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Uribe Ruíz NA, Villa MP, Gutiérrez AÁ, Saldarriaga Giraldo CI, Thorrens Ríos JG. Accelerated atherosclerosis in Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: case report. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:40-44. [PMID: 38596604 PMCID: PMC10999312 DOI: 10.47487/apcyccv.v5i1.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/04/2024] [Indexed: 04/11/2024]
Abstract
Accelerated atherosclerosis has been identified as a complication of multiple autoimmune diseases, among which Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis stands out. We describe the case of a 60-year-old patient with a history of hypertension, diabetes mellitus, and chronic kidney disease of unknown etiology, who presented two acute coronary syndromes with only a six-month difference. Rapid progression of coronary involvement was evidenced, along with increased markers of inflammatory response, usual interstitial pneumonia on tomography, and positive anti-myeloperoxidase antibodies (anti-MPO), leading to the diagnosis of microscopic polyangiitis (MPA). In these cases, timely diagnostic suspicion is crucial, as early treatment significantly impacts the course and prognosis of the disease.
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Affiliation(s)
- Natalia Andrea Uribe Ruíz
- Universidad de Antioquia, Medellín, Colombia.Universidad de AntioquiaUniversidad de AntioquiaMedellínColombia
| | - María Paulina Villa
- Universidad Pontificia Bolivariana, Medellín, Colombia.Universidad Pontificia BolivarianaUniversidad Pontificia BolivarianaMedellínColombia
| | - Alberto Álzate Gutiérrez
- Universidad de Antioquia, Medellín, Colombia.Universidad de AntioquiaUniversidad de AntioquiaMedellínColombia
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Kim JS, Park YB, Lee SW. Acute coronary syndrome in antineutrophil cytoplasmic antibody-associated vasculitis: a Korean single-centre cohort study. JOURNAL OF RHEUMATIC DISEASES 2023; 30:106-115. [PMID: 37483476 PMCID: PMC10324932 DOI: 10.4078/jrd.2023.0002] [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: 01/29/2023] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 07/25/2023]
Abstract
Objective This study investigated the incidence and patterns of the acute coronary syndrome (ACS) after AAV diagnosis and searched for the predictors of ACS in a single-centre cohort of Korean patients diagnosed with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods A total of 262 patients with AAV were included in this study. ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA) were defined as ACS in this study. Only ACS that occurred during or after AAV diagnosis was counted. Results The incidence of ACS in patients with AAV was 2.7% (7 patients), and the most common type of ACS was NSTEMI regardless of the affected site or the number of coronary arteries. Five patients with ACS were diagnosed with microscopic polyangiitis (MPA) and all of them had myeloperoxidase (MPO)-ANCA (or perinuclear [P]-ANCA), whereas the remaining two patients were diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). Of the seven patients, 2 patients experienced ACS within the first year after AAV diagnosis, and 2 experienced ACS 5 years after AAV diagnosis. Among clinical variables, only the male sex was a predictor of ACS during the follow-up period in patients diagnosed with AAV. Conclusion The incidence of ACS was 2.7%, and the most common type of ACS was NSTEMI in Korean patients with AAV.
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Affiliation(s)
- Jin Seok Kim
- Division of Rheumatology, Department of Internal Medicine, 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
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Hasegawa M, Iwasaki J, Sugiyama S, Ishihara T, Yamamoto Y, Asada H, Koide S, Hayashi H, Takahashi K, Inaguma D, Yuzawa Y, Tsuboi N. Development of aortic valve stenosis in myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis with renal involvement. PLoS One 2021; 16:e0245869. [PMID: 33481903 PMCID: PMC7822555 DOI: 10.1371/journal.pone.0245869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/10/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Degenerative aortic valve stenosis (AS) is a chronic progressive disease that resembles atherosclerosis development. Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is reportedly associated with accelerated atherosclerosis. This study aimed to examine the development of AS in patients with myeloperoxidase-AAV (MPO-AAV) with renal involvement at more than 1 year after the onset of vasculitis. Methods We performed a retrospective review of clinical records of MPO-AAV patients with renal involvement without AS at the onset of vasculitis who were treated in three hospitals and three dialysis clinics. Results The study included 97 MPO-AAV patients with renal involvement and 230 control patients with chronic kidney disease (CKD). Among them, 64 patients had AS. The prevalence rates of AS were 28.9% and 15.7% in MPO-AAV and control patients, respectively (p = 0.006). The multivariable logistic regression analysis showed that MPO-AAV, dialysis dependence, and hypertension were independently associated factors for AS. In MPO-AAV patients, systolic blood pressure was positively significantly associated with AS, whereas glucocorticoid dose of induction therapy was negatively significantly associated. The use of cyclophosphamide tended to be negatively associated with AS. The survival rate was significantly lower for patients with AS than for those without AS. Conclusions The AS prevalence rate was significantly higher in MPO-AAV patients at more than 1 year after the onset of vasculitis than in control CKD patients. Therefore, regular monitoring of echocardiography during MPO-AAV treatment is suggested.
