients using the 2023 American College of Rheumatology/The European Alliance of Associations for Rheumatology (ACR/EULAR) antiphospholipid syndrome (APS) classification criteria and compare the revised Sapporo criteria and the 2023 ACR/EULAR criteria and evaluate whether the 2023 ACR/EULAR criteria provide added value over the revised Sapporo criteria. METHODS In this descriptive study, 94 aPL-positive patients (with or without APS diagnosis) were identified from two hospital-based registries (Gazi and Hacettepe University). Patients were classified into four groups to compare both criteria sets. These four groups are as follows: (1) patients classified with only the revised Sapporo criteria; (2) patients classified with only the 2023 ACR/EULAR APS criteria; (3) patients classified with both two criteria sets; and (4) patients classified with neither two criteria set. RESULTS Of the 94 patients, 11 were classified with only the revised Sapporo criteria; one with only the 2023 ACR/EULAR APS criteria; 52 with both criteria sets; and 30 with neither set of criteria. For these 94 patients, the operating characteristics of the 2023 ACR/EULAR APS criteria, using the revised Sapporo criteria as the gold standard, the 2023 ACR/EULAR APS entry criteria demonstrated 100% sensitivity, and the 2023 ACR/EULAR APS classification criteria demonstrated 98% specificity and 82.5% sensitivity. CONCLUSION The study emphasizes the importance of recognizing differences in clinical manifestations, such as early pregnancy loss without severe preeclampsia (PEC) and/or severe placental insufficiency (PI) and calls for a nuanced discussion on anticardiolipin (aCL) and anti-beta 2-glycoprotein-I (anti-β2GPI) immunoglobulin G (IgG) cutoff values.
Collapse
Affiliation(s)
- İbrahim Vasi
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Rıza Can Kardaş
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Ekici
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Derya Yıldırım
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Burcugül Kaya
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Rahime Duran
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hazan Karadeniz
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aslıhan Avanoğlu Güler
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hamit Küçük
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Şule Apraş Bilgen
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
16
|
Ha JW, Pyo JY, Ahn SS, Song JJ, Park YB, Lee SW. Overlap syndrome of systemic sclerosis with antineutrophil cytoplasmic antibody-associated vasculitis according to 2022 ACR/EULAR criteria. Korean J Intern Med 2024; 39:524-536. [PMID: 38282414 PMCID: PMC11076885 DOI: 10.3904/kjim.2023.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND/AIMS This study applied the 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) to patients with systemic sclerosis (SSc) and investigated the frequency of overlap syndrome of SSc and AAV (SSc-AAV-OS). METHODS Among the 232 patients diagnosed with SSc, 105 with signs suggestive of small- or medium-vessel vasculitis, which were defined as the present of interstitial lung disease (ILD), peripheral neuropathy, or suspected renal vasculitis, were included in this study and analyzed. RESULTS Among the 105 SSc patients, the detection rate of ANCA was 19.0%. When the 2022 ACR/EULAR criteria were applied, the frequency of SSc-AAV-OS was 20.0%, which was much higher than 1.7% reported with previous criteria for AAV. ANCA positivity contributed to the reclassification of SSc-AAV-OS more than ANCA negativity in SSc patients with signs suggestive of small- or medium-vessel vasculitis. CONCLUSION The frequency of SSc-AAV-OS in SSc patients with signs suggestive of small- or medium-vessel vasculitis at diagnosis was 20.0%. Therefore, we suggest that physicians should perform ANCA tests in SSc patients exhibiting signs suggestive of small- or medium-vessel vasculitis and apply the new criteria for AAV.
Collapse
Affiliation(s)
- Jang Woo Ha
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Jung Yoon Pyo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Sung Soo Ahn
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin,
Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul,
Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul,
Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul,
Korea
| |
Collapse
|
17
|
Arora H, Sivasubramanian D, Sivakumar S, Sambandam A, Avula S. Seronegative Granulomatosis With Polyangiitis With Isolated Lung Lesions: A Case Report. Cureus 2024; 16:e59692. [PMID: 38841015 PMCID: PMC11150126 DOI: 10.7759/cureus.59692] [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] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
Granulomatosis with polyangiitis (GPA), previously referred to as Wegener's granulomatosis, is an uncommon form of necrotizing vasculitis that predominantly targets small and medium-sized blood vessels as a result of granulomatous inflammation. Granulomatosis with polyangiitis is defined by the existence of necrotizing granulomas in the upper respiratory tract, along with renal involvement, which includes necrotizing glomerulonephritis with extra capillary crescents. From a diagnostic perspective, there is a high correlation between GPA and proteinase-3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) because of the release of inflammatory cytokines, reactive oxygen species (ROS), and lytic enzymes. While ANCA-positive serology is commonly used as the diagnostic criteria, we present a seronegative GPA case with isolated lung lesions. A 54-year-old woman was referred for an assessment of hemoptysis and alterations in her chest radiograph. The patient's laboratory results showed a positive QuantiFERON test but negative results for ANCA and antinuclear antibodies (ANA) tests. A chest CT scan showed the presence of several pulmonary nodules in both lungs, with some cavitation. A CT-guided biopsy was conducted on a nodule located in the lower lobe of the right lung. The results showed that the nodule had non-neoplastic chronic inflammation and an area of geographic necrosis. A second robotic-assisted left upper and lower lobe wedge resection was done, which showed white to tan granular lesions with necrotizing granulomatous inflammation and lymph nodes with anthracosis and a lot of histiocytes, which is typical of GPA. The patient received a six-month course of intravenous rituximab treatment.
Collapse
Affiliation(s)
- Harkesh Arora
- Hospital Medicine, Lovelace Medical Center, Albuquerque, USA
| | | | | | - Aditya Sambandam
- Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Sreekant Avula
- Internal Medicine, University of Minnesota, Minneapolis, USA
| |
Collapse
|
18
|
Bardan-Inchaustegui AC, Esquivel-Valerio JA, Castillo-de la Garza RDJ, Cardenas-de la Garza JA, Gonzalez-Gonzalez V, Galarza-Delgado DA. Vasculitis that did not read the books. Ann Rheum Dis 2024; 83:677-678. [PMID: 38049979 DOI: 10.1136/ard-2023-225175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Ana C Bardan-Inchaustegui
- Rheumatology Department, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge A Esquivel-Valerio
- Rheumatology Department, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - Valeria Gonzalez-Gonzalez
- Rheumatology Department, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Dionicio Angel Galarza-Delgado
- Rheumatology Department, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| |
Collapse
|
19
|
Gong Y, Shen C, Meng T, Lin W, Hu X, Tang R, Xiong Q, Ooi JD, Eggenhuizen PJ, Chen J, Zhou YO, Luo H, Xu J, Liu N, Xiao P, Xiao X, Zhong Y. Clinical features and prognosis of ANCA-associated vasculitis patients who were double-seropositive for myeloperoxidase-ANCA and proteinase 3-ANCA. Clin Exp Med 2024; 24:66. [PMID: 38564029 PMCID: PMC10987344 DOI: 10.1007/s10238-024-01318-y] [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: 12/27/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients with dual positivity for proteinase 3-ANCA (PR3-ANCA) and myeloperoxidase-ANCA (MPO-ANCA) are uncommon. We aimed to investigate these idiopathic double-positive AAV patients' clinical features, histological characteristics, and prognosis. We reviewed all the electronic medical records of patients diagnosed with AAV to obtain clinical data and renal histological information from January 2010 to December 2020 in a large center in China. Patients were assigned to the MPO-AAV group or PR3-AAV group or idiopathic double-positive AAV group by ANCA specificity. We explored features of idiopathic double-positive AAV. Of the 340 patients who fulfilled the study inclusion criteria, 159 (46.76%) were female, with a mean age of 58.41 years at the time of AAV diagnosis. Similar to MPO-AAV, idiopathic double-positive AAV patients were older and had more severe anemia, lower Birmingham Vasculitis Activity Score (BVAS) and C-reactive protein (CRP) levels, less ear, nose, and throat (ENT) involvement, higher initial serum creatinine and a lower estimated glomerular filtration rate (eGFR) when compared with PR3-AAV (P < 0.05). The proportion of normal glomeruli of idiopathic double-positive AAV was the lowest among the three groups (P < 0.05). The idiopathic double-positive AAV patients had the worst remission rate (58.8%) among the three groups (P < 0.05). The relapse rate of double-positive AAV (40.0%) was comparable with PR3-AAV (44.8%) (P > 0.05). Although there was a trend toward a higher relapse rate of idiopathic double-positive AAV (40.0%) compared with MPO-AAV (23.5%), this did not reach statistical significance (P > 0.05). The proportion of patients who progressed to ESRD was 47.1% and 44.4% in the idiopathic double-positive AAV group and MPO-AAV group respectively, without statistical significance. Long-term patient survival also varied among the three groups (P < 0.05). Idiopathic double-positive AAV is a rare clinical entity with hybrid features of MPO-AAV and PR3-AAV. MPO-AAV is the "dominant" phenotype in idiopathic double-positive AAV.
