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O'Neill J, Dhillon SS, Ma CT, Stubbs EGC, Khalidi NA, Ioannidis G, Beattie KA, Carmona R. Axial Spondyloarthritis: Does Magnetic Resonance Imaging Classification Improve Report Interpretation. J Clin Rheumatol 2024:00124743-990000000-00207. [PMID: 38595264 DOI: 10.1097/rhu.0000000000002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE The interpretation of magnetic resonance imaging (MRI) reports is crucial for the diagnosis of axial spondyloarthritis, but the subjective nature of narrative reports can lead to varying interpretations. This study presents a validation of a novel MRI reporting system for the sacroiliac joint in clinical practice. METHODS A historical review was conducted on 130 consecutive patients referred by 2 rheumatologists for initial MRI assessment of possible axial spondyloarthritis. The original MRI reports were interpreted by the rheumatologists and the radiologist who originally read the images and then categorized according to the novel system. Two musculoskeletal radiologists then reinterpreted the original MRI scans using the new system, and the resulting reports were interpreted and categorized by the same rheumatologists. The quality of the new framework was assessed by comparing the interpretations of both reports. RESULTS Ninety-two patients met the study criteria. The rheumatologists disagreed on the categorization of the original MRI reports in 12% of cases. The rheumatologists and original radiologists disagreed on the categorization of the initial report in 23.4% of cases. In contrast, there was 100% agreement between the rheumatologists and radiologists on the categorization of the new MRI report. CONCLUSION The new MRI categorization system significantly improved the agreement between the clinician and radiologist in report interpretation. The system provided a standard vocabulary for reporting, reduced variability in report interpretation, and may therefore improve clinical decision-making.
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Karadag O, Bolek EC, Ayan G, Mohammad AJ, Grayson PC, Pagnoux C, Martín-Nares E, Monti S, Abe Y, Alberici F, Alibaz-Oner F, Cuthbertson D, Dagna L, Direskeneli H, Khalidi NA, Koening C, Langford CA, McAlear CA, Monach PA, Moroni L, Padoan R, Seo P, Warrington KJ, Hocevar A, Hinojosa-Azaola A, Furuta S, Emmi G, Ozen S, Jayne D, Merkel PA. Clinical Characteristics and Outcomes of Polyarteritis Nodosa: An International Study. Arthritis Rheumatol 2024. [PMID: 38343337 DOI: 10.1002/art.42817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/30/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE We describe the demographics, clinical features, disease course, and survival of polyarteritis nodosa (PAN) through an international collaboration (GLOBAL-PAN). METHODS Patients with PAN were recruited between 1990 and 2020 from observational cohorts of nine countries across Europe, Japan, and North America. Eligibility was retrospectively defined using the European Medicines Agency classification algorithm. Patients with PAN related to hepatitis B virus (n = 12) and two monogenic diseases mimicking PAN, deficiency of adenosine deaminase 2 enzyme (n = 16) or familial Mediterranean fever (n = 11), were excluded. Data regarding organ involvement, relapse, disease-related damage, and survival were analyzed. RESULTS Three hundred fifty-eight patients (female:male ratio 174:184), including those with systemic PAN (sPAN, n = 282) and cutaneous PAN (n = 76), were included. Twenty-five were pediatric onset. Mean ± SD age at diagnosis was 44.3 ± 18.1 years. Constitutional symptoms (71.5%), cutaneous involvement (70.5%), musculoskeletal findings (69.1%), and neurologic features (48.0%) were common manifestations. Among patients with sPAN, gastrointestinal involvement and proteinuria over 400 mg/day were reported in 52.2% and 11.2%, respectively. During a median (interquartile range) 59.6 (99.5) months of follow-up, relapse occurred in 48.5% of patients. One, 5- and 10-year survival rates for sPAN were 97.1%, 94.0%, and 89.0%, respectively. Predictors of death for sPAN included age ≥65 years at diagnosis, serum creatinine at diagnosis >140 μmol/L, gastrointestinal manifestations, and central nervous system (CNS) involvement. CONCLUSION The spectrum of PAN remains a complex, multifaceted disease. Relapse is common. Age ≥65 years and serum creatinine >140 μmol/L at diagnosis, as well as gastrointestinal and CNS involvement, are independent predictors of death in sPAN.
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Affiliation(s)
| | | | | | - Aladdin J Mohammad
- Skåne University Hospital, Lund, Sweden, and University of Cambridge, Cambridge, UK
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | - Eduardo Martín-Nares
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Yoshiyuki Abe
- Juntendo University School of Medicine, Tokyo, Japan
| | - Federico Alberici
- University of Brescia and Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Lorenzo Dagna
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | | | - Luca Moroni
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | | | - Phillip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | - Alojzija Hocevar
- University Medical Centre Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Andrea Hinojosa-Azaola
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | - David Jayne
- University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Bloom JL, Pickett K, Silveira L, Fuhlbrigge RC, Cuthbertson D, Akuthota P, Corbridge TC, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Rhee RL, Seo P, Silver J, Specks U, Warrington KJ, Wechsler ME, Merkel PA. The Association Between Age at Diagnosis and Disease Characteristics and Damage in Patients With ANCA-Associated Vasculitis. Arthritis Rheumatol 2023; 75:2216-2227. [PMID: 37433067 PMCID: PMC10782596 DOI: 10.1002/art.42651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This study examined the relationship between age at diagnosis and disease characteristics and damage in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS Analysis of a prospective longitudinal cohort of patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic GPA (EGPA) in the Vasculitis Clinical Research Consortium (2013-2021). Disease cohorts were divided by age at diagnosis (years): children (<18), young adults (18-40), middle-aged adults (41-65), and older adults (>65). Data included demographics, ANCA type, clinical characteristics, Vasculitis Damage Index (VDI) scores, ANCA Vasculitis Index of Damage (AVID) scores, and novel disease-specific and non-disease-specific damage scores built from VDI and AVID items. RESULTS Analysis included data from 1020 patients with GPA/MPA and 357 with EGPA. Female predominance in GPA/MPA decreased with age at diagnosis. AAV in childhood was more often GPA and proteinase 3-ANCA positive. Children with GPA/MPA experienced more subglottic stenosis and alveolar hemorrhage; children and young adults with EGPA experienced more alveolar hemorrhage, need for intubation, and gastrointestinal involvement. Older adults (GPA/MPA) had more neurologic manifestations. After adjusting for disease duration, medications, tobacco, and ANCA, all damage scores increased with age at diagnosis for GPA/MPA (P < 0.001) except the disease-specific damage score, which did not differ (P = 0.44). For EGPA, VDI scores increased with age at diagnosis (P < 0.009), whereas all other scores were not significantly different. CONCLUSION Age at diagnosis is associated with clinical characteristics in AAV. Although VDI and AVID scores increase with age at diagnosis, this is driven by non-disease-specific damage items.
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Affiliation(s)
| | | | | | | | | | | | | | - Nader A. Khalidi
- St. Joseph’s Healthcare Hamilton, McMaster University, Ontario, Canada
| | | | | | | | | | | | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, MD, USA
| | - Jared Silver
- US Medical Affairs - Respiratory GSK, Durham, NC, USA
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Almaani S, Song H, Suthanthira M, Toy C, Fussner LA, Meara A, Nagaraja H, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Warrington KJ, Monach PA, Merkel PA, Rovin B, Birmingham D. Urine and Plasma Complement Ba Levels During Disease Flares in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis. Kidney Int Rep 2023; 8:2421-2427. [PMID: 38025219 PMCID: PMC10658281 DOI: 10.1016/j.ekir.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Although the alternative complement pathway has been implicated in the pathogenesis of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV), the specific nature of its involvement is unclear. This study measured levels of urine and plasma complement fragment Ba at multiple time points in a group of patients with AAV. Methods The complement fragment Ba was measured by enzyme-linked immunosorbent assay in serial urine and plasma samples from 21 patients with AAV who developed a renal flare, 19 who developed a nonrenal flare, and 20 in long-term remission. Urine Ba levels were corrected for urine creatinine concentration. Changes in Ba levels were modeled using mixed linear-effect models. A logistic regression model was fit to predict a renal flare using Ba levels at the time of flare versus the nonrenal flare and long-term remission groups. Results Data from 60 patients with AAV were used for this analysis; 53% were male, 93% were White, and 74% had antiproteinase3-ANCA. Urine Ba levels increased at renal flare (P < 0.001) but remained stable during a nonrenal flare or long-term remission. Plasma Ba levels were stable over time in all groups. Urine Ba levels predicted a renal flare with an area under the curve of 0.76 (P < 0.001), with a cutoff of 12.53 ng/mg urine creatinine yielding a sensitivity of 76.2% and a specificity of 68.4%. Conclusion Urine Ba levels, but not plasma Ba levels, are increased at the time of a renal flare in AAV, suggesting intrarenal complement activation and highlighting the potential use of this biomarker for surveillance of active renal vasculitis.