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Affiliation(s)
- Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- * E-mail:
| | - Jin Iwasaki
- Tokoname City Hospital, Tokoname, Aichi, Japan
| | | | - Takuma Ishihara
- Gifu University Hospital Innovative and Clinical Research Promotion Center, Gifu City, Gifu, Japan
| | | | | | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kazuo Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Daijo Inaguma
- Department of Internal Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Houben E, Mendel A, van der Heijden JW, Simsek S, Bax WA, Carette S, Voskuyl AE, Pagnoux C, Penne EL. Prevalence and management of cardiovascular risk factors in ANCA-associated vasculitis. Rheumatology (Oxford) 2019; 58:2333-2335. [DOI: 10.1093/rheumatology/kez229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 01/11/2023] Open
Affiliation(s)
- Eline Houben
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Arielle Mendel
- Vasculitis Clinic, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada
| | - Joost W van der Heijden
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Willem A Bax
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Simon Carette
- Vasculitis Clinic, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada
| | - Alexandre E Voskuyl
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Christian Pagnoux
- Vasculitis Clinic, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada
| | - Erik L Penne
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
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Mourguet M, Chauveau D, Faguer S, Ruidavets J, Béjot Y, Ribes D, Huart A, Alric L, Balardy L, Astudillo L, Adoue D, Sailler L, Pugnet G. Increased ischemic stroke, acute coronary artery disease and mortality in patients with granulomatosis with polyangiitis and microscopic polyangiitis. J Autoimmun 2019; 96:134-141. [DOI: 10.1016/j.jaut.2018.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023]
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Ribatti D, Tamma R, Ruggieri S, Annese T, Marzullo A, Crivellato E. Mast cells and primary systemic vasculitides. Microcirculation 2018; 25:e12498. [DOI: 10.1111/micc.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/09/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Roberto Tamma
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Simona Ruggieri
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Tiziana Annese
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Andrea Marzullo
- Department of Emergency and Organ Transplantation; University of Bari Medical School; Bari Italy
| | - Enrico Crivellato
- Department of Medicine, Human Anatomy Section; University of Udine Medical School; Udine Italy
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Berti A, Matteson EL, Crowson CS, Specks U, Cornec D. Risk of Cardiovascular Disease and Venous Thromboembolism Among Patients With Incident ANCA-Associated Vasculitis: A 20-Year Population-Based Cohort Study. Mayo Clin Proc 2018; 93:597-606. [PMID: 29588079 PMCID: PMC6057792 DOI: 10.1016/j.mayocp.2018.02.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the cardiovascular disease (CVD) and venous thromboembolism (VTE) risks among patients with newly diagnosed antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). PATIENTS AND METHODS A population-based incident AAV cohort of 58 patients diagnosed between 1996 and 2015 in Olmsted County, MN, was identified by medical record review. For each patient, 3 age- and sex-matched non-AAV comparators were randomly selected from the same population and assigned an index date corresponding to the AAV incidence date. Medical records of cases and comparators were reviewed for CVD events, which included cardiac events (coronary artery disease, heart failure, and atrial fibrillation), cerebrovascular accidents (CVA), peripheral vascular disease (PVD), and VTE, which included deep vein thrombosis (DVT) and pulmonary embolism (PE). RESULTS Baseline total cholesterol, high-density lipoprotein, and current smoking rate were lower in AAV than in comparators (P=.03, P=.01, and P=.04, respectively), whereas other CVD risk factors and Framingham risk score were not significantly different between the 2 groups. The CVD events developed in 13 patients and 17 comparators, corresponding to a more than 3-fold increased risk (hazard ratio [HR], 3.15; 95% CI, 1.51-6.57). By subtypes, risks were increased for cardiac events (HR, 2.96; 95% CI, 1.42-6.15) and CVA (HR, 8.16; 95% CI, 2.45-27.15), but not for PVD. The HR for VTE was 3.26 (95% CI, 0.84-12.60), significantly increased for DVT (HR, 6.25; 95% CI, 1.16-33.60), but not for PE (HR, 1.33; 95% CI, 0.23-7.54). CONCLUSION Despite a similar prevalence of CVD risk factors at baseline, the risk of CVD is more than 3-fold higher and for CVA 8-fold higher in patients with incident AAV than in matched comparator subjects.
