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Yoshida Y, Nakamoto N, Oka N, Kidoguchi G, Hosokawa Y, Araki K, Ishitoku M, Watanabe H, Sugimoto T, Mokuda S, Kida T, Yajima N, Omura S, Nakagomi D, Abe Y, Kadoya M, Takizawa N, Nomura A, Kukida Y, Kondo N, Yamano Y, Yanagida T, Endo K, Matsui K, Takeuchi T, Ichinose K, Kato M, Yanai R, Matsuo Y, Shimojima Y, Nishioka R, Okazaki R, Takata T, Ito T, Moriyama M, Takatani A, Miyawaki Y, Ito-Ihara T, Kawaguchi T, Kawahito Y, Hirata S. Seasonal Influence on Development of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Cohort Study Conducted at Multiple Institutions in Japan (J-CANVAS). J Rheumatol 2023; 50:1152-1158. [PMID: 37263656 DOI: 10.3899/jrheum.2023-0040] [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: 05/03/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To clarify seasonal and other environmental effects on the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS We enrolled patients with new-onset eosinophilic granulomatosis with polyangiitis (EGPA), microscopic polyangiitis (MPA), and granulomatosis with polyangiitis (GPA) registered in the database of a Japanese multicenter cohort study. We investigated the relationship between environmental factors and clinical characteristics. Seasons were divided into 4 (spring, summer, autumn, and winter), and the seasonal differences in AAV onset were analyzed using Pearson chi-square test, with an expected probability of 25% for each season. RESULTS A total of 454 patients were enrolled, with a mean age of 70.9 years and a female proportion of 55.5%. Overall, 74, 291, and 89 patients were classified as having EGPA, MPA, and GPA, respectively. Positivity for myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA was observed in 355 and 46 patients, respectively. Overall, the seasonality of AAV onset significantly deviated from the expected 25% for each season (P = 0.001), and its onset was less frequently observed in autumn. In ANCA serotypes, seasonality was significant in patients with MPO-ANCA (P < 0.001), but not in those with PR3-ANCA (P = 0.97). Additionally, rural residency of patients with AAV was associated with PR3-ANCA positivity and biopsy-proven pulmonary vasculitis. CONCLUSION The onset of AAV was influenced by seasonal variations and was less frequently observed in autumn. In contrast, the occurrence of PR3-ANCA was triggered, not by season, but by rural residency.
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Affiliation(s)
- Yusuke Yoshida
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima;
| | - Naoki Nakamoto
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Naoya Oka
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Genki Kidoguchi
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Yohei Hosokawa
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Kei Araki
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Michinori Ishitoku
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Hirofumi Watanabe
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Tomohiro Sugimoto
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Sho Mokuda
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Takashi Kida
- T. Kida, MD, PhD, MPH, S. Omura, MD, Y. Kawahito, MD, PhD, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Nobuyuki Yajima
- N. Yajima, MD, PhD, MPH, R. Yanai, MD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
| | - Satoshi Omura
- T. Kida, MD, PhD, MPH, S. Omura, MD, Y. Kawahito, MD, PhD, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Daiki Nakagomi
- D. Nakagomi, MD, PhD, Department of Rheumatology, University of Yamanashi Hospital, Chuo
| | - Yoshiyuki Abe
- Y. Abe, MD, PhD, Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo
| | - Masatoshi Kadoya
- M. Kadoya, MD, PhD, Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto
| | - Naoho Takizawa
- N. Takizawa, MD, Department of Rheumatology, Chubu Rosai Hospital, Nagoya
| | - Atsushi Nomura
- A. Nomura, MD, PhD, Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo
| | - Yuji Kukida
- Y. Kukida, MD, PhD, Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto
| | - Naoya Kondo
- N. Kondo, PhD, Department of Nephrology, Kyoto Katsura Hospital, Kyoto
| | - Yasuhiko Yamano
- Y. Yamano, PhD, Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto
| | - Takuya Yanagida
- T. Yanagida, MD, Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima
| | - Koji Endo
- K. Endo, MD, Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, and Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto
| | - Kiyoshi Matsui
- K. Matsui, MD, PhD, Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya
| | - Tohru Takeuchi
- T. Takeuchi, MD, PhD, Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka
| | - Kunihiro Ichinose
- K. Ichinose, MD, PhD, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, and Department of Rheumatology, Shimane University Faculty of Medicine, Izumo
| | - Masaru Kato