Collapse
Affiliation(s)
- Yizi Gong
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Chanjuan Shen
- Department of Hematology, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
| | - Ting Meng
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
| | - Wei Lin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xueling Hu
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
| | - Rong Tang
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
| | - Qi Xiong
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
| | - Joshua D Ooi
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Peter J Eggenhuizen
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Jinbiao Chen
- Department of Medical Records and Information, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ya-Ou Zhou
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Luo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, China
| | - Jia Xu
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
| | - Ning Liu
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
| | - Ping Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China.
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Yong Zhong
- Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, China.
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| |
Collapse
|
20
|
Aseem F, Lin V, Gilbert AL, Rivadeneira AC, Jennette JC, Bouldin TW, Khoshbakht F, Lee YZ, Chamberlin K, Gelinne A, Mehrabyan AC, Javed B, Dujmovic Basuroski I, Diaz MM. ANCA-associated vasculitis presenting with isolated neurological manifestations in a patient with cocaine abuse: a case report and literature review. Clin Rheumatol 2024; 43:1401-1407. [PMID: 38416306 DOI: 10.1007/s10067-024-06919-2] [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: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare conditions predominantly affecting small vessels of skin, musculoskeletal, pulmonary, renal, and rarely central and peripheral nervous systems. Isolated neurological manifestations of AAV are uncommon and challenging to diagnose. Cocaine has been reported as a potential trigger for the development of AAV. There are only a few case reports of isolated neurological involvement in cocaine-induced AAV with poorly characterized histopathological features. We present a unique case of AAV with isolated neurological manifestations presenting with multiple cranial neuropathies, leptomeningeal enhancement on imaging and histopathologic evidence of small-vessel vasculitis in the leptomeninges and brain and extensive dural fibrosis in a patient with cocaine abuse. The patient's progressive neurological deficits were controlled after starting immunosuppression with rituximab and prednisone. We also reviewed the literature to provide the diagnostic overview of AAV and evaluate intervention options. To our knowledge, this is the first case of AAV with isolated neurological manifestations and histopathologic evidence of small-vessel vasculitis in a patient with cocaine abuse. Patients with multiple cranial neuropathies and meningeal involvement should be screened for AAV, especially if they have a history of cocaine abuse.
Collapse
Affiliation(s)
- Fazila Aseem
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Victor Lin
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Abigail L Gilbert
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Alfredo C Rivadeneira
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Freshta Khoshbakht
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Kelly Chamberlin
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Aaron Gelinne
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Anahit C Mehrabyan
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Bushra Javed
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Irena Dujmovic Basuroski
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Monica M Diaz
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
21
|
Auanassova A, Yessirkepov M. Clinical and anamnestic features of patients with systemic vasculitis: a single-center retrospective study. Rheumatol Int 2024; 44:687-692. [PMID: 38319375 DOI: 10.1007/s00296-024-05533-4] [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: 10/30/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
Systemic vasculitides are the most complex and problematic autoimmune rheumatic diseases characterized by affections of large, medium, or small vessels. Although the immunopathogenesis of vasculitides is thoroughly studied, the epidemiology and etiology are poorly explored. The main triggers of vasculitides are environmental, genetic, and various infectious factors. Diagnosis of vasculitides is complicated due to the non-specific nature of their symptoms. Vasculitides affect various organ systems with abrupt or slow (weeks-months) development of symptoms. This study aims to analyze the demographic and clinical-anamnestic characteristics of patients with systemic vasculitides in a single centre before and during the COVID-19 pandemic in Kazakhstan. A single-centre retrospective study of medical records of 80 patients above 18 years was conducted in the Almaty City Rheumatology Center. Medical records of 24 males (30%) and 56 females (70%) with systemic vasculitides, diagnosed from January 2019 to December 2021, were analyzed. Age, gender, damaged organ systems, disability, concomitant diseases, disease experience, laboratory data, and other variables were recorded. The records of hospitalized patients with systemic vasculitides were analyzed. Of 80 patients registered in 2019-2021, the most common were those with IgA vasculitis (n = 32, 40%), Takayasu arteritis (n = 17, 21.25%), and granulomatosis with polyangiitis (n = 12, 15%). Behçet disease was diagnosed less frequently (n = 9, 11.25%). Patients with systemic vasculitides had pre-obesity (n = 19), class 1 obesity (n = 13), and class 2 obesity (n = 2). Musculoskeletal affections were present in 52 patients (65%). Gastrointestinal, cutaneous, and cardiovascular affections were recorded in 45 (56.3%), 37 (46.3%), and 39 (48.8%) cases, respectively. Only 8 patients (10%) had affections of the nervous system. Most patients had elevated C-reactive protein (n = 29, 36.3%) and leukocytosis (n = 33, 41.3%). One-third of patients with vasculitides had a history of abortions. Musculoskeletal, cutaneous, gastrointestinal, and cardiovascular affections are common in patients with systemic vasculitides. Obesity is a frequent comorbidity in vasculitides. Comorbidities and abortions complicate the disease course and its management.
Collapse
Affiliation(s)
- Akerke Auanassova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| |
Collapse
|
22
|
Fadoul MA, Tjaden B, Daneshpooy S, McMackin K. Spontaneous brachial artery pseudoaneurysm secondary to vasculitis. Vascular 2024; 32:391-394. [PMID: 36282952 DOI: 10.1177/17085381221135696] [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: 02/18/2024]
Abstract
BACKGROUND Avoiding operative intervention during the active phase of vasculitis is a central tenant of management of this pathology. For unusual presentations of vascular disease, the early diagnosis of vasculitis is imperative to guide treatment. METHODS We present the case of a 68-year-old female who presented with a spontaneous brachial artery pseudoaneurysm and was found to have granulomatosis with polyangiitis. RESULTS AND CONCLUSION The management of arterial complications of vasculitis are particularly difficult in the active phase of disease. Our patient had successful resolution of her pseudoaneurysm with ultrasound compression, avoiding open or endovascular intervention during the active phase of disease.
Collapse
Affiliation(s)
- Mikael A Fadoul
- Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
| | - Bruce Tjaden
- Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
| | | | - Katherine McMackin
- Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
| |
Collapse
|
23
|
Song X, Li M, Song Y, Tu P, Li H, Wang Y, Xu R, Chen M, Yu X, Wang S, Zhou F, Zhao M, Li R, Jia X, Wang X. Granulomatosis with polyangiitis presented as multiple cutaneous abscesses after hysterectomy. Chin Med J (Engl) 2024; 137:755-756. [PMID: 38431768 PMCID: PMC10950151 DOI: 10.1097/cm9.0000000000002995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Xiaoting Song
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing 100034, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| | - Mengrui Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Yinggai Song
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing 100034, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing 100034, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| | - Hang Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing 100034, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing 100034, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| | - Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Xiaojuan Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Suxia Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Fude Zhou
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing 100034, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| | - Xiaoyu Jia
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China
- Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| | - Xiaowen Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing 100034, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| |
Collapse
|
24
|
Han SJ, Kim HH, Hyun DG, Ji W, Choi CM, Lee JC, Kim HC. Clinical characteristics and outcome of lung cancer in patients with fibrosing interstitial lung disease. BMC Pulm Med 2024; 24:136. [PMID: 38491506 PMCID: PMC10943814 DOI: 10.1186/s12890-024-02946-6] [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: 01/14/2024] [Accepted: 03/02/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Lung cancer (LC) is an important comorbidity of interstitial lung disease (ILD) and has a poor prognosis. The clinical characteristics and outcome of each ILD subtype in LC patients have not been sufficiently investigated. Therefore, this study aimed to evaluate the difference between idiopathic pulmonary fibrosis (IPF) and non-IPF ILD as well as prognostic factors in patients with ILD-LC. METHODS The medical records of 163 patients diagnosed with ILD-LC at Asan Medical Center from January 2018 to May 2023 were retrospectively reviewed. Baseline characteristics and clinical outcomes were compared between the IPF-LC and non-IPF ILD-LC groups, and prognostic factors were analyzed using the Cox proportional-hazard model. RESULTS The median follow-up period was 11 months after the cancer diagnosis. No statistically significant differences were observed in clinical characteristics and mortality rates (median survival: 26 vs. 20 months, p = 0.530) between the groups. The independent prognostic factors in patients with ILD-LC were higher level of Krebs von den Lungen-6 (≥ 1000 U/mL, hazard ratio [HR] 1.970, 95% confidence interval [CI] 1.026-3.783, p = 0.025) and advanced clinical stage of LC (compared with stage I, HR 3.876 for stage II, p = 0.025, HR 5.092 for stage III, p = 0.002, and HR 5.626 for stage IV, p = 0.002). In terms of treatment, surgery was the significant factor for survival (HR 0.235; 95% CI 0.106-0.520; p < 0.001). CONCLUSIONS No survival difference was observed between IPF-LC and non-IPF ILD-LC patients. A higher level of Krebs von den Lungen-6 may act as a prognostic marker in ILD-LC patients.