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Affiliation(s)
- Salem Almaani
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Huijuan Song
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Meshora Suthanthira
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher Toy
- Department of Soil and Crop Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lynn A. Fussner
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alexa Meara
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Haikady Nagaraja
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, Tampa, Florida, USA
| | - Nader A. Khalidi
- Division of Rheumatology, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | | | | | - Carol A. McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Larry W. Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, Colorado, USA
| | - Christian Pagnoux
- Division of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Ulrich Specks
- Mayo Clinic College of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Antoine G. Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth J. Warrington
- Mayo Clinic College of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Paul A. Monach
- Veteran’s Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Peter A. Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brad Rovin
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel Birmingham
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Michailidou D, Grayson PC, Hermanson P, Chapa JAG, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Sreih AG, Warrington KJ, Monach PA, Merkel PA, Lood C. Mitochondrial-mediated inflammation and platelet activation in giant cell arteritis. Clin Immunol 2023; 255:109746. [PMID: 37625669 PMCID: PMC10543636 DOI: 10.1016/j.clim.2023.109746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
Markers of extracellular mitochondria are present in giant cell arteritis (GCA) patients. However, their role in promoting inflammation and platelet activation is no known. To investigate this, isolated mitochondria were opsonized with plasma from GCA patients or healthy individuals and incubated with peripheral blood mononuclear cells (PBMCs) or platelets and assessed for inflammatory cytokine production and platelet activation. Plasma from GCA patients promoted increased mitochondrial-mediated cytokine production by PBMCs as compared to healthy controls (p < 0.05). Mitochondria opsonized with plasma factors from patients with GCA induced higher platelet activation as compared to mitochondria opsonized with plasma factors from healthy individuals (p = 0.0015). Platelet levels of P-selectin were associated with disease activity in GCA (r = 0.34, p = 0.01). GCA patients have impaired ability to regulate the clearance of extracellular mitochondria, possibly contributing to excessive inflammation and platelet activation. Targeting key drivers of mitochondrial extrusion and/or their clearance could lead to new therapeutic interventions in GCA.
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Affiliation(s)
- Despina Michailidou
- Division of Rheumatology, University of Washington, Seattle, WA, USA; Division of Rheumatology, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA; Division of Rheumatology, Oklahoma City VA Health Care System, Oklahoma, OK, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Payton Hermanson
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | | | - David Cuthbertson
- Health Informatics Institute, University of South Florida, South Florida, FL, USA
| | - Nader A Khalidi
- Division of Rheumatology, Mc Master University, Ontario, Canada
| | | | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, CO, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Lood
- Division of Rheumatology, University of Washington, Seattle, WA, USA.
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6
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Junek ML, Zhao L, Garner S, Cuthbertson D, Pagnoux C, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Rhee RL, Seo P, Specks U, Sreih AG, Warrington K, Wechsler ME, Merkel PA, Khalidi NA. Ocular manifestations of ANCA-associated vasculitis. Rheumatology (Oxford) 2023; 62:2517-2524. [PMID: 36440847 PMCID: PMC10321114 DOI: 10.1093/rheumatology/keac663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/12/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES ANCA-associated vasculitis (AAV) is a group of multisystem diseases that can have several ocular manifestations. There are published data on ocular manifestations of granulomatosis with polyangiitis (GPA), but few for eosinophilic granulomatosis with polyangiitis (EGPA) or microscopic polyangiitis (MPA). There is little information concerning chronicity, complications, and association with other cranial manifestations of AAV. METHODS This study retrospectively analysed longitudinal multicentre cohorts of individuals with AAV followed between 2006 and 2022. Data included diagnosis, demographics, cranial manifestations of disease, presence of manifestations at onset of disease and/or follow-up, and ocular complications of disease. Univariate and multivariable logistic regression analysis assessed associations across disease manifestations. RESULTS Data from 1441 patients were analysed, including 395 with EGPA, 876 with GPA, and 170 with MPA. Ocular manifestations were seen within 23.1% of patients: 39 (9.9%) with EGPA, 287 (32.7%) with GPA, and 12 (7.1%) with MPA at any time in the disease course. There were more ocular manifestations at onset (n = 224) than during follow-up (n = 120). The most common disease-related manifestations were conjunctivitis/episcleritis and scleritis. In multivariable analysis, dacryocystitis, lacrimal duct obstruction, and retro-orbital disease were associated with sinonasal manifestations of GPA; ocular manifestations were associated with hearing loss in MPA. The most common ocular complications and/or damage seen were cataracts (n = 168) and visual impairment (n = 195). CONCLUSION Ocular manifestations occur in all forms of AAV, especially in GPA. Clinicians should be mindful of the wide spectrum of ocular disease in AAV, caused by active vasculitis, disease-associated damage, and toxicities of therapy.
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Affiliation(s)
- Mats L Junek
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Lily Zhao
- Division of Ophthalmology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Stephanie Garner
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - Paul A Monach
- Rheumatology Section, Veteran’s Affairs Boston Healthcare System, Boston, MA, USA
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Nader A Khalidi
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
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Michailidou D, Kuley R, Wang T, Hermanson P, Grayson PC, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Warrington KJ, Monach PA, Merkel PA, Lood C. Neutrophil extracellular trap formation in anti-neutrophil cytoplasmic antibody-associated and large-vessel vasculitis. Clin Immunol 2023; 249:109274. [PMID: 36878421 PMCID: PMC10066833 DOI: 10.1016/j.clim.2023.109274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
Levels of neutrophil extracellular traps (NETs) were measured in plasma of healthy controls (HC, n = 30) and patients with granulomatosis with polyangiitis (GPA, n = 123), microscopic polyangiitis (MPA, n = 61), Takayasu's arteritis (TAK, n = 58), and giant cell arteritis (GCA, n = 68), at times of remission or activity and correlated with levels of the platelet-derived thrombospondin-1 (TSP-1). Levels of NETs were elevated during active disease in patients with GPA (p < 0.0001), MPA (p = 0.0038), TAK (p < 0.0001), and GCA (p < 0.0001), and in remission for GPA, p < 0.0001, MPA, p = 0.005, TAK, p = 0.03, and GCA, p = 0.0009. All cohorts demonstrated impaired NET degradation. Patients with GPA (p = 0.0045) and MPA (p = 0.005) had anti-NET IgG antibodies. Patients with TAK had anti-histone antibodies (p < 0.01), correlating with presence of NETs. Levels of TSP-1 were increased in all patients with vasculitis, and associated with NET formation. NET formation is a common process in vasculitides. Targeting NET formation or degradation could be potential therapeutic approaches for vasculitides.
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Affiliation(s)
| | - Runa Kuley
- Division of Rheumatology, University of Washington, Seattle, USA; Center for Life Sciences, Mahindra University, Hyderabad, India
| | - Ting Wang
- Division of Rheumatology, University of Washington, Seattle, USA
| | - Payton Hermanson
- Division of Rheumatology, University of Washington, Seattle, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, South Florida, FL, USA
| | - Nader A Khalidi
- Division of Rheumatology, Mc Master University, Ontario, Canada
| | | | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, CO, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Lood
- Division of Rheumatology, University of Washington, Seattle, USA.
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8
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Doubelt I, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach P, Seo P, Specks U, Warrington KJ, Merkel PA, Pagnoux C. Vitamin D status in ANCA-associated vasculitis. Rheumatol Adv Pract 2023; 7:rkad021. [PMID: 36874269 PMCID: PMC9977244 DOI: 10.1093/rap/rkad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
Objective Vitamin D might participate in the pathogenesis of several immune-mediated diseases, but few related data are available for ANCA-associated vasculitis (AAV). In this study, we analysed the association between vitamin D status and disease in patients with AAV. Methods Serum levels of 25(OH)D2/ 3 were measured in 125 randomly selected patients with AAV [granulomatosis with polyangiitis (n = 50), eosinophilic granulomatosis with polyangiitis (n = 50) or microscopic polyangiitis (n = 25)] enrolled in the Vasculitis Clinical Research Consortium Longitudinal Studies at the time of enrolment and a subsequent relapse visit. Sufficient, insufficient and deficient vitamin D status were defined as 25(OH)D3 levels >30, 20-30 and ˂20 ng/ml, respectively. Results Seventy of 125 patients (56%) were female, with a mean age of 51.5 (16) years at diagnosis; 84 (67%) were ANCA positive. Mean 25(OH)D was 37.6 (16) ng/ml, with vitamin D deficiency in 13 (10.4%) and insufficiency in 26 (20.8%). In univariate analysis, lower vitamin D status was associated with male sex (P = 0.027) and disease activity (P = 0.047). In univariate and multivariate analyses, deficient vitamin D status was associated with disease activity (P = 0.015). Mean 25(OH)D status in the 21 patients with a subsequent relapse did not differ between baseline and relapse visit [37.8 (16) vs 38.0 (10) ng/ml, respectively; P = 0.92]. Conclusion Most patients with AAV have sufficient 25(OH)D levels, although those with lower vitamin D status were more likely to be male and to have active disease. Whether optimization of vitamin D status alters disease manifestations or activity in AAV remains to be determined. Trial Registration Vasculitis Clinical Research Consortium (VCRC) Longitudinal Study (LS), NCT00315380, https://clinicaltrials.gov/ct2/show/NCT00315380.