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Affiliation(s)
- Alvise Berti
- Division of Pulmonary and Critical Care Medicine, Rochester, MN; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Santa Chiara Hospital, Trento, Italy
| | - Eric L Matteson
- Division of Rheumatology, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Rochester, MN.
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN; Division of Rheumatology, Rochester, MN
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Rochester, MN
| | - Divi Cornec
- Division of Pulmonary and Critical Care Medicine, Rochester, MN; INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, CHU de Brest, Brest, France
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Bai YH, Li ZY, Chang DY, Chen M, Kallenberg CGM, Zhao MH. The BVAS is an independent predictor of cardiovascular events and cardiovascular disease-related mortality in patients with ANCA-associated vasculitis. Semin Arthritis Rheum 2018; 47:524-529. [DOI: 10.1016/j.semarthrit.2017.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/08/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
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Liozon E. Improving diagnosis and prognosis in giant cell arteritis: Still more issues than answers. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Rodrigues JC, Walsh M. Risks and Benefits of Glucocorticoids in ANCA-Associated Vasculitis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0081-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hirahashi J, Kawahata K, Arita M, Iwamoto R, Hishikawa K, Honda M, Hamasaki Y, Tanaka M, Okubo K, Kurosawa M, Takase O, Nakakuki M, Saiga K, Suzuki K, Kawachi S, Tojo A, Seki G, Marumo T, Hayashi M, Fujita T. Immunomodulation with eicosapentaenoic acid supports the treatment of autoimmune small-vessel vasculitis. Sci Rep 2014; 4:6406. [PMID: 25230773 PMCID: PMC4166948 DOI: 10.1038/srep06406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/11/2014] [Indexed: 12/13/2022] Open
Abstract
Small-vessel vasculitis is a life-threatening autoimmune disease that is frequently associated with anti-neutrophil cytoplasmic antibodies (ANCAs). Conventional immunotherapy including steroids and cyclophosphamide can cause serious adverse events, limiting the efficacy and safety of treatment. Eicosapentaenoic acid (EPA), a key component of fish oil, is an omega-3 polyunsaturated fatty acid widely known to be cardioprotective and beneficial for vascular function. We report two elderly patients with systemic ANCA-associated vasculitis (AAV) in whom the administration of EPA in concert with steroids safely induced and maintained remission, without the use of additioal immunosuppressants. To explore the mechanisms by which EPA enhances the treatment of AAV, we employed SCG/Kj mice as a spontaneous murine model of AAV. Dietary enrichment with EPA significantly delayed the onset of crescentic glomerulonephritis and prolonged the overall survival. EPA-derived anti-inflammatory lipid mediators and their precursors were present in the kidney, plasma, spleen, and lungs in the EPA-treated mice. Furthermore, a decrease in ANCA production and CD4/CD8-double negative T cells, and an increase in Foxp3(+) regulatory T cells in the lymph nodes of the kidney were observed in the EPA-treated mice. These clinical and experimental observations suggest that EPA can safely support and augment conventional therapy for treating autoimmune small-vessel vasculitis.