Collapse
Affiliation(s)
- Soo Jin Han
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyeon Hwa Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong-Gon Hyun
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
25
|
Gutierrez-Rodrigues F, Wells KV, Jones AI, Hironaka D, Rankin C, Gadina M, Sikora KA, Alemu L, Calado RT, Quinn KA, Patel B, Young NS, Grayson PC. Clonal haematopoiesis across the age spectrum of vasculitis patients with Takayasu's arteritis, ANCA-associated vasculitis and giant cell arteritis. Ann Rheum Dis 2024; 83:508-517. [PMID: 38049983 PMCID: PMC10939924 DOI: 10.1136/ard-2023-224933] [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: 08/29/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Ageing and inflammation are associated with clonal haematopoiesis (CH), the emergence of somatic mutations in haematopoietic cells. This study details CH in patients with systemic vasculitis in association with clinical, haematological and immunological parameters. METHODS Patients with three forms of vasculitis were screened for CH in peripheral blood by error-corrected sequencing. Relative contributions of age and vasculitis on CH prevalence were calculated using multivariable logistic regression. Clonal hierarchies were assessed by proteogenomic single-cell DNA sequencing, and functional experiments were performed in association with CH status. RESULTS Patients with Takayasu's arteritis (TAK; n=70; mean age=33.2 years), antineutrophil cytoplasmic antibody-associated vasculitis (AAV; n=47; mean age=55.3 years) and giant cell arteritis (GCA; n=59; mean age=71.2 years) were studied. CH, most commonly in DNMT3A and TET2, was detected in 34% (60/176) of patients versus 18% (28/151) of age-matched controls (p<0.01). Prevalence of CH was independently associated with age (standardised B=0.96, p<0.01) and vasculitis (standardised B=0.46, p<0.01), occurring in 61%, 32% and 13% of patients with GCA, AAV and TAK, respectively. Both branched and linear clonal trajectories showed myeloid-lineage bias, and CH was associated with markers of cellular activation. In GCA, mutations were detected in temporal artery biopsies, and clinical relapse correlated with CH in a dose-dependent relationship with clone size. CONCLUSIONS Age was more strongly associated with CH prevalence than inflammation in systemic vasculitis. Clonal profile was dominated by DNMT3A mutations which were associated with relapse in GCA. CH is not likely a primary causal factor in systemic vasculitis but may contribute to inflammation.
Collapse
Affiliation(s)
- Fernanda Gutierrez-Rodrigues
- Hematology Branch, National Heart Lung and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Kristina V Wells
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Adrianna I Jones
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Dalton Hironaka
- Hematology Branch, National Heart Lung and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Cameron Rankin
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Massimo Gadina
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Keith A Sikora
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Lemlem Alemu
- Hematology Branch, National Heart Lung and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Rodrigo T Calado
- Medical Imaging, Hematology, and Oncology, University of São Paulo, Sao Paulo, Brazil
| | - Kaitlin A Quinn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Bhavisha Patel
- Hematology Branch, National Heart Lung and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Neal S Young
- Hematology Branch, National Heart Lung and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| |
Collapse
|
26
|
Iwamura N, Tsutsumi K, Ueno Y, Tamura Y, Nakano T. A case of seronegative microscopic polyangiitis following the diagnosis of renal pelvic carcinoma. CEN Case Rep 2024:10.1007/s13730-024-00856-4. [PMID: 38436874 DOI: 10.1007/s13730-024-00856-4] [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: 01/04/2024] [Accepted: 01/27/2024] [Indexed: 03/05/2024] Open
Abstract
The incidence rate of malignancy in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is higher than that in the general population. Malignancy has been indicated to be a risk factor or inducer of AAV. Herein, we report the case of a healthy 84-year-old man with seronegative microscopic polyangiitis (MPA) after the diagnosis of renal pelvic carcinoma. Four weeks before admission, his estimated glomerular filtration rate (eGFR) was 85 ml/min/1.73 m2, and no hematuria or proteinuria was detected. Renal biopsy on admission revealed invasive urothelial carcinoma of the right renal pelvis. On day 15, his eGFR decreased to 30 ml/min/1.73 m2 without any incitement. The renal specimen extracted via right robot-assisted nephroureterectomy indicated the presence of ANCA-associated glomerulonephritis. On day 37, urinary protein/urinary creatinine level of 6.48 g/gCre, serum albumin level of 2.1 mg/dL, and eGFR of 20 ml/min/1.73 m2 indicated the presence of nephrotic syndrome. His blood sputum was analyzed via chest computed tomography, which revealed alveolar hemorrhage. Although his myeloperoxidase-ANCA was negative, he was diagnosed with MPA based on the 2022 American College of Rheumatology/European League Against Rheumatism classification criteria. This is the first case report of MPA or AAV complicated with renal pelvic carcinoma. The clinical indicators demonstrated that renal pelvic carcinoma preceded the onset of MPA. The spatial proximity of both diseases indicated that renal pelvic carcinoma had some influence on MPA development via the mechanism of inflammatory cytokines or neutrophil extracellular traps. Our report may be useful in elucidating the mechanism of MPA development.
Collapse
Affiliation(s)
- Narumichi Iwamura
- Department of Nephrology, Japan Community Health Care Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishi-Ku, Kitakyushu-Shi, Fukuoka, 806-8501, Japan.
| | - Kanako Tsutsumi
- Department of Nephrology, Steel Memorial Yahata Hospital, Kitakyushu, Japan
| | - Yuki Ueno
- Department of Nephrology, Japan Community Health Care Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishi-Ku, Kitakyushu-Shi, Fukuoka, 806-8501, Japan
| | - Yasuhisa Tamura
- Department of Nephrology, Japan Community Health Care Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishi-Ku, Kitakyushu-Shi, Fukuoka, 806-8501, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
27
|
Aringer M, Mosca M. SLE criteria are by necessity still based on clinical (and immunological) criteria items. Expert Rev Clin Immunol 2024; 20:305-311. [PMID: 38073566 DOI: 10.1080/1744666x.2023.2292188] [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: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION The 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for systemic lupus erythematosus (SLE) rely on clinical and routine immunological items. The criteria have anti-nuclear antibodies (ANA) as an obligatory entry criterion; items are weighted and ordered in domains. While demonstrating good sensitivity and specificity, the lack of a more molecular approach to some came as a disappointment. AREAS COVERED Based on a non-systematic literature search, this review covers items investigated in the EULAR/ACR classification criteria project, but not included in the set of criteria. It demonstrates data on the importance of the criteria and analyses implications of multiomics studies started around the same time as the criteria project. We also discuss data on the type-I interferon signature and on other cytokines, as well as on complement proteins and their split products. The final part deals with the variability in disease and the apparently random pattern of autoantibodies and organ manifestations in individual patients. EXPERT OPINION We believe that the EULAR/ACR criteria are a relevant step toward the right direction. A more uniform molecular approach will not be feasible as long as the molecular mechanisms underlying the tendency toward producing multiple autoantibodies are not better understood.
Collapse
Affiliation(s)
- Martin Aringer
- Chief Division of Rheumatology, Department of Medicine III, and Director, interdisciplinary University Center for Autoimmune and Rheumatic Entities (UCARE), University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Chief Division of Rheumatology, Azienda Ospedaliero Universitaria Pisana, Italy, Pisa
| |
Collapse
|
28
|
Oakman G, Bach CA, Ong C. Incidence of anti-neutrophil cytoplasmic antibody-associated renal vasculitis: a retrospective study in rural and regional Victoria, Australia. Intern Med J 2024; 54:461-466. [PMID: 37183767 DOI: 10.1111/imj.16127] [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: 02/05/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The epidemiology of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) varies worldwide. Previous Australian studies described a higher incidence of AAV in rural areas; however, this has not yet been investigated in Victoria. AIMS To calculate the incidence of AAV in rural and regional Victoria and characterise the demographics and clinical outcomes of this cohort. METHODS We performed a retrospective review of patients with newly diagnosed AAV confirmed on renal biopsy at Bendigo Health between 2013 and 2021. Cases were classified according to the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria. Local disease incidence was calculated using Estimated Resident Population data for our catchment, the Loddon Mallee region. RESULTS Twenty-eight cases of new AAV were identified; 17 were classified as microscopic polyangiitis (MPA) and the remainder as granulomatosis with polyangiitis (GPA). The median age at diagnosis was 68 years (interquartile range (IQR): 59-77). The incidence per million person-years was 9.3 for AAV overall (95% CI: 6.2-13.5), 5.7 for MPA (95% CI: 3.3-9.1) and 3.7 for GPA (95% CI: 1.8-6.6). With a median follow-up time of 3.3 years (IQR: 1.9-5.6), one-quarter of patients relapsed (n = 7, 25%), and six required ongoing renal-replacement therapy (21%). CONCLUSIONS The calculated incidence of AAV in rural and regional Victoria is not higher than the reported incidence in most urban Australian cohorts. This study may underestimate the true local disease incidence as only patients with renal vasculitis were included.