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Affiliation(s)
- Irena Doubelt
- Vasculitis Clinic, Mount Sinai Hospital, Department of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Vasculitis Clinic, Mount Sinai Hospital, Department of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah Hospital, Salt Lake City, UT, USA
| | - Carol Langford
- Division of Rheumatology, Cleveland Clinic, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul Monach
- Division of Rheumatology, VA Boston Healthcare System, Boston, MA, USA
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, Department of Rheumatology, University of Toronto, Toronto, ON, Canada
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9
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Michailidou D, Duvvuri B, Kuley R, Cuthbertson D, Grayson PC, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Warrington KJ, Mustelin T, Monach PA, Merkel PA, Lood C. Neutrophil activation in patients with anti-neutrophil cytoplasmic autoantibody-associated vasculitis and large-vessel vasculitis. Arthritis Res Ther 2022; 24:160. [PMID: 35768848 PMCID: PMC9241246 DOI: 10.1186/s13075-022-02849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To assess markers of neutrophil activation such as calprotectin and N-formyl methionine (fMET) in anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) and large-vessel vasculitis (LVV). Methods Levels of fMET, and calprotectin, were measured in the plasma of healthy controls (n=30) and patients with AAV (granulomatosis with polyangiitis (GPA, n=123), microscopic polyangiitis (MPA, n=61)), and LVV (Takayasu’s arteritis (TAK, n=58), giant cell arteritis (GCA, n=68)), at times of remission or flare. Disease activity was assessed by physician global assessment. In vitro neutrophil activation assays were performed in the presence or absence of formyl peptide receptor 1 (FPR1) inhibitor cyclosporine H. Results Levels of calprotectin, and fMET were elevated in patients with vasculitis as compared to healthy individuals. Levels of fMET correlated with markers of systemic inflammation: C-reactive protein (r=0.82, p<0.0001), and erythrocyte sedimentation rate (r=0.235, p<0.0001). The neutrophil activation marker, calprotectin was not associated with disease activity. Circulating levels of fMET were associated with neutrophil activation (p<0.01) and were able to induce de novo neutrophil activation via FPR1-mediated signaling. Conclusion Circulating fMET appears to propagate neutrophil activation in AAV and LVV. Inhibition of fMET-mediated FPR1 signaling could be a novel therapeutic intervention for systemic vasculitides.
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Affiliation(s)
- Despina Michailidou
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - Bhargavi Duvvuri
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - Runa Kuley
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, South Florida, Tampa, FL, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Nader A Khalidi
- Division of Rheumatology, Mc Master University, Hamilton, Ontario, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, CO, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Tomas Mustelin
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Lood
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA.
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10
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Doubelt I, Springer JM, Kermani TA, Sreih AG, Burroughs C, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach PA, Shaw DG, Seo P, Specks U, Warrington KJ, Young K, Merkel PA, Pagnoux C. Self-Reported Data and Physician-Reported Data in Patients With Eosinophilic Granulomatosis With Polyangiitis: Comparative Analysis. Interact J Med Res 2022; 11:e27273. [PMID: 35612893 PMCID: PMC9178459 DOI: 10.2196/27273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/03/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patient-based registries can help advance research on rare diseases such as eosinophilic granulomatosis with polyangiitis (EGPA), a complex multiorgan form of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis. Objective The aim of this study is to compare patient-reported and physician-reported data on manifestations, treatments, and outcomes for patients with EGPA. Methods We completed a comparative analysis of patients ≥18 years with EGPA in Canada and the United States from the following 2 cohorts: (1) The Vasculitis Patient-Powered Research Network (VPPRN), a self-enrolled secure portal with patient-entered data updated quarterly (2014-2019) and (2) the Vasculitis Clinical Research Consortium (VCRC) observational studies, a physician-entered database (2003-2019) of patients who fulfilled the 1990 American College of Rheumatology classification criteria for EGPA. The studied parameters included demographic characteristics, clinical manifestations, ANCA status, treatments, and relapses. Results Data from 195 patients with a validated diagnosis of EGPA in the VPPRN and 354 patients enrolled in the VCRC were analyzed. Compared to the VCRC cohort, the patients in the VPPRN cohort were more likely to be female (135/195, 69.2% compared to 209/354, 59%; P=.02) and younger at diagnosis (47.3 compared to 50.0 years; P=.03); both cohorts reported similar frequencies of asthma (177/184, 96.2% in the VPPRN cohort compared to 329/354, 92.9% in the VCRC cohort; P=.13) and cardiac manifestations (44/153, 28.8% compared to 75/354, 21.2%; P=.06), but the VPPRN cohort reported less frequent lung manifestations other than asthma and more frequent disease manifestations in all other organ systems. The ANCA positivity was 48.9% (64/131) in the VPPRN patients compared to 38.9% (123/316; P=.05) in the VCRC cohort. Relapsing disease after study enrollment was reported in 32.3% (63/195) of patients in the VPPRN compared to 35.7% (99/277) of patients in the VCRC. Most therapies (GC, cyclophosphamide, mepolizumab) were used at similar frequencies in both groups, except for rituximab with VPPRN patients reporting more use than the VCRC cohort (47/195, 24.1% compared to 29/277, 10.5%; P<.001). Conclusions Overall, patients and physicians report manifestations of EGPA at similar frequencies. However, observed differences between patient and physician reports imply the potential occurrence of selection biases. These results support the use of patient-reported data in EGPA but also the need for careful consideration of disease-specific definitions for the study of EGPA and how patient- and physician-reported data are collected. Trial Registration ClinicalTrials.gov NCT00315380, https://clinicaltrials.gov/ct2/show/NCT00315380; ClinicalTrials.gov NCT01241305, https://clinicaltrials.gov/ct2/show/NCT01241305
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Affiliation(s)
- Irena Doubelt
- Vasculitis Clinic, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Jason M Springer
- Division of Rheumatology and Immunology, Medical Center, Vanderbilt University, Nashville, TN, United States
| | - Tanaz A Kermani
- Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Cristina Burroughs
- Health Informatics Institute, University of South Florida, Tampa, FL, United States
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, Tampa, FL, United States
| | - Simon Carette
- Vasculitis Clinic, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah Hospital, Salt Lake City, UT, United States
| | - Carol Langford
- Division of Rheumatology, Cleveland Clinic, Cleveland, OH, United States
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Paul A Monach
- Division of Rheumatology, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Dianne G Shaw
- Vasculitis Foundation, Kansas City, MO, United States
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Kenneth J Warrington
- Division of Rheumatology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Kalen Young
- Vasculitis Foundation, Kansas City, MO, United States
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Rheumatology, University of Toronto, Toronto, ON, Canada
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11
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Kermani TA, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Specks U, Sreih A, Warrington KJ, Merkel PA. Hypothyroidism in vasculitis. Rheumatology (Oxford) 2021; 61:2942-2950. [PMID: 34730828 PMCID: PMC9607991 DOI: 10.1093/rheumatology/keab817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To study the prevalence, risk and clinical associations of hypothyroidism among several forms of vasculitis. METHODS Patients with GCA, Takayasu's arteritis (TAK), PAN and the three forms of ANCA-associated vasculitis [AAV; granulomatosis with polyangiitis (GPA), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (EGPA)] enrolled in a prospective, multicentre, longitudinal study were included. RESULTS The study included data on 2085 patients [63% female, 90% White] with a mean age of 54.6 years (s.d. 17.2). Diagnoses were GCA (20%), TAK (11%), PAN (5%), GPA (42%), microscopic polyangiitis (8%) and EGPA (14%). Hypothyroidism was present in 217 patients (10%) (83% female), with a mean age 59.8 years (s.d. 14.5). Age- and sex-adjusted risk of hypothyroidism was GCA, odds ratio (OR) 0.61 (95% CI 0.41, 0.90); TAK, OR 0.57 (95% CI 0.31, 1.03); PAN, OR 0.59 (95% CI 0.25, 1.38); GPA, OR 1.51 (95% CI 1.12, 2.05); microscopic polyangiitis, OR 1.81 (95% CI 1.18, 2.80) and EGPA, OR 0.82 (95% CI 0.52, 1.30). Among patients with AAV, age- and sex-adjusted risk of hypothyroidism was higher with positive MPO-ANCA [OR 1.89 (95% CI 1.39, 2.76)]. The clinical manifestations of vasculitis were similar in patients with and without hypothyroidism, except transient ischaemic attacks, which were more frequently observed in patients with GCA and hypothyroidism (12% vs 2%; P = 0.001). CONCLUSIONS Differences in the risk of hypothyroidism among vasculitides may be due to genetic susceptibilities or immune responses. This study confirms an association of hypothyroidism with MPO-ANCA.
