|
1
|
Quinn KA, Gelbard A, Sibley C, Sirajuddin A, Ferrada MA, Chen M, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Ytterberg SR, Merkel PA, Grayson PC. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology (Oxford) 2020; 58:2203-2211. [PMID: 31199488 DOI: 10.1093/rheumatology/kez217] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/03/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe tracheobronchial disease in patients with granulomatosis with polyangiitis (GPA) and evaluate the utility of dynamic expiratory CT to detect large-airway disease. METHODS Demographic and clinical features associated with the presence of subglottic stenosis (SGS) or endobronchial involvement were assessed in a multicentre, observational cohort of patients with GPA. A subset of patients with GPA from a single-centre cohort underwent dynamic chest CT to evaluate the airways. RESULTS Among 962 patients with GPA, SGS and endobronchial disease were identified in 95 (10%) and 59 (6%) patients, respectively. Patients with SGS were more likely to be female (72% vs 53%, P < 0.01), younger at time of diagnosis (36 vs 49 years, P < 0.01), and have saddle-nose deformities (28% vs 10%, P < 0.01), but were less likely to have renal involvement (39% vs 62%, P < 0.01). Patients with endobronchial disease were more likely to be PR3-ANCA positive (85% vs 66%, P < 0.01), with more ENT involvement (97% vs 77%, P < 0.01) and less renal involvement (42% vs 62%, P < 0.01). Disease activity in patients with large-airway disease was commonly isolated to the subglottis/upper airway (57%) or bronchi (32%). Seven of 23 patients screened by dynamic chest CT had large-airway pathology, including four patients with chronic, unexplained cough, discovered to have tracheobronchomalacia. CONCLUSION SGS and endobronchial disease occur in 10% and 6% of patients with GPA, respectively, and may occur without disease activity in other organs. Dynamic expiratory chest CT is a potential non-invasive screening test for large-airway involvement in GPA.
Collapse
Affiliation(s)
- Kaitlin A Quinn
- Division of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA.,Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Alexander Gelbard
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA
| | - Cailin Sibley
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
| | | | - Marcela A Ferrada
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Marcus Chen
- National Institutes of Health, NHLBI, Bethesda, MD, USA
| | - David Cuthbertson
- Biostatistics and Informatics, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, MN, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| |
Collapse
|
|
2
|
Affiliation(s)
- Antoine Eskander
- From the Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology (A.E., J.R.A., J.C.I.) and the Institute for Health Policy Management and Evaluation (A.E., J.R.A.), University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital (A.E.), the Institute for Clinical Evaluative Sciences (A.E.), and Princess Margaret Cancer Centre (J.R.A., J.C.I.) - all in Toronto
| | - John R de Almeida
- From the Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology (A.E., J.R.A., J.C.I.) and the Institute for Health Policy Management and Evaluation (A.E., J.R.A.), University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital (A.E.), the Institute for Clinical Evaluative Sciences (A.E.), and Princess Margaret Cancer Centre (J.R.A., J.C.I.) - all in Toronto
| | - Jonathan C Irish
- From the Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology (A.E., J.R.A., J.C.I.) and the Institute for Health Policy Management and Evaluation (A.E., J.R.A.), University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital (A.E.), the Institute for Clinical Evaluative Sciences (A.E.), and Princess Margaret Cancer Centre (J.R.A., J.C.I.) - all in Toronto
| |
Collapse
|