Collapse
Affiliation(s)
- Georgina Oakman
- Department of Renal Medicine, Bendigo Health, Victoria, Bendigo, Australia
- Department of Medicine, Austin Health, Victoria, Heidelberg, Australia
| | - Cindy-Anne Bach
- Department of Renal Medicine, Bendigo Health, Victoria, Bendigo, Australia
- Department of Medicine, Austin Health, Victoria, Heidelberg, Australia
| | - Cindy Ong
- Department of Renal Medicine, Bendigo Health, Victoria, Bendigo, Australia
| |
Collapse
|
29
|
Kojima K, Fukui S, Tanigawa M, Sumiyoshi R, Koga T, Shimakura A, Okano S, Kawakami A. Severe prolonged liver abnormality with jaundice during treatment for granulomatosis with polyangiitis with rituximab and avacopan. Rheumatology (Oxford) 2024; 63:e101-e103. [PMID: 37740250 DOI: 10.1093/rheumatology/kead509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Kanako Kojima
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shoichi Fukui
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mai Tanigawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Remi Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akane Shimakura
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinji Okano
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
30
|
Henes J, Richter JG, Thiele K, Kiltz U, Callhoff J, Albrecht K. Trends in health care of patients with vasculitides, including giant cell arteritis, Takayasu arteritis, ANCA-associated vasculitis and Behçet's disease: cross-sectional data of the German National Database 2007-2021. Rheumatol Int 2024; 44:497-507. [PMID: 38180499 PMCID: PMC10866751 DOI: 10.1007/s00296-023-05508-x] [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: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
The aim of this study is to present the current care situation of patients with giant cell arteritis (GCA), Takayasu arteritis (TAK), ANCA-associated vasculitis (AAV) and Behçet's disease (BD). Trends over the last 15 years will reflect improvements and remaining deficits in the management of vasculitides. Consecutive cross-sectional data from patients with vasculitides from the German National Database (NDB) of the Collaborative Arthritis Centres between 2007 and 2021 were included. Medication, physician- and patient-reported outcomes on disease activity and disease burden, inpatient stays and occupational participation are compared for different vasculitis entities and over time. Employment rates were compared to German population rates. Between 502 and 854 vasculitis patients were annually documented. GCA and AAV were the most common vasculitides. Median disease duration ranged from 2 to 16 years. Over the years, glucocorticoids decreased in proportion and dose, most markedly in GCA and TAK, while biologic therapies increased up to 27%. Physicians rated disease activity as low for the vast majority of patients, while patients-reported moderate outcomes in many dimensions. PROs remained largely unchanged. The proportion of employed patients (< 65 years) increased from 47 to 57%. In recent years, biologics are increasingly used in patients with vasculitides, while glucocorticoids decreased significantly. PRO's have not improved. Work participation increased but remains lower than that in the German population.
Collapse
Affiliation(s)
- Jörg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoimmune Diseases and Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Jutta G Richter
- Department of Rheumatology, Faculty of Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Faculty of Medicine, Hiller Research Centre Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Katja Thiele
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Uta Kiltz
- Ruhr Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Johanna Callhoff
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katinka Albrecht
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany.
| |
Collapse
|
31
|
Kronbichler A, Bajema IM, Bruchfeld A, Mastroianni Kirsztajn G, Stone JH. Diagnosis and management of ANCA-associated vasculitis. Lancet 2024; 403:683-698. [PMID: 38368016 DOI: 10.1016/s0140-6736(23)01736-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/05/2023] [Accepted: 08/17/2023] [Indexed: 02/19/2024]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis consists of two main diseases, granulomatosis with polyangiitis and microscopic polyangiitis, and remains among the most devastating and potentially lethal forms of autoimmune inflammatory disease. Granulomatosis with polyangiitis and microscopic polyangiitis are characterised by a necrotising vasculitis that can involve almost any organ, and have generally been studied together. The diseases commonly affect the kidneys, lungs, upper respiratory tract, skin, eyes, and peripheral nerves. Granulomatous inflammation and multinucleated giant cells are key pathological hallmarks of granulomatosis with polyangiitis, but are absent in microscopic polyangiitis. Many immune system events are essential to disease aetiopathogenesis, such as activation of the alternative complement pathway, neutrophil activation via complement receptors, and the influx of inflammatory cells, including monocytes and macrophages. These cells perpetuate inflammation and lead to organ damage. During the 21st century, the management of ANCA-associated vasculitis has moved away from reliance on cytotoxic medications and towards targeted biological medications for both the induction and maintenance of disease remission. Earlier diagnosis, partly the result of more reliable ANCA testing, has led to improved patient outcomes and better survival. Reductions in acute disease-related mortality have now shifted focus to long-term morbidities related to ANCA-associated vasculitis and their treatments, such as chronic kidney disease and cardiovascular disease. Therapeutic approaches in both clinical trials and clinical practice still remain too reliant on glucocorticoids, and continued efforts to reduce toxicity from glucocorticoids remain a priority in the development of new treatment strategies.
Collapse
Affiliation(s)
- Andreas Kronbichler
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria; Department of Medicine, University of Cambridge, Cambridge, UK.
| | - Ingeborg M Bajema
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, Netherlands
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | | | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
32
|
Vainutienė V, Ivaška J, Dadonienė J, Beleškienė V, Ivaškienė T, Lesinskas E. Audiological Manifestations in Patients with Granulomatosis with Polyangiitis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:267. [PMID: 38399554 PMCID: PMC10890050 DOI: 10.3390/medicina60020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Granulomatosis with Polyangiitis (GPA) is a rare, autoimmune, multisystemic disease characterized by vasculitis and necrotizing granuloma that commonly affects the upper and lower respiratory tract and kidneys. Audiovestibular dysfunction in GPA diseases may have different clinical presentations. The aim of the present study was to evaluate hearing function in patients with GPA and to compare the results with a healthy control group. Materials and Methods: A total of 34 individuals participated in the study. The GPA group consisted of 14 participants, and the control group was composed of 20 healthy participants with no signs or symptoms of ear disease. The ages ranged from 18 to 65 years old, with a mean age of 43.8 years. The participants underwent a complete audiological evaluation using otoscopy, impedance audiometry, pure tone audiometry, speech audiometry-evaluation of speech thresholds, and speech recognition in quiet. Both ears were tested. All of the participants of the study were native Lithuanian speakers. Data were statistically analyzed using the Statistical Analysis System software SAS® Studio 3.8. A p value < 0.05 was regarded as statistically significant. Results: 92.85% of patients from the GPA group reported hearing-related symptoms: hearing loss, tinnitus, and fullness in the ears. The arithmetic means of all hearing thresholds at frequencies from 125 Hz to 8000 Hz were significantly higher in the GPA group. The results revealed statistically significant differences between the two groups in the Speech Detection Threshold, Speech Recognition Threshold, Speech Discomfort level, and Word Recognition Scores. Conclusions: The frequency of hearing loss, the average hearing thresholds, and speech thresholds were higher in GPA patients than in healthy individuals. The most common type of hearing loss was sensorineural. Audiological assessments should be considered during the routine evaluation of patients with GPA disease to prevent hearing-related disabilities.
Collapse
Affiliation(s)
- Vija Vainutienė
- State Research Institute Centre for Innovative Medicine, Santariškių str. 5, LT-08406 Vilnius, Lithuania; (J.D.); (T.I.)
| | - Justinas Ivaška
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.I.); (V.B.); (E.L.)
| | - Jolanta Dadonienė
- State Research Institute Centre for Innovative Medicine, Santariškių str. 5, LT-08406 Vilnius, Lithuania; (J.D.); (T.I.)
- Department of Public Health, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania
| | - Vilma Beleškienė
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.I.); (V.B.); (E.L.)
| | - Tatjana Ivaškienė
- State Research Institute Centre for Innovative Medicine, Santariškių str. 5, LT-08406 Vilnius, Lithuania; (J.D.); (T.I.)
| | - Eugenijus Lesinskas
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.I.); (V.B.); (E.L.)
| |
Collapse
|
33
|
Löffler C, Hellmich B. [Management of ANCA-associated vasculitides]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:93-106. [PMID: 38253699 DOI: 10.1007/s00108-023-01655-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune-mediated inflammation of small and medium-sized vessels that can affect virtually any organ system and bears the risk of irreversible organ damage. Without treatment the mortality rates are high, which necessitates rapid diagnosis and initiation of treatment. Histological confirmation, which is not feasible in all cases, should be strived for, especially to delineate differential diagnoses and vasculitis mimics. The new American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria are primarily designed for study purposes and show limitations in the routine application. Globally, the recently updated EULAR recommendations represent the most up to date management guidelines. Therapeutically, rituximab and cyclophosphamide in combination with glucocorticoids remain the pillars of treatment in remission induction for severe organ-threatening and life-threatening diseases. For the first time, mepolizumab and avacopan represent approved treatment options for specific entities that make a significant contribution to steroid reduction. New attention has been paid to patient-reported outcomes, for which a disease-specific outcome questionnaire is now available.
Collapse
Affiliation(s)
- Christian Löffler
- Klinik für Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, medius Klinik Kirchheim, Eugenstr. 3, 73230, Kirchheim unter Teck, Deutschland.
- Vaskulitis-Referenzzentrum der Europäischen Union ERN-RITA, Lehrkrankenhaus der Eberhard Karls Universität Tübingen, Kirchheim unter Teck, Deutschland.