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Affiliation(s)
- Tanaz A Kermani
- Correspondence to: Tanaz A. Kermani, Division of Rheumatology, University of California Los Angeles,2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA 90404, USA. E-mail:
| | - David Cuthbertson
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto
| | - Nader A Khalidi
- Department of Medicine, Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Department of Medicine, Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Carol A Langford
- Department of Medicine, Division of Rheumatology, Cleveland Clinic, Cleveland, OH
| | - Carol A McAlear
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Larry Moreland
- Department of Medicine, Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Christian Pagnoux
- Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto
| | - Philip Seo
- Department of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Ulrich Specks
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Antoine Sreih
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Kenneth J Warrington
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Peter A Merkel
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA
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12
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Doubelt I, Cuthbertson D, Carette S, Chung SA, Forbess LJ, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach PA, Seo P, Specks U, Spiera RF, Springer JM, Sreih AG, Warrington KJ, Merkel PA, Pagnoux C. Clinical Manifestations and Long-Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America. ACR Open Rheumatol 2021; 3:404-412. [PMID: 34032390 PMCID: PMC8207688 DOI: 10.1002/acr2.11263] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 11/08/2022] Open
Abstract
Objective To describe clinical manifestations and outcomes in patients with eosinophilic granulomatosis with polyangiitis (EGPA) in North America. Methods Analysis of patients aged 18 years or older who fulfilled the 1990 American College of Rheumatology Classification Criteria for EGPA enrolled in the Vasculitis Clinical Research Consortium from 2003 to 2019. Main clinical characteristics, treatments, outcomes, and accumulated damage were studied. Results The cohort included 354 patients; 59% female; age at diagnosis of 50.0 (±14) years; 39% were antineutrophil cytoplasm antibody (ANCA) positive. Time from diagnosis to last follow‐up was 7.0 (±6.2) years; 49.4% had one or more relapse. Patients positive for ANCA more commonly had neurological and kidney involvement when compared with patients negative for ANCA, who had more cardiac and lung manifestations. At last study visit, only 35 (12.6%) patients had been off all therapy for more than 2 years during their follow‐up. The overall mortality rate was 4.0% and did not differ by ANCA status or cyclophosphamide use. Scores on the Vasculitis Damage Index (VDI) for 134 patients with two or more visits and more than 1 year of follow‐up increased from 1.7 (±1.8) at enrollment (3.7 [±5.1] years after diagnosis) to 3.35 (±2.1) at last follow‐up (7.5 [±5.8] years after diagnosis), mainly represented by chronic asthma (67.5%), peripheral neuropathy (49.6%), and chronic sinusitis (31.3%). Longer duration of glucocorticoid use and relapse were associated with higher VDI scores. Conclusion This analysis describes the many clinical manifestations and varied outcomes of EGPA and highlights the ongoing need to attain more sustained, long‐term remission to limit the accrual of disease‐related damage.
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Affiliation(s)
- Irena Doubelt
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Simon Carette
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Lindsy J Forbess
- Cedars Sinai Medical Center, Los Angeles, California, United States
| | - Nader A Khalidi
- McMaster University and St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | | | | | | | - Larry W Moreland
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Paul A Monach
- Division of Rheumatology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Ulrich Specks
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States
| | - Robert F Spiera
- Hospital for Special Surgery, New York, New York, United States
| | | | | | - Kenneth J Warrington
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States
| | | | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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13
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Schnappauf O, Moura NS, Aksentijevich I, Stoffels M, Ombrello AK, Hoffmann P, Barron K, Remmers EF, Hershfield M, Kelly SJ, Cuthbertson D, Carette S, Chung SA, Forbess L, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Springer JM, Sreih AG, Warrington KJ, Ytterberg SR, Kastner DL, Grayson PC, Merkel PA. Sequence-Based Screening of Patients With Idiopathic Polyarteritis Nodosa, Granulomatosis With Polyangiitis, and Microscopic Polyangiitis for Deleterious Genetic Variants in ADA2. Arthritis Rheumatol 2021; 73:512-519. [PMID: 33021335 PMCID: PMC9945880 DOI: 10.1002/art.41549] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Deficiency of adenosine deaminase 2 (DADA2) is a monogenic form of vasculitis that can resemble polyarteritis nodosa (PAN). This study was undertaken to identify potential disease-causing sequence variants in ADA2 in patients with idiopathic PAN, granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA). METHODS Patients with idiopathic PAN (n = 118) and patients with GPA or MPA (n = 1,107) were screened for rare nonsynonymous variants in ADA2 using DNA sequencing methods. ADA-2 enzyme activity was assessed in selected serum samples. RESULTS Nine of 118 patients with PAN (7.6%) were identified as having rare nonsynonymous variants in ADA2. Four patients (3.4%) were biallelic for pathogenic or likely pathogenic variants, and 5 patients (4.2%) were monoallelic carriers for 3 variants of uncertain significance and 2 likely pathogenic variants. Serum samples from 2 patients with PAN with biallelic variants were available and showed markedly reduced ADA-2 enzyme activity. ADA-2 enzyme testing of 86 additional patients revealed 1 individual with strongly reduced ADA-2 activity without detectable pathogenic variants. Patients with PAN and biallelic variants in ADA2 were younger at diagnosis than patients with 1 or no variant in ADA2, with no other clinical differences noted. None of the patients with GPA or MPA carried biallelic variants in ADA2. CONCLUSION A subset of patients with idiopathic PAN meet genetic criteria for DADA2. Given that tumor necrosis factor inhibition is efficacious in DADA2 but is not conventional therapy for PAN, these findings suggest that ADA-2 testing should strongly be considered in patients with hepatitis B virus-negative idiopathic PAN.
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Affiliation(s)
- Oskar Schnappauf
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Natalia Sampaio Moura
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Ivona Aksentijevich
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Monique Stoffels
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Amanda K. Ombrello
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Patrycja Hoffmann
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Karyl Barron
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Elaine F. Remmers
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | - Paul A. Monach
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Daniel L. Kastner
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Peter C. Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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14
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Ortiz-Fernández L, Saruhan-Direskeneli G, Alibaz-Oner F, Kaymaz-Tahra S, Coit P, Kong X, Kiprianos AP, Maughan RT, Aydin SZ, Aksu K, Keser G, Kamali S, Inanc M, Springer J, Akar S, Onen F, Akkoc N, Khalidi NA, Koening C, Karadag O, Kiraz S, Forbess L, Langford CA, McAlear CA, Ozbalkan Z, Yavuz S, Çetin GY, Alpay-Kanitez N, Chung S, Ates A, Karaaslan Y, McKinnon-Maksimowicz K, Monach PA, Ozer HT, Seyahi E, Fresko I, Cefle A, Seo P, Warrington KJ, Ozturk MA, Ytterberg SR, Cobankara V, Onat AM, Duzgun N, Bıcakcıgil M, Yentür SP, Lally L, Manfredi AA, Baldissera E, Erken E, Yazici A, Kısacık B, Kaşifoğlu T, Dalkilic E, Cuthbertson D, Pagnoux C, Sreih A, Reales G, Wallace C, Wren JD, Cunninghame-Graham DS, Vyse TJ, Sun Y, Chen H, Grayson PC, Tombetti E, Jiang L, Mason JC, Merkel PA, Direskeneli H, Sawalha AH. Identification of susceptibility loci for Takayasu arteritis through a large multi-ancestral genome-wide association study. Am J Hum Genet 2021; 108:84-99. [PMID: 33308445 DOI: 10.1016/j.ajhg.2020.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
Takayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 × 10-5) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets.
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Gribbons KB, Ponte C, Carette S, Craven A, Cuthbertson D, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Quinn KA, Robson JC, Seo P, Sreih AG, Suppiah R, Warrington KJ, Ytterberg SR, Luqmani R, Watts R, Merkel PA, Grayson PC. Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2020; 72:1615-1624. [PMID: 31444857 DOI: 10.1002/acr.24055] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). METHODS Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort. RESULTS A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage. CONCLUSION Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis.