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Affiliation(s)
- Junichi Hirahashi
- 1] Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo [2] Apheresis and Dialysis Center, School of Medicine, Keio University
| | - Kimito Kawahata
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo
| | - Makoto Arita
- 1] Department of Health Chemistry, Graduate School of Pharmaceutical Sciences, The University of Tokyo [2]
| | - Ryo Iwamoto
- Department of Health Chemistry, Graduate School of Pharmaceutical Sciences, The University of Tokyo
| | - Keiichi Hishikawa
- Department of Advanced Nephrology and Regenerative Medicine, Graduate School of Medicine, The University of Tokyo
| | - Mie Honda
- 1] Department of Health Chemistry, Graduate School of Pharmaceutical Sciences, The University of Tokyo [2]
| | - Yoshifumi Hamasaki
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo
| | - Mototsugu Tanaka
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo
| | - Koshu Okubo
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo
| | - Miho Kurosawa
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo
| | - Osamu Takase
- Department of Advanced Nephrology and Regenerative Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masanori Nakakuki
- Development Research, Pharmaceutical Research Center, Mochida Pharmaceutical Co., Ltd
| | - Kan Saiga
- Pharmaceutical Research Laboratories, Nippon Kayaku Co. Ltd
| | - Kazuo Suzuki
- Inflammation Program, Chiba University Graduate School of Medicine
| | - Shoji Kawachi
- Division of Anesthesia, Surgical Operation Department, National Center for Global Health and Medicine
| | - Akihiro Tojo
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo
| | - George Seki
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo
| | - Takeshi Marumo
- Clinical Epigenetics, Research Center for Advanced Science and Technology, The University of Tokyo
| | | | - Toshiro Fujita
- 1] Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo [2] Clinical Epigenetics, Research Center for Advanced Science and Technology, The University of Tokyo
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Characteristics, prognosis, and outcomes of cutaneous ischemia and gangrene in systemic necrotizing vasculitides: A retrospective multicenter study. Semin Arthritis Rheum 2014; 43:681-8. [DOI: 10.1016/j.semarthrit.2013.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/04/2013] [Accepted: 09/13/2013] [Indexed: 11/23/2022]
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Bartoloni E, Shoenfeld Y, Gerli R. Inflammatory and autoimmune mechanisms in the induction of atherosclerotic damage in systemic rheumatic diseases: Two faces of the same coin. Arthritis Care Res (Hoboken) 2011; 63:178-83. [DOI: 10.1002/acr.20322] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Life-Threatening Presentations of ANCA-Associated Vasculitis. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kälsch AI, Csernok E, Münch D, Birck R, Yard BA, Gross W, Kälsch T, Schmitt WH. Use of highly sensitive C-reactive protein for followup of Wegener's granulomatosis. J Rheumatol 2010; 37:2319-25. [PMID: 20716656 DOI: 10.3899/jrheum.100302] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Since Wegener's granulomatosis (WG) represents a relapsing disease, efforts have been made to reliably predict relapses using blood tests. Followup measures such as conventionally determined C-reactive protein (CRP), antineutrophil cytoplasmic antibody (C-ANCA) titer, and proteinase-3 (PR3) ELISA are applied. We evaluated whether during remission elevated highly sensitive CRP (hsCRP) precedes relapse as a marker of subclinical inflammation and thus might improve clinical assessment. METHODS We investigated 227 sera of 57 patients with WG: 74 sera collected from patients in remission who subsequently relapsed (before relapse), 30 sera collected during relapse, and 123 sera from patients in remission without relapse. We also distinguished between major and minor relapse. hsCRP, conventionally determined CRP (CRP), C-ANCA, PR3-ELISA, and erythrocyte sedimentation rate (ESR) were measured using commercial kits, and levels were correlated to clinical status. RESULTS Only hsCRP and ANCA titer, but not CRP levels, were higher in sera from patients who subsequently relapsed versus those who did not, indicating patients at risk. Levels of hsCRP, CRP, and ESR were higher in sera collected during relapse than in the sera before relapse. hsCRP, conventional CRP, and ESR were also higher in samples collected during major relapse than before major relapse. Looking at the levels just before relapse compared to previous levels during remission, none of these measures rose directly before the clinical manifestation of the relapse. CONCLUSION Our study provides evidence for an additional value of hsCRP in the clinical assessment of patients with WG.
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Affiliation(s)
- Anna-Isabelle Kälsch
- Fifth Medical Department, University Medical Centre Mannheim, Medical Faculty of Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68187 Mannheim, Germany.