- Klinik für Nephrologie, Endokrinologie, Hypertensiologie und Rheumatologie, Universitätsmedizin Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim, Deutschland.
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, medius Klinik Kirchheim, Eugenstr. 3, 73230, Kirchheim unter Teck, Deutschland
- Vaskulitis-Referenzzentrum der Europäischen Union ERN-RITA, Lehrkrankenhaus der Eberhard Karls Universität Tübingen, Kirchheim unter Teck, Deutschland
| |
Collapse
|
34
|
Ahn SS, Heo SJ, Ha JW, Park YB, Lee SW. Clinical association of health-related quality of life and mortality in an antineutrophil cytoplasmic antibody-associated vasculitis cohort. Semin Arthritis Rheum 2024; 64:152353. [PMID: 38128176 DOI: 10.1016/j.semarthrit.2023.152353] [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: 08/14/2023] [Revised: 10/27/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To evaluate the association between health-related quality of life (HRQoL) and mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS We searched patients with AAV assessed for HRQoL at initial diagnosis using Short Form 36 (SF-36). Relationships between SF-36 physical component summary (PCS) and mental component summary (MCS) scales and variables were estimated using Pearson's correlation analysis. Contal's and O'Quigley's methods were used to determine optimal SF-36 PCS cut-off for predicting all-cause mortality. The Cox proportional hazards model and inverse probability of treatment weighting (IPTW) analysis were used to ascertain prognostic implications of SF-36 scales and mortality. RESULTS The median SF-36 PCS and MCS values of the 189 patients were 47.5 and 53.3, respectively, and 21 (11.1%) patients (microscopic polyangiitis [MPA], n=15; granulomatosis with polyangiitis [GPA], n=6) died during follow-up. SF-36 PCS was significantly but weakly associated with Birmingham Vasculitis Activity Score, Five-factor score, erythrocyte sedimentation rate (ESR), and C-reactive protein. However, SF-36 MCS was not associated with ESR. In the multivariable Cox analysis, a decrease of SF-36 PCS score by one unit indicated a higher death risk (hazard ratio [HR]: 1.030; 95% confidence interval [CI]: 1.007, 1.052; p=0.041), which was not for SF-36 MCS. IPTW analysis in a subgroup of MPA and GPA patients revealed increased patient mortality with SF-36 PCS <53.75 independently (HR: 3.249; 95% CI: 1.169, 9.033; p=0.024). CONCLUSION Poor baseline physical functioning associated with premature death in patients with MPA and GPA. HRQoL assessment during initial diagnosis may provide clinical insights for this population.
Collapse
Affiliation(s)
- Sung Soo Ahn
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jang Woo Ha
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
35
|
Yoon T, Ha JW, Pyo JY, Song JJ, Park YB, Ahn SS, Lee SW. Circulating cold-inducible RNA-binding protein levels in microscopic polyangiitis and granulomatosis with polyangiitis : Correlation with disease activity. Z Rheumatol 2024; 83:230-235. [PMID: 36732449 DOI: 10.1007/s00393-023-01320-x] [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: 01/05/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study investigated whether circulating cold-inducible RNA-binding protein (CIRP) could be a biomarker to reflect the current activity, function, and damage status in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). METHODS This study selected 39 MPA and 26 GPA patients. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-specific indices include the Birmingham Vasculitis Activity Index (BVAS), five-factor score (FFS), the Korean version of the Short-Form 36-Item Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), and the vasculitis damage index (VDI). The highest tertile of BVAS was defined as high activity of AAV. RESULTS The median age of the study subjects was 65.0 years and 53.8% were women. The median BVAS, FFS, SF-36 PCS, MCS, and VDI scores were 12.0, 2.0, 47.5, 50.3, and 3.0, respectively. The median circulating CIRP level was 6.4 ng/mL. Among the four AAV-specific indices, circulating CIRP was significantly correlated with BVAS (r = 0.256). Using the receiver operator characteristic curve, the cut-off of circulating CIRP for high activity of AAV was 6.16 ng/mL. High activity of AAV was identified more frequently in patients with circulating CIRP ≥ 6.16 ng/mL than in those with circulating CIRP < 6.16 ng/mL (48.6% vs. 21.4%). In addition, patients with circulating CIRP ≥ 6.16 ng/mL exhibited a significantly higher risk for high activity of AAV than those with circulating CIRP < 6.16 ng/mL (relative risk 3.474). CONCLUSION This study suggests the clinical potential of circulating CIRP as a biomarker for reflecting the current BVAS and predicting high activity of AAV in patients with MPA and GPA.
Collapse
Affiliation(s)
- Taejun Yoon
- Department of Medical Science, BK21 Plus Project, Yonsei University, College of Medicine, Seoul, Korea (Republic of)
| | - Jang Woo Ha
- Division of Rheumatology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, 16995, Yongin, Gyeonggi-do, Korea (Republic of)
| | - Jung Yoon Pyo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea (Republic of)
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea (Republic of)
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea (Republic of)
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, 16995, Yongin, Gyeonggi-do, Korea (Republic of).
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea (Republic of).
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea (Republic of).
| |
Collapse
|
36
|
Perray L, Nguyen Y, Clavel Refregiers G, Chazal T, Héron E, Pouchelon C, Dunogué B, Costedoat-Chalumeau N, Murarasu A, Régent A, Puéchal X, Thoreau B, Lifermann F, Graveleau J, Hié M, Froissart A, Baudet A, Deroux A, Lavigne C, Puigrenier S, Mesbah R, Moulinet T, Vasco C, Revuz S, Pugnet G, Rieu V, Combes A, Brézin A, Terrier B. ANCA-associated scleritis: impact of ANCA on presentation, response to therapy and outcome. Rheumatology (Oxford) 2024; 63:329-337. [PMID: 37233203 DOI: 10.1093/rheumatology/kead252] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To describe the characteristics, treatment and outcome of isolated ANCA-associated scleritis at diagnosis compared with idiopathic scleritis with negative ANCA tests. METHODS This retrospective multicentre case-control study was performed within the French Vasculitis Study Group (FVSG) network and in three French tertiary ophthalmologic centres. Data from patients with scleritis without any systemic manifestation and with positive ANCA results were compared with those of a control group of patients with idiopathic scleritis with negative ANCA tests. RESULTS A total of 120 patients, including 38 patients with ANCA-associated scleritis and 82 control patients, diagnosed between January 2007 and April 2022 were included. The median follow-up was 28 months (IQR 10-60). The median age at diagnosis was 48 years (IQR 33-60) and 75% were females. Scleromalacia was more frequent in ANCA-positive patients (P = 0.027) and 54% had associated ophthalmologic manifestations, without significant differences. ANCA-associated scleritis more frequently required systemic medications, including glucocorticoids (76% vs 34%; P < 0.001), and rituximab (P = 0.03) and had a lower remission rate after the first- and second-line treatment. Systemic ANCA-associated vasculitis (AAV) occurred in 30.7% of patients with PR3- or MPO-ANCA, after a median interval of 30 months (IQR 16.3-44). Increased CRP >5 mg/l at diagnosis was the only significant risk factor of progression to systemic AAV [adjusted hazard ratio 5.85 (95% CI 1.10, 31.01), P = 0.038]. CONCLUSION Isolated ANCA-associated scleritis is mostly anterior scleritis with a higher risk of scleromalacia than ANCA-negative idiopathic scleritis and is more often difficult to treat. One-third of patients with PR3- or MPO-ANCA scleritis progressed to systemic AAV.