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Affiliation(s)
- K Bates Gribbons
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
| | | | - Simon Carette
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Paul A Monach
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | | | - Christian Pagnoux
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin A Quinn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland, and Georgetown University, Washington, DC
| | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | - Richard Watts
- Norwich Medical School, University of East Anglia, Norwich, and University of Oxford, Oxford, UK
| | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
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Goel R, Gribbons KB, Carette S, Cuthbertson D, Hoffman GS, Joseph G, Khalidi NA, Koening CL, Kumar S, Langford C, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Nair A, Pagnoux C, Quinn KA, Ravindran R, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Merkel PA, Danda D, Grayson PC. Derivation of an angiographically based classification system in Takayasu's arteritis: an observational study from India and North America. Rheumatology (Oxford) 2020; 59:1118-1127. [PMID: 31580452 DOI: 10.1093/rheumatology/kez421] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/08/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To develop and replicate, using data-driven methods, a novel classification system in Takayasu's arteritis based on distribution of arterial lesions. METHODS Patients were included from four international cohorts at major academic centres: India (Christian Medical College Vellore); North America (National Institutes of Health, Vasculitis Clinical Research Consortium and Cleveland Clinic Foundation). All patients underwent whole-body angiography of the aorta and branch vessels, with categorization of arterial damage (stenosis, occlusion or aneurysm) in 13 territories. K-means cluster analysis was performed to identify subgroups of patients based on pattern of angiographic involvement. Cluster groups were identified in the Indian cohort and independently replicated in the North American cohorts. RESULTS A total of 806 patients with Takayasu's arteritis from India (n = 581) and North America (n = 225) were included. Three distinct clusters defined by arterial damage were identified in the Indian cohort and replicated in each of the North American cohorts. Patients in cluster one had significantly more disease in the abdominal aorta, renal and mesenteric arteries (P < 0.01). Patients in cluster two had significantly more bilateral disease in the carotid and subclavian arteries (P < 0.01). Compared with clusters one and two, patients in cluster three had asymmetric disease with fewer involved territories (P < 0.01). Demographics, clinical symptoms and clinical outcomes differed by cluster. CONCLUSION This large study in Takayasu's arteritis identified and replicated three novel subsets of patients based on patterns of arterial damage. Angiographic-based disease classification requires validation by demonstrating potential aetiological or prognostic implications.
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Affiliation(s)
- Ruchika Goel
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - K Bates Gribbons
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Gary S Hoffman
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Sathish Kumar
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Carol Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Carol A McAlear
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Division of Rheumatology, VA Boston Healthcare System, Boston, MA
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Aswin Nair
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | | | - Kaitlin A Quinn
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA.,Division of Rheumatology, Georgetown University, Washington DC, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Antoine G Sreih
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | | | | | - Peter A Merkel
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Peter C Grayson
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
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Nevskaya T, Jiang Y, Wang M, Baron M, Pope J, Pope JE, Baron M, Hudson M, Gyger G, Larché MJ, Khalidi NA, Masetto A, Sutton E, Robinson D, Rodriguez-Reyna TS, Smith D, Thorne C, Fortin PR, Fritzler MJ. FRI0258 CUMULATIVE INCIDENCE, SURVIVAL AND PREDICTORS OF PULMONARY HYPERTENSION IN SYSTEMIC SCLEROSIS SUBSETS: PAH IS NOT INCREASED IN LIMITED VS DIFFUSE PATIENTS BY ADJUSTED COMPETING RISK ANALYSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Pulmonary hypertension (PH) is a life-threatening complication of systemic sclerosis (SSc), thought to be more commonly found in limited cutaneous (lcSSc) compared to diffuse (dcSSc) subset. Since lcSSc has a better prognosis, it is unclear whether a higher occurrence of PH in lcSSc reflects survival bias.Objectives:To compare the cumulative PH incidence in disease subsets, after accounting for death as a competing event, in a large multi-center SSc cohort.Methods:Cumulative incidence of PH was studied in 1431 Canadian Scleroderma Research Group (CSRG) database patients (57% lcSSc; follow-up 3.5±2.9 years, range 1-14) by Fine-Gray analysis, unadjusted and adjusted for sex, age and SSc-related autoantibodies (SAS 9.4). Survival curves, predictors of PH development and survival were analyzed by Kaplan-Meier and Cox proportional hazards analyses (SPSS 25.0). Subgroup analysis was performed for PAH.Results:157 SSc patients had PH (including 117 PAH), either confirmed by RHC or postmortem. Compared to those without PH, lcSSc-PH patients had longer disease and older age at SSc diagnosis, while dcSSc-PH patients - more severe peripheral vascular and gastrointestinal involvement. The cumulative incidences of PH/PAH were similar in dcSSc and lcSSc after accounting for death in the adjusted competitive risk model (Table 1; Fig.1). 47% of PH- and 42% of PAH-patients died over a FU period. Male gender (p<0.0001) and anti-Scl-70 (p<0.001) were associated with earlier PH development, while older age (p=0.006) - with PAH (Table 2). ACA-negativity and older age predicted worse PH prognosis.Figure 1.Cumulative incidence curves for PH (A) and PAH (B).Conclusion:Cumulative incidence of PH, after accounting for death as competing event, was comparable in SSc subsets. Vigilance should be considered in males, Scl-70 positive and late age-onset SSc.Table 1.Sub-distribution Hazard ratio of incident PH and PAH.PHPAHHazard ratio (95% CIs)P valuesHazard ratio (95% CIs)P valuesCrude ModelDcSSc vs lcSSc2.03 (1.13, 3.66)0.01861.60 (0.82, 3.16)0.1710Adjusted modelDcSSc vs lcSSc1.82 (0.93, 3.57)0.08181.57 (0.69, 3.59)0.2812Female vs male0.98 (0.42, 2.32)0.96602.10 (0.51, 8.65)0.3040Age1.00 (0.99, 1.02)0.70411.01 (0.98, 1.03)0.5498AntibodiesACA vs negative0.95 (0.46, 1.96)0.89911.08 (0.50, 2.35)0.8391ATA vs negative1.93 (0.84, 4.42)0.11980.59 (0.13, 2.73)0.4970Anti-RNAP vs negative1.24 (0.45, 3.43)0.68411.77 (0.58, 5.44)0.3181Disclosure of Interests:Tatiana Nevskaya: None declared, Yuxuan Jiang: None declared, Mianbo Wang: None declared, Murray Baron: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB
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18
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Quinn KA, Gribbons KB, Carette S, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Novakovich E, Merkel PA, Grayson PC. Patterns of clinical presentation in Takayasu's arteritis. Semin Arthritis Rheum 2020; 50:576-581. [PMID: 32460147 DOI: 10.1016/j.semarthrit.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Takayasu's arteritis (TAK) is a clinically heterogenous disease. Patterns of clinical presentation in TAK at diagnosis have not been well described, and a "triphasic pattern" of constitutional symptoms evolving into vascular inflammation and fibrosis has been reported but never systematically evaluated. METHODS Patients with TAK were prospectively recruited from the National Institutes of Health (NIH) and the Vasculitis Clinical Research Consortium (VCRC). Based on clinical presentation at diagnosis, patients were divided into five categories: (1) constitutional symptoms alone, (2) carotidynia, (3) other vascular-associated symptoms, (4) major ischemic event, or (5) asymptomatic. Associated clinical characteristics were evaluated in each category. Preceding symptoms were also assessed to determine the presence of a triphasic disease pattern. RESULTS A total of 275 patients with TAK were included (VCRC=208; NIH=67). Similar heterogeneity of clinical presentation was identified in each cohort: constitutional symptoms (8%), carotidynia (13-15%), other vascular symptoms (43-47%), major ischemic event (28-30%), and asymptomatic (2-6%). An increased relative proportion of males was seen in patients who presented with constitutional symptoms or were asymptomatic at diagnosis (p<0.01). Patients who presented with constitutional symptoms and major ischemic events were youngest at diagnosis. Patients in the asymptomatic group were oldest at diagnosis and often were not treated (p<0.01). Relapse was most frequent in patients who presented with carotidynia (p<0.01). A minority of patients (19%) who presented with a major ischemic event reported a triphasic pattern of disease. CONCLUSION There are diverse clinical presentations at diagnosis in TAK. Patients do not necessarily progress sequentially through phases of disease.