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Rúa-Figueroa Fernández de Larrinoa I, Erausquin Arruabarrena C. Tratamiento de las vasculitis sistémicas asociadas a ANCA. ACTA ACUST UNITED AC 2010; 6:161-72. [DOI: 10.1016/j.reuma.2009.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 01/15/2009] [Indexed: 11/30/2022]
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Morgan MD, Turnbull J, Selamet U, Kaur-Hayer M, Nightingale P, Ferro CJ, Savage COS, Harper L. Increased incidence of cardiovascular events in patients with antineutrophil cytoplasmic antibody-associated vasculitides: a matched-pair cohort study. ACTA ACUST UNITED AC 2010; 60:3493-500. [PMID: 19877070 DOI: 10.1002/art.24957] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the risk of cardiovascular disease in patients with antineutrophil cytoplasmic antibody-associated vasculitides (AAVs) and to assess contributing risk factors. METHODS In a retrospective matched-pair cohort study, 113 of 131 patients with AAVs from a vasculitis clinic registry were matched 1:1 for renal function, age at diagnosis, sex, smoking status, and previous history of a cardiovascular disease to patients with noninflammatory chronic kidney disease (CKD). Cardiovascular events were defined as acute coronary syndrome, new-onset angina, symptomatic peripheral vascular disease, stroke, and transient ischemic attack. RESULTS Median followup times were 3.4 years for the AAV patients and 4.2 years for the CKD patients. More cardiovascular events occurred in the AAV group (23 of 113) than in the CKD group (16 of 113). Cox regression survival analysis showed a significantly increased risk of a cardiovascular event for AAV patients, with a hazard ratio (HR) of 2.23 (95% confidence interval [95% CI] 1.1-4.4) (P = 0.017). Within the cohort of AAV patients, the most strongly predictive factors were previous history of cardiovascular disease (HR 4 [95% CI 1.7-9.8]), history of dialysis dependency (HR 4.3 [95% CI 1.5-12.1]), ever having smoked (HR 3.9 [95% CI 1.5-10]), age at diagnosis (HR 1.038 [95% CI 1.006-1.072]), estimated glomerular filtration rate at remission (HR 0.977 [95% CI 0.957-0.998]), and serum cholesterol concentration at presentation (HR 0.637 [95% CI 0.441-0.92]). CONCLUSION In this retrospective study, patients with AAVs appear at greater risk of cardiovascular disease, with increased risk in those with a previous history of cardiovascular disease, dialysis dependency, poor renal function at remission, or a history of smoking. Measures to reduce the risk of cardiovascular disease should be integral to the management of systemic vasculitis.
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Abstract
Rheumatic disease is characterized by inflammation and endothelial dysfunction, which contribute to accelerated atherosclerosis. Circulating endothelial progenitor cells (EPCs) can restore dysfunctional endothelium and thereby protect against atherosclerotic vascular disease. The number and function of EPCs are, however, affected in rheumatic diseases such as psoriatic arthritis, rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and antineutrophil cytoplasmic autoantibody-associated vasculitis. rheumatic disease is often characterized by decreased numbers, and impaired function, of EPCs, although numbers of these cells might increase during the initial years of systemic sclerosis. Pioneering studies show that EPC dysfunction might be improved with pharmacological treatment. How best to restore EPC function, and whether achieving this aim can prevent long-term cardiovascular complications in rheumatic disease, remain to be established.
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Association of plasma circulatory markers, Chlamydia pneumoniae, and high sensitive C-reactive protein in coronary artery disease patients of India. Mediators Inflamm 2009; 2009:561532. [PMID: 19360108 PMCID: PMC2665731 DOI: 10.1155/2009/561532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 12/15/2008] [Accepted: 01/12/2009] [Indexed: 01/30/2023] Open
Abstract
Plasma inflammatory markers have been shown to be predictors for cardiovascular risk, however, there is no study where the levels of plasma circulatory markers have been evaluated in coronary artery disease patients (CAD pts) positive for C. pneumoniae IgA and high sensitive C-reactive protein (hsCRP) which may help in better understanding of disease pathogenesis. A total of 192 patients and 192 controls attending the Cardiology Outpatient Department of Safdarjung Hospital were enrolled. The levels of plasma circulatory inflammatory markers were evaluated by ELISA. The levels of circulatory plasma markers (IL-4, IL-8, IL-13, ICAM-1, and VCAM-1) were significantly higher, whereas, levels of IL-10 and IFN-γ
were significantly lower in CAD pts compared to healthy controls. The levels of IL-4, IL-8, and ICAM-1 (P = .007, .015, and .048) were significantly higher, however, IL-10 and IFN-γ
were significantly lower (P < .001, < .001) in C. pneumoniae IgA positive CAD pts. The levels of IL-4, IL-8, IL-13, ICAM-1, and VCAM-1 were higher but not significant and levels of IL-10 and IFN-γ
were significantly (P < .001, < .001) lower in hsCRP positive CAD pts. Our study suggested that circulatory cytokines, namely, IL-4, IL-8, and adhesive molecules like ICAM-1 were enhanced after infection with C. pneumoniae whereas in contrast to this IL-10 and IFN-λ
were lowered. Suggesting the important role of these cytokines in progression of CAD.
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Challenges in the management of microscopic polyangiitis: past, present and future. Curr Opin Rheumatol 2008; 20:3-9. [DOI: 10.1097/bor.0b013e3282f370d1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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