Collapse
Affiliation(s)
- Laura Perray
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Thibaud Chazal
- Department of Internal Medicine, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Clara Pouchelon
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Bertrand Dunogué
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Anne Murarasu
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Julie Graveleau
- Department of Internal Medicine, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Miguel Hié
- Department of Internal Medicine, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Antoine Froissart
- Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre Hospitalier d'Annecy, Annecy, France
| | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Christian Lavigne
- Department of Internal Medicine, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sébastien Puigrenier
- Department of Internal Medicine, Centre Hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Rafik Mesbah
- Department of Nephrology, Centre Hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Thomas Moulinet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Claire Vasco
- Department of Internal Medicine, Centre Hospitalier de Libourne, Libourne, France
| | - Sabine Revuz
- Department of Internal Medicine, Centre Hospitalier Universitaire Saint Pierre, La Réunion, Saint Pierre, France
| | - Grégory Pugnet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Rieu
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anaïs Combes
- Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France
| | - Antoine Brézin
- Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| |
Collapse
|
37
|
Ou CC, Wu YC, Chen JP, Huang WN, Chen YH, Chen YM. Association of atypical anti-neutrophil cytoplasmic antibody with comorbidities and outcome in a hospital-based population. Heliyon 2024; 10:e24105. [PMID: 38234907 PMCID: PMC10792567 DOI: 10.1016/j.heliyon.2024.e24105] [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: 06/23/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
Introduction Atypical anti-neutrophil cytoplasmic antibody (a-ANCA) is characterized by a positive fluorescence staining other than typical cytoplasmic or perinuclear ANCA. ANCA is associated with increased risk of dialysis and mortality in patients with ANCA vasculitis. However, comorbidities related to a-ANCA and whether a-ANCA exhibits an increased risk for renal failure and mortality remain unclear. This study aimed to explore the comorbidities and outcome associated with a-ANCA. Materials and methods This retrospective study enrolled 164 and 170 patients with typical ANCA and a-ANCA positivity, respectively, who visited Taichung Veterans General Hospital, Taiwan from January 2016 to March 2021. Logistic regression analysis was used to determine risk factors and the rheumatological diagnosis associated with a-ANCA. Cox proportional hazard regression and Kaplan-Meier curves were employed to identify variables associated with 5-year renal survival and mortality. Results Patients with a-ANCA had lower chance of ANCA-associated vasculitis (OR: 0.02, 95 % CI: 0.01-0.07 p < 0.001), and systemic lupus erythematosus (OR: 0.23, 95 % CI: 0.11-0.48, p < 0.001), but a higher risk of rheumatoid arthritis (OR: 2.99, 95 % CI: 1.15-7.83, p = 0.025) and ulcerative colitis (OR: 5.50, 95 % CI: 1.20-25.29, p = 0.028). Patients with a-ANCA had a better renal survival (OR: 0.14, 95 % CI: 0.08-0.24, p < 0.001) and lower mortality (OR: 0.31, 95 % CI: 0.16-0.60, p = 0.001) than patents in the typical ANCA group. The 5-year renal survival and mortality was 89.3 % and 8.8 %, respectively, in patients with a-ANCA. Conclusion Patients with a-ANCA had better renal survival and lower mortality rates compared to patients with typical ANCA. These real-world data provide evidence of the long-term outcome and shed light on avenues for the strategic management of patients with a-ANCA.
Collapse
Affiliation(s)
- Chiao-Chi Ou
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Yen-Ching Wu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Peng Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Nan Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Business and Management, Ling Tung University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Precision Medicine Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| |
Collapse
|
38
|
Klapa S, Arnold S, Lamprecht P. [Granulomatosis with polyangiitis and microscopic polyangiitis]. Laryngorhinootologie 2024. [PMID: 38211619 DOI: 10.1055/a-2217-4457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are two entities of ANCA-associated vasculitis (AAV). Both diseases are characterised by systemic necrotising small-vessel vasculitis, which can affect any organ. In GPA, extravascular necrotising granulomatous inflammation, usually affecting the respiratory tract, is found in addition. In the majority of cases, the clinical presentation is dominated by a pulmonary-renal syndrome with alveolar haemorrhage and rapidly progressive glomerulonephritis. Other organ involvement is found as well. In GPA, the upper respiratory tract is commonly affected. GPA is associated with anti-neutrophil cytoplasmic autoantibodies (ANCA) with specificity for proteinase 3 (PR3-ANCA) and MPA with specificity for myeloperoxidase (MPO-ANCA). Immunosuppressive therapy depends on disease activity and the severity of organ involvement.
Collapse
Affiliation(s)
- Sebastian Klapa
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Sabrina Arnold
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
39
|
Libra A, Colaci M, Spicuzza L, Luca G, Fischetti S, Pashalidis G, Ferrara CA, Ielo G, Sambataro D, La Rosa G, Libra F, Palmucci S, Vancheri C, Sambataro G. The Pattern and Progression of "Usual" Interstitial Pneumonia with Autoimmune Features: Comparison with Patients with Classic Interstitial Pneumonia with Autoimmune Features and Idiopathic Pulmonary Fibrosis. J Clin Med 2024; 13:369. [PMID: 38256503 PMCID: PMC10816405 DOI: 10.3390/jcm13020369] [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: 12/20/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND We proposed the term "UIPAF" to define patients with Usual Interstitial Pneumonia (UIP) associated with only one domain of the classification called "Interstitial Pneumonia with Autoimmune Features" (IPAF). The objective of this study was to evaluate the clinical presentation and prognosis of UIPAF patients, compared with two cohorts, composed of IPAF and idiopathic pulmonary fibrosis (IPF) patients, respectively. METHODS The patients were enrolled as IPAF, UIPAF, or IPF based on clinical, serological, and radiological data and evaluated by a multidisciplinary team. RESULTS We enrolled 110 patients with IPF, 69 UIPAF, and 123 IPAF subjects. UIPAF patients were similar to IPAF regarding autoimmune features, except for the prevalence of Rheumatoid Factor in UIPAF and anti-SSA in IPAF. A similar proportion of the two cohorts progressed toward a specific autoimmune disease (SAD), with differences in the kind of SAD developed. The real-life management and prognosis of UIPAF patients proved to be almost identical to IPF. CONCLUSIONS UIPAF shared with IPAF similar autoimmune features, suggesting the opportunity to be considered IPAF, excluding the morphological domain by the classification. However, the real-life management and prognosis of UIPAF are similar to IPF. These data suggest a possible modification in the therapeutic management of UIPAF.
Collapse
Affiliation(s)
- Alessandro Libra
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy;
| | - Lucia Spicuzza
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giuliana Luca
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Sefora Fischetti
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giorgio Pashalidis
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Chiara Alfia Ferrara
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giuseppe Ielo
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Domenico Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia (CT), Italy;
| | - Giuliana La Rosa
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (G.L.R.); (F.L.)
| | - Federica Libra
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (G.L.R.); (F.L.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Unità Operativa Semplice Dipartimentale di Imaging Polmonare e Tecniche Radiologiche Avanzate (UOSD IPTRA), 95123 Catania, Italy;
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy;
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia (CT), Italy;
| |
Collapse
|
40
|
Hellmich B, Sanchez-Alamo B, Schirmer JH, Berti A, Blockmans D, Cid MC, Holle JU, Hollinger N, Karadag O, Kronbichler A, Little MA, Luqmani RA, Mahr A, Merkel PA, Mohammad AJ, Monti S, Mukhtyar CB, Musial J, Price-Kuehne F, Segelmark M, Teng YKO, Terrier B, Tomasson G, Vaglio A, Vassilopoulos D, Verhoeven P, Jayne D. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update. Ann Rheum Dis 2024; 83:30-47. [PMID: 36927642 DOI: 10.1136/ard-2022-223764] [Citation(s) in RCA: 93] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Since the publication of the EULAR recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in 2016, several randomised clinical trials have been published that have the potential to change clinical care and support the need for an update. METHODS Using EULAR standardised operating procedures, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 16 countries. We modified existing recommendations and created new recommendations. RESULTS Four overarching principles and 17 recommendations were formulated. We recommend biopsies and ANCA testing to assist in establishing a diagnosis of AAV. For remission induction in life-threatening or organ-threatening AAV, we recommend a combination of high-dose glucocorticoids (GCs) in combination with either rituximab or cyclophosphamide. We recommend tapering of the GC dose to a target of 5 mg prednisolone equivalent/day within 4-5 months. Avacopan may be considered as part of a strategy to reduce exposure to GC in granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). Plasma exchange may be considered in patients with rapidly progressive glomerulonephritis. For remission maintenance of GPA/MPA, we recommend rituximab. In patients with relapsing or refractory eosinophilic GPA, we recommend the use of mepolizumab. Azathioprine and methotrexate are alternatives to biologics for remission maintenance in AAV. CONCLUSIONS In the light of recent advancements, these recommendations provide updated guidance on AAV management. As substantial data gaps still exist, informed decision-making between physicians and patients remains of key relevance.
Collapse
Affiliation(s)
- Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim unter Teck, Germany
| | | | - Jan H Schirmer
- Rheumatology & Clinical Immunology and Cluster of Excellence Precision Medicine in Chronic Inflammation, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Alvise Berti
- CIBIO, Universita degli Studi di Trento, Trento, Italy
- Rheumatology, Santa Chiara Hospital, Trento, Italy
| | - Daniel Blockmans
- Department of Internal Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumuenster, Germany
| | - Nicole Hollinger
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim unter Teck, Germany
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Anakra, Turkey
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Medical University, Innsbruck, Austria
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | - Alfred Mahr
- Klinik für Rheumatologie, Kantonspital St Gallen, St Gallen, Switzerland
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aladdin J Mohammad
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Clinical Sciences, Lund University & Department of Rheumatology, Skåne Hospital, Lund, Sweden
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Jacek Musial
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis-, and Complement-Mediated Systemic Autoimmune Diseases (LuVaCs), Department of Internal Medicine, Section Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Gunnar Tomasson
- Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Rheumatology and Centre for Rheumatology Research, University Hospital Reykjavik, Reykjavik, Iceland
| | - Augusto Vaglio
- Nephrology Unit, Meyer Children's Hospital, and Department of Biomedical, Experimental and Clinical Science, University of Florence, Florence, Italy
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Peter Verhoeven
- Dutch Patient Vasculitis Organization, Haarlem, The Netherlands
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
41
|
Kelly S, Jackson KJ, Peters TJ, Suan D, Goodnow CC. Isolation and characterisation of PR3-specific B cells and their immunoglobulin sequences. J Autoimmun 2024; 142:103129. [PMID: 37952292 DOI: 10.1016/j.jaut.2023.103129] [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: 09/21/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND PR3 autoantibodies are essential to the diagnosis and monitoring of granulomatosus with polyangiitis, but to date no PR3 autoantibody sequences have been published. OBJECTIVES To identify and characterise PR3-specific B cells from the peripheral blood of patients with PR3 autoantibodies. METHODS Peripheral blood mononuclear cells from seven patients with PR3 autoantibodies were stained with PR3. B cells that bound PR3 underwent single cell sorting, transcriptome sequencing, and their immunoglobulin sequences expressed as antibodies and tested for PR3-specificity by ELISA. RESULTS We identified 19 PR3-specific B cells from only one PR3-seropositive patient at a low frequency (0.0075 % of B cells) in the peripheral blood. These were polyclonal, IgG+ and enriched for IgG4, lambda pairing, IGHJ6 gene usage, CDRH3 length, IGHE and CD71 expression. They demonstrated relatively low levels of somatic hypermutation and variably reduced PR3 binding when reverted to germline. CONCLUSIONS Identifying PR3-specific B cells in the peripheral blood is possible but challenging and those we did identify exhibited features suggesting that PR3-self reactivity may occur early in B-cell development.