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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.
| | - K Bates Gribbons
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, CA
| | - David Cuthbertson
- Department of Biostatistics, University of South Florida, Tampa, FL, USA
| | | | - 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 Foundation, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Monach
- Division of Rheumatology, VA Boston Healthcare System, Boston, MA, USA
| | | | - Christian Pagnoux
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, CA
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, MD, USA
| | - Antoine G Sreih
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Elaine Novakovich
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Peter A Merkel
- Division of Rheumatology, 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
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Donaldson L, Nanji K, Rebello R, Khalidi NA, Rodriguez AR. Involvement of the intracranial circulation in giant cell arteritis. Can J Ophthalmol 2020; 55:391-400. [PMID: 32416931 DOI: 10.1016/j.jcjo.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/13/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most common primary vasculitis affecting the elderly population. GCA preferentially involves the extracranial branches of the carotid artery; intracranial vasculitis is thought to be a rare occurrence. This study determined the prevalence of intracranial vasculitis in a large series of patients evaluated for GCA and describes the clinical presentation of such cases. DESIGN Retrospective chart review using a prospective database. When possible, subjects underwent high-resolution 3T contrast-enhanced magnetic resonance imaging (MRI) and MR angiography (MRA) of the scalp and intracranial arteries. PARTICIPANTS Patients presenting with suspected GCA between January 2015 and December 2018. Four additional, non-database cases of GCA with intracranial involvement are also described. RESULTS Of 197 patients, 168 had a contrast-enhanced MRI of the head and 51 had imaging findings suggestive of vasculitis. Five patients showed probable or definitive involvement of both the anterior and posterior intracranial circulation with isolated posterior intracranial circulation involvement in one additional patient. One of these patients showed evidence of acute posterior circulation ischemia and presented with vertigo but no evidence of ischemic optic neuropathy or ophthalmic artery enhancement. Of the 51 patients, 14 had abnormal enhancement of the ophthalmic arteries, including 1 with arteritic ischemic anterior optic neuropathy and vertebral arteritis and 1 patient with involvement of the internal carotid and posterior cerebral arteries but no reported vision changes. CONCLUSION Although uncommon, clinicians should be aware that GCA can directly involve the intracranial circulation with both the anterior and posterior circulation affected in most of our cases.
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Affiliation(s)
- Laura Donaldson
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ont
| | - Keean Nanji
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ont
| | - Ryan Rebello
- Department of Radiology, McMaster University, Hamilton, Ont
| | - Nader A Khalidi
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ont
| | - Amadeo R Rodriguez
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ont.; Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ont..
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20
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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: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Moran SM, Monach PA, Zgaga L, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland L, Pagnoux C, Seo P, Specks U, Sreih A, Wyse J, Ytterberg SR, Merkel PA, Little MA. Urinary soluble CD163 and monocyte chemoattractant protein-1 in the identification of subtle renal flare in anti-neutrophil cytoplasmic antibody-associated vasculitis. Nephrol Dial Transplant 2020; 35:283-291. [PMID: 30380100 PMCID: PMC8205505 DOI: 10.1093/ndt/gfy300] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/18/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prior work has shown that urinary soluble CD163 (usCD163) displays excellent biomarker characteristics for detection of active renal vasculitis using samples that included new diagnoses with highly active renal disease. This study focused on the use of usCD163 in the detection of the more clinically relevant state of mild renal flare and compared results of usCD163 testing directly to testing of urinary monocyte chemoattractant protein-1 (uMCP-1). METHODS Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV, n = 88) were identified within a serially sampled, longitudinal and multicentre cohort. Creatinine-normalized usCD163 and uMCP-1 levels were measured by enzyme-linked immunosorbent assay and, both alone and in combination, were compared between times of active renal AAV and during remission and/or active non-renal AAV. RESULTS Samples from 320 study visits included times of active renal vasculitis (n = 39), remission (n = 233) and active extrarenal vasculitis (n = 48). Median creatinine levels were 0.9 mg/dL [interquartile range (IQR) 0.8-1.2] in remission and 1.4 mg/dL (IQR 1.0-1.8) during renal flare. usCD163 levels were higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 162 ng/mmol (IQR 79-337), 44 (17-104) and 38 (7-76), respectively (P < 0.001). uMCP-1 levels were also higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 10.6 pg/mmol (IQR 4.6-23.5), 4.1 (2.5-8.4) and 4.1 (1.9-6.8), respectively (P < 0.001). The proposed diagnostic cut-points for usCD163 and uMCP-1 were 72.9 ng/mmol and 10.0 pg/mmol, respectively. usCD163 and uMCP-1 levels were marginally correlated (r2 = 0.11, P < 0.001). Combining novel and existing biomarkers using recursive tree partitioning indicated that elevated usCD163 plus either elevated uMCP-1 or new/worse proteinuria improved the positive likelihood ratio (PLR) of active renal vasculitis to 19.2. CONCLUSION A combination of usCD163 and uMCP-1 measurements appears to be useful in identifying the diagnosis of subtle renal vasculitis flare.
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Affiliation(s)
- Sarah M Moran
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
- Rheumatology Section, VA Boston Healthcare System, Boston, MA, USA
| | - Lina Zgaga
- Department of Public Health and General Practice, Trinity College Dublin, Dublin, Ireland
| | - David Cuthbertson
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Nader A Khalidi
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry Moreland
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Antoine Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Wyse
- Discipline of Statistics, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
- Irish Centre for Vascular Biology, Trinity College Dublin, Dublin, Ireland
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22
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Rodriguez-Pla A, Warner RL, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Ytterberg SR, Johnson KJ, Merkel PA, Monach PA. Evaluation of Potential Serum Biomarkers of Disease Activity in Diverse Forms of Vasculitis. J Rheumatol 2019; 47:1001-1010. [PMID: 31474593 PMCID: PMC7050393 DOI: 10.3899/jrheum.190093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We evaluated potential circulating biomarkers of disease activity in giant cell arteritis (GCA), Takayasu arteritis (TA), polyarteritis nodosa (PAN), and eosinophilic granulomatosis with polyangiitis (EGPA). METHODS A panel of 22 serum proteins was tested in patients enrolled in the Vasculitis Clinical Research Consortium Longitudinal Studies of GCA, TA, PAN, or EGPA. Mixed models were used for most analyses. A J48 classification tree method was used to find the most relevant markers to differentiate between active and inactive GCA. RESULTS Tests were done on 418 samples from 152 patients (60 GCA, 29 TA, 26 PAN, 37 EGPA), during both active vasculitis and remission. In GCA, these showed significant (p < 0.05) differences between disease states: B cell-attracting chemokine 1 (BCA)-1/CXC motif ligand 13 (CXCL13), erythrocyte sedimentation rate (ESR), interferon-γ-induced protein 10/CXC motif chemokine 10, soluble interleukin 2 receptor α (sIL-2Rα), and tissue inhibitor of metalloproteinase-1 (TIMP-1). In EGPA, these showed significant increases during active disease: granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage-CSF, interleukin (IL)-6, IL-15, and sIL-2Rα. BCA-1/CXCL13 also showed such increases, but only after adjustment for treatment. In PAN, ESR and matrix metalloprotease (MMP)-3 showed significant differences between disease states. Differences in biomarker levels between diseases were significant for 11 markers and were more striking (all p < 0.01) than differences related to disease activity. A combination of lower values of TIMP-1, IL-6, interferon-γ, and MMP-3 correctly classified 87% of samples with inactive GCA. CONCLUSION We identified novel biomarkers of disease activity in GCA and EGPA. Differences of biomarker levels between diseases, independent of disease activity, were more apparent than differences related to disease activity. Further studies are needed to determine whether these serum proteins have potential for clinical use in distinguishing active disease from remission or in predicting longer-term outcomes.