- M. Kato, MD, PhD, Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Sapporo
| | - Ryo Yanai
- N. Yajima, MD, PhD, MPH, R. Yanai, MD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
| | - Yusuke Matsuo
- Y. Matsuo, MD, PhD, Department of Rheumatology, Tokyo Kyosai Hospital, and Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo
| | - Yasuhiro Shimojima
- Y. Shimojima, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Ryo Nishioka
- R. Nishioka, MD, Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa
| | - Ryota Okazaki
- R. Okazaki, MD, PhD, Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago
| | - Tomoaki Takata
- T. Takata, MD, PhD, Division of Gastroenterology and Nephrology, Tottori University, Yonago
| | - Takafumi Ito
- T. Ito, MD, PhD, Division of Nephrology, Shimane University Hospital, Izumo
| | - Mayuko Moriyama
- M. Moriyama, MD, Department of Rheumatology, Shimane University Faculty of Medicine, Izumo
| | - Ayuko Takatani
- A. Takatani, MD, PhD, Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo
| | - Yoshia Miyawaki
- Y. Miyawaki, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Toshiko Ito-Ihara
- T. Ito-Ihara, MD, PhD, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto
| | - Takashi Kawaguchi
- T. Kawaguchi, PhD, Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yutaka Kawahito
- T. Kida, MD, PhD, MPH, S. Omura, MD, Y. Kawahito, MD, PhD, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Shintaro Hirata
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
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McGovern DP, Lees JS, Traynor JP, Mackinnon B, Bell S, Hunter RW, Dhaun N, Metcalfe W, Kidder D, Lim M, Joss N, Kelly M, Taylor A, Cousland Z, Dey V, Buck K, Brix S, Geddes CC, McQuarrie EP, Stevens KI. Outcomes in ANCA-Associated Vasculitis in Scotland: Validation of the Renal Risk Score in a Complete National Cohort. Kidney Int Rep 2023; 8:1648-1656. [PMID: 37547534 PMCID: PMC10403670 DOI: 10.1016/j.ekir.2023.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) causes autoimmune-mediated inflammation of small blood vessels in multiple organs, including the kidneys. The ability to accurately predict kidney outcomes would enable a more personalized therapeutic approach. Methods We used our national renal biopsy registry to validate the ability of ANCA Renal Risk Score (ARRS) to predict end-stage kidney disease (ESKD) for individual patients. This score uses histopathological and biochemical data to stratify patients as high, medium, or low risk for developing ESKD. Results A total of 288 patients were eligible for inclusion in the study (low risk n = 144, medium risk n = 122, high risk n = 12). Using adjusted Cox proportional hazard models with the low-risk group as reference, we show that outcome differs between the categories: high-risk hazard ratio (HR) 16.69 (2.91-95.81, P = 0.002); medium risk HR 4.14 (1.07-16.01, P = 0.039). Incremental multivariable-adjusted Cox proportional hazards models demonstrated that adding ARRS to a model adjusted for multiple clinical parameters enhanced predictive discrimination (basic model C-statistic 0.864 [95% CI 0.813-0.914], basic model plus ARRS C-statistic 0.877 [95% CI 0.823-0.931]; P <0.01). Conclusion The ARRS better discriminates risk of ESKD in AAV and offers clinicians more prognostic information than the use of standard biochemical and clinical measures alone. This is the first time the ARRS has been validated in a national cohort. The proportion of patients with high-risk scores is lower in our cohort compared to others and should be noted as a limitation of this study.
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Affiliation(s)
- Dominic P. McGovern
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer S. Lees
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jamie P. Traynor
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bruce Mackinnon
- Department of Nephrology and Transplantation, John Hunter Hospital, New South Wales, Australia
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Robert W. Hunter
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Dana Kidder
- Renal Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michelle Lim
- Renal Unit, Ninewells Hospital and Medical School, Dundee, UK
| | - Nicola Joss
- Renal Unit, Raigmore Hospital, Inverness, UK
| | - Michael Kelly
- Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | | | | | - Vishal Dey
- Renal Unit, University Hospital Crosshouse, Kilmarnock, UK
| | - Kate Buck
- Renal Unit, Queen Margaret Hospital, Fife Acute Hospitals Trust, Kirkcaldy, Fife, UK
| | - Silke Brix
- Renal, Urology and Transplantation Unit, Manchester University Hospitals, Manchester, UK
- Cardiovascular Science, University of Manchester, Manchester, UK
| | - Colin C. Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emily P. McQuarrie
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kathryn I. Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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