Collapse
Affiliation(s)
- Shane Kelly
- Garvan Institute of Medical Research, UNSW Sydney, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, NSW, 2052, Australia.
| | - Katherine Jl Jackson
- Garvan Institute of Medical Research, UNSW Sydney, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, NSW, 2052, Australia
| | - Timothy J Peters
- Garvan Institute of Medical Research, UNSW Sydney, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, NSW, 2052, Australia
| | - Dan Suan
- Garvan Institute of Medical Research, UNSW Sydney, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, NSW, 2052, Australia
| | - Christopher C Goodnow
- Garvan Institute of Medical Research, UNSW Sydney, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia; Cellular Genomics Futures Institute & School of Biomedical Sciences, UNSW Sydney, Australia
| |
Collapse
|
42
|
Liberatore J, Nguyen Y, Hadjadj J, Cohen P, Mouthon L, Puéchal X, Guillevin L, Terrier B. Risk factors for hypogammaglobulinemia and association with relapse and severe infections in ANCA-associated vasculitis: A cohort study. J Autoimmun 2024; 142:103130. [PMID: 37956529 DOI: 10.1016/j.jaut.2023.103130] [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: 04/07/2023] [Revised: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES B-cell depletion induced by rituximab (RTX) in ANCA-associated vasculitis (AAV) is a risk factor for hypogammaglobulinemia. Aggregating data on gammaglobulin levels kinetics during RTX and its association with the risk of relapse and severe infection is of interest. METHODS Gammaglobulin levels were collected before induction therapy and during RTX maintenance therapy. We used different definitions of gammaglobulin decline: 1/gammaglobulin levels <6 g/L after induction; 2/>25 % decline in gammaglobulin levels between induction and maintenance, and 3/both. Our primary objective was the impact of gammaglobulin decline on the risk of relapse and severe infections. RESULTS We included 98 patients. Patients with gammaglobulin level <6 g/L after induction and gammaglobulin decline >25 % were older (OR 3.9; 95%CI 1.1-16.1), had more frequently baseline gammaglobulin levels <10 g/L (OR 6.0; 95%CI 1.7-25.8) and received more frequent pulses of methylprednisolone at induction (OR 4.6; 95%CI 1.3-18.5). Severe infection-free survival was significantly poorer in patients with both gammaglobulin <6 g/L and gammaglobulin decline >25 % (adjusted HR 2.3; 95%CI 1.0-5.1) and in those who received pulses of methylprednisolone (HR 5.6; 95%CI 2.3-13.4). Gammaglobulin decline was in contrast not associated with the risk of relapse. CONCLUSION Older age, low gammaglobulin levels and pulses of methylprednisolone at induction increase the likelihood of gammaglobulin decline after induction therapy. Such decline was associated with an increased risk of severe infections but not lower risk of vasculitis relapse. Pulses of methylprednisolone at induction had an independent negative impact on gammaglobulin levels and the risk of severe infections.
Collapse
Affiliation(s)
- Johanne Liberatore
- Department of Internal Medicine, Centre Hospitalier d'Angoulême, Chemin du Grand Girac, 16959, Angoulême, France
| | - Yann Nguyen
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France
| | - Jérôme Hadjadj
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France
| | - Pascal Cohen
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France
| | - Luc Mouthon
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France.
| |
Collapse
|
43
|
Roper T, Salama AD. ANCA-Associated Vasculitis: Practical Issues in Management. Indian J Nephrol 2024; 34:6-23. [PMID: 38645911 PMCID: PMC11003588 DOI: 10.4103/ijn.ijn_346_23] [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: 08/06/2023] [Accepted: 09/20/2023] [Indexed: 04/23/2024] Open
Abstract
ANCA associated vasculitides are multi-system autoimmune diseases which are increasing in prevalence. In this review we will discuss the clinical manifestations and review the management options. We highlight the various trials of induction and maintenance therapy and discuss the areas of unmet need. These include understanding which patients are at highest risk of relapse, clinical adaptation of improved biomarkers of disease activity and tools to discuss long term prognosis.
Collapse
Affiliation(s)
- Tayeba Roper
- UCL Department of Renal Medicine, Royal Free Hospital, London NW3 2PF, UK
| | - Alan David Salama
- UCL Department of Renal Medicine, Royal Free Hospital, London NW3 2PF, UK
| |
Collapse
|
44
|
Yazici Y. Current treatment approach to ANCA-associated vasculitis. Curr Opin Rheumatol 2024; 36:35-39. [PMID: 37755381 DOI: 10.1097/bor.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW This review will attempt to summarize the most potentially impactful new data on the way ANCA-associated vasculitis (AAV) is diagnosed, treated, and monitored. RECENT FINDINGS The newly developed classification criteria for AAV have serious methodological issues that need to be addressed before they are widely adopted. The newly approved drugs and studies into both achieving remission and maintaining it have added to our overall knowledge of managing AAV and should hopefully contribute to improving outcomes in AAV. SUMMARY The diagnosis, treatment and monitoring of AAV have seen major improvements in the last two years. The remaining issues outlined in this review still need to be addressed to best serve AAV patients.
Collapse
Affiliation(s)
- Yusuf Yazici
- Clinical Associate Professor of Medicine, NYU Grossman School of Medicine, New York, NY, US
| |
Collapse
|
45
|
Pella E, Iatridi F, Sgouropoulou V, Boutou A, Dimitroulas T. Pulmonary involvement in antineutrophil cytoplasmic antibody-associated vasculitides. Int J Rheum Dis 2024; 27:e14933. [PMID: 37753535 DOI: 10.1111/1756-185x.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Eva Pella
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Sgouropoulou
- First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Forth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
46
|
Mohamadi A, Soroureddin S, Nayebirad S, Tamartash Z, Mohebbi M, Kavosi H. New-onset ANCA-associated vasculitis presenting with neuropathy after COVID-19 infection: A case report and literature review. Clin Case Rep 2024; 12:e8457. [PMID: 38259866 PMCID: PMC10801276 DOI: 10.1002/ccr3.8457] [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: 09/07/2023] [Revised: 12/10/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is a viral infection caused by SARS-CoV-2, which can trigger autoimmune diseases such as antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis (AAV) that affect small and medium-sized blood vessels in multiple organs. This study discusses a case with neuropathy and positive ANCA after COVID-19 infection and reviews the literature on AAV following COVID-19 infection. A 59-year-old man is presented that was referred to Shariati Hospital for evaluation of neurologic problems after a COVID-19 infection. Initially, he had flu-like symptoms. A few days later, he developed right distal upper and lower limb paresthesia. His electromyography (EMG) and nerve conduction velocity (NCV) results were consistent with polyneuropathy. Lumbar puncture (LP) was normal except for positive COVID-19 polymerase chain reaction (PCR). The patient's paresthesia worsened. Laboratory data showed leukocytosis, anemia, thrombocytosis, high erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Perinuclear anti-neutrophil cytoplasmic antibody (MPO-ANCA) was positive. According to the results, vasculitis was the main differential diagnosis. The sural nerve biopsy was performed, and the result was consistent with small to medium-sized vessel vasculitis. The patient was diagnosed with COVID-induced AAV. He was prescribed methylprednisolone and cyclophosphamide and was discharged with prednisolone and cotrimoxazole. In this study, a unique case of AAV induced by COVID-19 infection confirmed by nerve biopsy is presented. A review of the literature found 48 cases of new-onset AAV in adults and pediatrics after COVID-19 infection. Further research is needed to completely understand the relationship between COVID-19.