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Affiliation(s)
- Alicia Rodriguez-Pla
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Roscoe L Warner
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - David Cuthbertson
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Simon Carette
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Nader A Khalidi
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Curry L Koening
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Carol A Langford
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Carol A McAlear
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Larry W Moreland
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Christian Pagnoux
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Philip Seo
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Ulrich Specks
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Antoine G Sreih
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Steven R Ytterberg
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Kent J Johnson
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Peter A Merkel
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
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Alsilmi R, Wongkarnjana A, Scallan CJ, Haider E, Al-Douri F, Zou H, Beattie K, Granholm MA, Kolb M, Khalidi NA, Hambly N, Makhdami N, Nair P, Cox G. 275. FACTORS ASSOCIATED WITH DISEASE PROGRESSION IN PATIENTS WITH MYELOPEROXIDASE-ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-RELATED PULMONARY FIBROSIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez062.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gribbons K, Goel R, Cuthbertson D, Carette S, Hoffman GS, Joseph G, Khalidi NA, Koening CL, Langford C, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Nair A, Pagnoux C, Ravindran R, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Merkel PA, Danda D, Grayson PC. 084. DISCOVERY AND VALIDATION OF A NOVEL ANGIOGRAPHIC CLASSIFICATION SCHEME IN TAKAYASU’S ARTERITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sreih AG, Ezzedine R, Leng L, Fan J, Yao J, Reid D, Piecychna M, Carette S, Cuthbertson D, Dellaripa P, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Mahr A, McAlear CA, Maksimowicz-Mckinnon K, Monach PA, Seo P, Specks U, St Clair EW, Stone JH, Ytterberg SR, Edberg J, Merkel PA, Bucala R. Role of Macrophage Migration Inhibitory Factor in Granulomatosis With Polyangiitis. Arthritis Rheumatol 2018; 70:2077-2086. [PMID: 29953750 DOI: 10.1002/art.40655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/26/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the association between macrophage migration inhibitory factor (MIF) promoter polymorphisms and granulomatosis with polyangiitis (GPA) in human subjects, and to assess the role of MIF in a murine model of granulomatous vasculitis. METHODS The human study involved 1,077 patients with GPA and healthy controls whose serum was genotyped by capillary electrophoresis for the MIF -794 CATT5-8 promoter microsatellite (rs5844572). MIF promoter, CATT-length-dependent gene expression in response to β-glucan was assessed by gene reporter assays. In mouse studies, granulomatous disease was induced by injection of Candida albicans β-glucan into wild-type (WT) or Mif-knockout (Mif-KO) C57BL/6 mice and C57BL/6 mice transgenically overexpressing Mif in lung epithelium (Mif lung-Tg2.1). Mice were treated with a neutralizing anti-MIF antibody and analyzed for the density of pulmonary granulomas, expression of inflammatory chemokines, and frequency of mortality. RESULTS The percentage of human subjects carrying >5 CATT repeats in each MIF allele (high genotypic MIF expressers) was 60.2% among patients with GPA and 53.9% among healthy controls (adjusted P = 0.049). In response to granulomatous stimulation, human MIF gene expression increased proportionally with CATT length. Mif lung-Tg2.1 mice exhibited more pulmonary granulomas than WT mice, which in turn showed more granulomas than Mif-KO mice. A significantly higher percentage of Mif lung-Tg2.1 mice, compared to Mif-KO or WT mice, died when injected with Candida albicans β-glucan, and treatment of these mice with an anti-MIF monoclonal antibody protected against a lethal outcome. Levels of MIF-dependent neutrophil/macrophage chemokines were elevated in the bronchoalveolar lavage fluid or plasma of Mif lung-Tg2.1 mice. CONCLUSION Patients with GPA have an increased frequency of high MIF expression CATT alleles. Higher Mif expression increases the incidence of mortality and pulmonary granulomas in Mif lung-Tg2.1 mice, while anti-MIF treatment protects these mice against death. Blockade of MIF in high genotypic MIF expressers may therefore offer a selective pharmacologic therapy for GPA.
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Affiliation(s)
| | | | - Lin Leng
- Yale School of Medicine, New Haven, Connecticut
| | - Juan Fan
- Yale School of Medicine, New Haven, Connecticut
| | - Jie Yao
- Yale School of Medicine, New Haven, Connecticut
| | - Duncan Reid
- Yale School of Medicine, New Haven, Connecticut
| | | | - Simon Carette
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Dellaripa
- Brigham and Women's Hospital, and Harvard University, Boston, Massachusetts
| | | | - Nader A Khalidi
- St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | - Ulrich Specks
- Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - John H Stone
- Massachusetts General Hospital and Harvard University, Boston, Massachusetts
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Kermani TA, Sreih AG, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Warrington KJ, Ytterberg SR, Merkel PA. Evaluation of damage in giant cell arteritis. Rheumatology (Oxford) 2018; 57:322-328. [PMID: 29112740 DOI: 10.1093/rheumatology/kex397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate damage and variables associated with damage in GCA. Methods Patients with GCA enrolled in a prospective, multicentre, longitudinal study were included. Per-protocol assessments were made with the Vasculitis Damage Index and the Large-Vessel Vasculitis Index of Damage. Results The study included 204 patients: 156 women (76%), mean age at diagnosis 71.3 years (s.d. 8.3), mean follow-up of 3.5 years (s.d. 1.9). One or more damage item was present in 54% at baseline and 79% at the last follow-up on the Vasculitis Damage Index, and 60% at baseline and 82% at the last follow-up on the Large-Vessel Vasculitis Index of Damage. The most frequently observed damage items were large-artery complications (29% cohort) and ocular (22%). Among 117 patients with new damage, most new items were ocular (63 patients), cardiac/vascular (48) and musculoskeletal (34). Of these, treatment-associated items were frequently observed, including cataracts (46 patients), osteoporosis (22) and weight gain (22). Disease-associated new damage included ischaemic optic neuropathy (3 patients), limb claudication (13), arterial occlusions (10) and damage requiring vascular intervention (10). In univariate analysis, the risk of damage increased 22% for every additional year of disease duration [odds ratio (OR) 1.22 (95% CI 1.04, 1.45)]. In 94 patients enrolled within ⩽90 days of diagnosis of GCA, the risk of new damage at the last follow-up decreased 30% for each additional relapse [OR 0.70 (95% CI 0.51, 0.97)]. Conclusions Large-artery complications and ocular manifestations are the most commonly occurring items of damage in GCA. Most new damage is associated with treatment. These findings emphasize the cumulative burden of disease in GCA.
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Affiliation(s)
- Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, Los Angeles, CA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - David Cuthbertson
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Gary S Hoffman
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Nader A Khalidi
- Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Larry Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | | | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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Kermani TA, Diab S, Sreih AG, Cuthbertson D, Borchin R, Carette S, Forbess L, Koening CL, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Spiera RF, Warrington KJ, Ytterberg SR, Langford CA, Merkel PA, Khalidi NA. Arterial lesions in giant cell arteritis: A longitudinal study. Semin Arthritis Rheum 2018; 48:707-713. [PMID: 29880442 DOI: 10.1016/j.semarthrit.2018.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate large-vessel (LV) abnormalities on serial imaging in patients with giant cell arteritis (GCA) and discern predictors of new lesions. METHODS Clinical and imaging data from patients with GCA (including subjects diagnosed by LV imaging) enrolled in a prospective, multicenter, longitudinal study and/or a randomized clinical trial were included. New arterial lesions were defined as a lesion in a previously unaffected artery. RESULTS The study included 187 patients with GCA, 146 (78%) female, mean (±SD) age at diagnosis 68.5 ± 8.5 years; 39% diagnosed by LV imaging. At least one arterial lesion was present in 123 (66%) on the first study. The most frequently affected arteries were subclavian (42%), axillary (32%), and thoracic aorta (20%). In 106 patients (57%) with serial imaging, new arterial lesions were noted in 41 patients (39%), all of whom had a baseline abnormality, over a mean (±SD) follow-up of 4.39 (2.22) years. New abnormalities were observed in 33% patients by year 2; clinical features of active disease were present at only 50% of these cases. There were no differences in age, sex, temporal artery biopsy positivity, or disease activity in patients with or without new lesions. CONCLUSIONS In this cohort of patients with GCA, LV abnormalities on first imaging were common. Development of new arterial lesions occurred in patients with arterial abnormalities at first imaging, often in the absence of symptoms of active disease. Arterial imaging should be considered in all patients with GCA at diagnosis and serial imaging at least in patients with baseline abnormalities.
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Affiliation(s)
- Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540 Santa Monica, CA 90404.
| | - Sehriban Diab
- Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - David Cuthbertson
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL
| | - Renée Borchin
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lindsy Forbess
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Larry Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Robert F Spiera
- Division of Rheumatology, Hospital for Special Surgery, New York, NY
| | | | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH
| | - Peter A Merkel
- Division of Rheumatology and the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Nader A Khalidi
- Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
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Oommen E, Hummel A, Allmannsberger L, Cuthbertson D, Carette S, Pagnoux C, Hoffman GS, Jenne DE, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland L, Seo P, Sreih A, Ytterberg SR, Merkel PA, Specks U, Monach PA. IgA antibodies to myeloperoxidase in patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Clin Exp Rheumatol 2017; 35 Suppl 103:98-101. [PMID: 28281453 PMCID: PMC5514423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine the prevalence of anti-myeloperoxidase (MPO) antibodies of IgA (IgA anti-MPO) isotype in patients with eosinophilic granulomatosis with polyangiitis (EGPA), and the association of the IgA antibodies with IgG anti-MPO and with disease activity. METHODS Serum samples from patients with EGPA followed in a multicenter longitudinal cohort were tested by ELISA for the presence of IgA anti-MPO and IgG anti-MPO antibodies. Sera from 87 healthy controls were used to define a positive test. Sera from 168 patients with EGPA (298 samples) were tested. Frequencies of positive testing for IgA anti-MPO were compared between patients with active EGPA, patients in remission, and controls. RESULTS IgA anti-MPO was detected in 10 of 168 (6%) patients with EGPA (11 of 298 serum samples) compared to 1 of 87 (1%) healthy controls (p=0.10). All 11 samples testing positive for IgA anti-MPO also tested positive for IgG anti-MPO. Ninety samples tested positive for IgG anti-MPO but negative for IgA. Samples taken during active EGPA were positive for IgA anti-MPO in 6/72 cases (8%), compared to 5/226 (2%) during remission (p=0.03). Among samples taken during moderate or high disease activity, 5/41 were positive (12%, p=0.01 compared to remission). CONCLUSIONS Although IgA anti-MPO antibodies are detectable in some patients with EGPA and may be detectable more frequently during active disease, their presence seems unlikely to provide information beyond what is obtained from conventional IgG anti-MPO.