Collapse
Affiliation(s)
- Aida Mohamadi
- Rheumatology Research CenterTehran University of Medical SciencesTehranIran
| | | | - Sepehr Nayebirad
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Zahra Tamartash
- Rheumatology Research CenterTehran University of Medical SciencesTehranIran
| | - Maryam Mohebbi
- Rheumatology Research CenterTehran University of Medical SciencesTehranIran
| | - Hoda Kavosi
- Rheumatology Research CenterTehran University of Medical SciencesTehranIran
| |
Collapse
|
47
|
Higashida-Konishi M, Akiyama M, Hama S, Oshige T, Izumi K, Oshima H, Okano Y. Successful treatment of PR3-ANCA-positive interstitial pneumonia with a moderate dose of glucocorticoid and rituximab. Mod Rheumatol Case Rep 2023; 8:137-140. [PMID: 37225939 DOI: 10.1093/mrcr/rxad024] [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: 03/17/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-positive interstitial pneumonia (IP) is reported as IP that is ANCA-positive and does not involve organ damage associated with vasculitis other than the lungs. While the combination of glucocorticoid and rituximab is effective in ANCA-associated vasculitis, the treatment strategy for ANCA-positive IP has not been established. Here, we report the first case of successful treatment of proteinase 3 (PR3)-ANCA-positive IP with a moderate dose of glucocorticoid and rituximab. The patient was an 80-year-old male who presented with subacute dry cough and dyspnoea. Blood tests revealed elevated levels of C-reactive protein, Krebs von den Lungen 6 (KL-6), and PR3-ANCA. Chest computed tomography (CT) showed interstitial shadows and infiltrates around honeycomb cysts. 18F-fluorodeoxyglucose (FDG) positron emission tomography CT revealed an uptake of FDG in the IP area. After starting treatment with a moderate dose of prednisolone and rituximab, the patient's clinical symptoms disappeared, C-reactive protein and KL-6 turned to be normal, and infiltrates around the cysts of honeycomb lungs disappeared. Prednisolone was gradually decreased to 2 mg, and no relapse or adverse events were observed during the course of treatment. Our case suggests that early treatment with a moderate dose of glucocorticoid and rituximab is effective for PR3-ANCA-positive IP.
Collapse
Affiliation(s)
- Misako Higashida-Konishi
- Division of Rheumatology, Department of Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Mitsuhiro Akiyama
- Division of Rheumatology, Department of Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Hama
- Division of Rheumatology, Department of Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tatsuhiro Oshige
- Division of Rheumatology, Department of Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Izumi
- Division of Rheumatology, Department of Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hisaji Oshima
- Division of Rheumatology, Department of Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yutaka Okano
- Division of Rheumatology, Department of Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| |
Collapse
|
48
|
Uccello G, Bonacchi G, Rossi VA, Montrasio G, Beltrami M. Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis. J Clin Med 2023; 13:150. [PMID: 38202158 PMCID: PMC10780032 DOI: 10.3390/jcm13010150] [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: 12/03/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term "chronic inflammatory cardiomyopathy" describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype-phenotype association is suspected, as this has significant implications for patients' and their family members' prognoses. Recognition of the pathophysiological pathway and clinical "red flags" and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes.
Collapse
Affiliation(s)
- Giuseppe Uccello
- Division of Cardiology, Alessandro Manzoni Hospital—ASST Lecco, 23900 Lecco, Italy;
| | - Giacomo Bonacchi
- Division of Cardiology, Tor Vergata University Hospital, 00133 Rome, Italy;
| | | | - Giulia Montrasio
- Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BS, UK;
| | - Matteo Beltrami
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
- Arrhythmia and Electrophysiology Unit, Careggi University Hospital, 50134 Florence, Italy
| |
Collapse
|
49
|
Sada KE, Kaname S, Higuchi T, Furuta S, Nagasaka K, Nanki T, Tsuboi N, Amano K, Dobashi H, Hiromura K, Bando M, Wada T, Arimura Y, Makino H, Harigai M. Validation of new ACR/EULAR 2022 classification criteria for anti-neutrophil cytoplasmic antibody-associated vasculitis. Mod Rheumatol 2023; 34:144-150. [PMID: 36715080 DOI: 10.1093/mr/road017] [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: 12/01/2022] [Revised: 01/08/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The objective of this study was to compare the American College of Rheumatology/European Alliance of Associations for Rheumatology 2022 criteria with the previous classification algorithm for anti-neutrophil cytoplasmic antibody-associated vasculitis. METHODS We used data from two nationwide, prospective, inception cohort studies. The enrolled patients were classified as having eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA) according to the new criteria; these criteria were compared with Watts' algorithm. RESULTS Among 477 patients, 10.7%, 9.9%, and 75.6% were classified as having EGPA, GPA, and MPA, respectively; 6.1% were unclassifiable. Three patients met both the EGPA and MPA criteria, and eight patients met both the GPA and MPA criteria. Of 78 patients with GPA classified using Watts' algorithm, 27 (34.6%) patients were reclassified as having MPA. Ear, nose, and throat involvement was significantly less frequent in patients reclassified as having MPA than in those reclassified as having GPA. Of 73 patients unclassifiable using Watts' algorithm, 62 were reclassified as having MPA. All patients reclassified as having MPA were myeloperoxidase-anti-neutrophil cytoplasmic antibody positive, and 46 had interstitial lung disease. CONCLUSION Although the American College of Rheumatology/European Alliance of Associations for Rheumatology 2022 criteria cause overlapping multiple criteria fulfilments in some patients, those items contribute to classifying unclassifiable patients using Watts' algorithm into MPA.
Collapse
Affiliation(s)
- Ken-Ei Sada
- Department of Clinical Epidemiology, Kochi Medical School, Nankoku, Japan
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoaki Higuchi
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University, Chiba, Japan
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital, Ome, Japan
- Department of Rheumatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiro Nanki
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Graduate School of Medicine, Fujita Health University, Toyoake, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Keiju Hiromura
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | | | - Yoshihiro Arimura
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
- Kichijoji Asahi Hospital, Musashino, Japan
| | | | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|
50
|
Moronti V, Carubbi F, Sollima L, Piscitani L, Ferri C. End stage renal disease in patient with microscopic polyangiitis and atypical hemolytic-uremic syndrome arose 3 weeks after the third dose of anti-SARS-CoV2 vaccine mRNA-1273: A case report with literature revision. Medicine (Baltimore) 2023; 102:e36560. [PMID: 38115241 PMCID: PMC10727565 DOI: 10.1097/md.0000000000036560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE Immune system deregulation, including AAV, is a key event that may potentially evolve into ESRD. Abnormal activation of the cAP is also a cardinal feature of TMA, particularly aHUS. The kidney is the most frequently involved organ, and renal-limited forms of TMA are often encountered in clinical practice. Isolated case reports described the occurrence of renal TMA in AAV patients. Some cases of both de novo and relapses of AAV and/or TMAs after anti-SARS-CoV2 vaccination have been reported. We reported, for the 1st time, a case of patients with new-onset MPA and aHUS occurring 3 weeks after the third dose of mRNA-1273 vaccine anti-SARS-CoV2. PATIENT CONCERNS We present a 67-year-old man, affected by arterial hypertension, reported, after mRNA-1273 vaccine anti-SARS-CoV2, anuria, fatigue, anorexia and nausea. Laboratory data revealed acute renal failure. DIAGNOSIS Positivity of MPO-ANCA was observed. 7 days after admission, we observed a worsening of anemia and thrombocytopenia with haptoglobin reduction, LDH increase and presence of schistocytes. Plasma levels of ADAMTS-13 were normal. A renal biopsy was performed, and findings were consistent with microscopic polyangiitis, with features of micro-thrombotic glomerulopathy. Genetic tests revealed absence of hybrid genes associated with the increased risk of aHUS. INTERVENTIONS AND OUTCOMES We started renal replacement treatment, including hemodialysis, and pulsed methylprednisolone, with no improvement of laboratory parameters. Then, plasma exchange was performed leading to partial haematological response. Only with Eculizumab, a human C5 inhibitor, we observed a normalization of haptoglobin levels and platelets' count. However, three months after discharge, the patient still required hemodialysis. LESSONS To our knowledge we observed the first case aHUS, without genetic predisposition, associated with MPA occurring after the third dose of anti-SARS-CoV2 vaccine. This case report highlights the potential link between anti-SARS-CoV2 vaccine as a trigger of MPA and aHUS. This systematic review offers additional perspectives. It is plausible to hypothesize that the vaccine was the trigger for the development of these 2 diseases.Solid evidence on the mechanisms of interaction between vaccine and immune system, the role of genetic predisposition, and other variables, will shed additional light on the controversial link between anti-SARS-CoV2 vaccine and autoimmunity.
Collapse
Affiliation(s)
- Veronica Moronti
- University of L’Aquila, Department of Life, Health and Environmental Sciences; Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, L’Aquila, Italy
| | - Francesco Carubbi
- University of L’Aquila, Department of Life, Health and Environmental Sciences; Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, L’Aquila, Italy
| | - Laura Sollima
- Anatomy and Pathological Histology Division, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, L’Aquila, Italy
| | - Luca Piscitani
- Nephrology and Dialysis Division, Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, L’Aquila, Italy
| | - Claudio Ferri
- University of L’Aquila, Department of Life, Health and Environmental Sciences; Internal Medicine and Nephrology Division, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, L’Aquila, Italy
| |
Collapse
|