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Affiliation(s)
- Esha Oommen
- Section of Rheumatology, Boston University School of Medicine, Boston, MA; and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Amber Hummel
- Division of Pulmonology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Gary S Hoffman
- Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nader A Khalidi
- Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Carol A Langford
- Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Antoine Sreih
- Division of Rheumatology and Clinical Immunology, 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 Clinical Immunology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ulrich Specks
- Division of Pulmonology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine; and Rheumatology Section, VA Boston Healthcare System, Boston, MA, USA.
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Rhéaume M, Rebello R, Pagnoux C, Carette S, Clements‐Baker M, Cohen‐Hallaleh V, Doucette‐Preville D, Stanley Jackson B, Salama Sargious Salama S, Ioannidis G, Khalidi NA. High‐Resolution Magnetic Resonance Imaging of Scalp Arteries for the Diagnosis of Giant Cell Arteritis: Results of a Prospective Cohort Study. Arthritis Rheumatol 2016; 69:161-168. [DOI: 10.1002/art.39824] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/21/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Maxime Rhéaume
- St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada, and Hôpital du Sacré‐Coeur de MontréalMontreal Quebec Canada
| | - Ryan Rebello
- St. Joseph's Hospital, McMaster UniversityHamilton Ontario Canada
| | | | - Simon Carette
- Mount Sinai Hospital, University of TorontoToronto Ontario Canada
| | | | | | | | | | | | - George Ioannidis
- St. Joseph's Hospital, McMaster UniversityHamilton Ontario Canada
| | - Nader A. Khalidi
- St. Joseph's Hospital, McMaster UniversityHamilton Ontario Canada
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Rhéaume M, Pagnoux C, Khalidi NA. Reply. Arthritis Rheumatol 2016; 69:477-478. [PMID: 27696761 DOI: 10.1002/art.39936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/13/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Maxime Rhéaume
- St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.,Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | - Nader A Khalidi
- St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
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Kermani TA, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McKinnon-Maksimowicz K, McAlear CA, Monach PA, Seo P, Warrington KJ, Ytterberg SR, Merkel PA, Matteson EL. The Birmingham Vasculitis Activity Score as a Measure of Disease Activity in Patients with Giant Cell Arteritis. J Rheumatol 2016; 43:1078-84. [PMID: 27036388 PMCID: PMC4891218 DOI: 10.3899/jrheum.151063] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the performance of the Birmingham Vasculitis Activity Score (BVAS) in the assessment of disease activity in giant cell arteritis (GCA). METHODS Patients with GCA enrolled in a prospective, multicenter, longitudinal study with symptoms of active vasculitis during any visit were included. Spearman's rank correlation was used to explore the association of the BVAS with other measures of disease activity. RESULTS During a mean (SD) followup of 2.3 (1.6) years, symptoms of active GCA were present in 236 visits in 136 subjects (100 female, 74%). Median (range) BVAS1 (new/worse symptoms) was 1 (0-10) and median (range) BVAS2 (persistent symptoms) was 0 (0-5). Median (range) physician's global assessment (PGA) was 4 (0-9) for disease activity in the past 28 days and 2 (0-9) for activity on the day of the visit. Important ischemic manifestations of active vasculitis not recorded by the BVAS included tongue/jaw claudication (27%), upper extremity claudication (15%), lower extremity claudication (5%), carotidynia (7%), and ischemic retinopathy (5%). During 25 visits (11%) with active disease, all symptoms of active vasculitis were placed in the "Other" category yet still resulted in a BVAS1 and BVAS2 of 0. BVAS1 moderately correlated with PGA for the past 28 days (Spearman's correlation 0.50) and physician-rated disease activity for the past 28 days (Spearman's correlation 0.46). CONCLUSION The BVAS has limited utility in GCA. Patients with active GCA can have a BVAS of 0. Many important ischemic symptoms attributable to active vasculitis are not included in the composite score.
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Affiliation(s)
- Tanaz A Kermani
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - David Cuthbertson
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Simon Carette
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Gary S Hoffman
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Nader A Khalidi
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Curry L Koening
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Carol A Langford
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Kathleen McKinnon-Maksimowicz
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Carol A McAlear
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Paul A Monach
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Philip Seo
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Kenneth J Warrington
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Steven R Ytterberg
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Peter A Merkel
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
| | - Eric L Matteson
- From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
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Wu M, Assassi S, Salazar GA, Pedroza C, Gorlova OY, Chen WV, Charles J, Taing ML, Liao K, Wigley FM, Hummers LK, Shah AA, Hinchcliff M, Khanna D, Schiopu E, Phillips K, Furst DE, Steen V, Baron M, Hudson M, Zhou X, Pope J, Jones N, Docherty P, Khalidi NA, Robinson D, Simms RW, Silver RM, Frech TM, Fessler BJ, Fritzler MJ, Molitor JA, Segal BM, Movahedian M, Martín J, Varga J, Mayes MD. Genetic susceptibility loci of idiopathic interstitial pneumonia do not represent risk for systemic sclerosis: a case control study in Caucasian patients. Arthritis Res Ther 2016; 18:20. [PMID: 26792595 PMCID: PMC4719560 DOI: 10.1186/s13075-016-0923-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/06/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc)-related interstitial lung disease (ILD) has phenotypic similarities to lung involvement in idiopathic interstitial pneumonia (IIP). We aimed to assess whether genetic susceptibility loci recently identified in the large IIP genome-wide association studies (GWASs) were also risk loci for SSc overall or severity of ILD in SSc. METHODS A total of 2571 SSc patients and 4500 healthy controls were investigated from the US discovery GWAS and additional US replication cohorts. Thirteen IIP-related selected single nucleotide polymorphisms (SNPs) were genotyped and analyzed for their association with SSc. RESULTS We found an association of SSc with the SNP rs6793295 in the LRRC34 gene (OR = 1.14, CI 95 % 1.03 to 1.25, p value = 0.009) and rs11191865 in the OBFC1 gene (OR = 1.09, CI 95 % 1.00 to 1.19, p value = 0.043) in the discovery cohort. Additionally, rs7934606 in MUC2 (OR = 1.24, CI 95 % 1.01 to 1.52, p value = 0.037) was associated with SSc-ILD defined by imaging. However, these associations failed to replicate in the validation cohort. Furthermore, SNPs rs2076295 in DSP (β = -2.29, CI 95 % -3.85 to -0.74, p value = 0.004) rs17690703 in SPPL2C (β = 2.04, CI 95 % 0.21 to 3.88, p value = 0.029) and rs1981997 in MAPT (β = 2.26, CI 95 % 0.35 to 4.17, p value = 0.02) were associated with percent predicted forced vital capacity (FVC%) even after adjusting for the anti-topoisomerase (ATA)-positive subset. However, these associations also did not replicate in the validation cohort. CONCLUSIONS Our results add new evidence that SSc and SSc-related ILD are genetically distinct from IIP, although they share phenotypic similarities.
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Affiliation(s)
- Minghua Wu
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Shervin Assassi
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Gloria A Salazar
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Claudia Pedroza
- Department of Pediatrics, The University of Texas Mcgovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Olga Y Gorlova
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA.
| | - Wei V Chen
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA.
| | - Julio Charles
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Miranda L Taing
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Kelley Liao
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Fredrick M Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview circle, Baltimore, MD, 21224, USA.
| | - Laura K Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview circle, Baltimore, MD, 21224, USA.
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview circle, Baltimore, MD, 21224, USA.
| | - Monique Hinchcliff
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, 240 East Huron Street, Chicago, IL, 60611, USA.
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Health Center, 300 North Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Elena Schiopu
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Health Center, 300 North Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Kristine Phillips
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Health Center, 300 North Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Daniel E Furst
- Division of Rheumatology, University of California Los Angeles, 1000 Veterans Avenue, Los Angeles, CA, 90024, USA.
| | - Virginia Steen
- Division of Rheumatology, Georgetown University Medical Center, 3800 Reservoir Road, Washington, MD, 20007, USA.
| | - Murray Baron
- Division of Rheumatology, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
| | - Marie Hudson
- Division of Rheumatology, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
| | - Xiaodong Zhou
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Janet Pope
- Division of Rheumatology, St. Joseph's Health Care, University of Western Ontario, 268 Grosvenor Street, London, ON, Canada.
| | - Niall Jones
- Division of Rheumatology, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Peter Docherty
- Division of Rheumatology, Moncton Hospital, 135 MacBeath Avenue, Moncton, NB, E1C 6Z8, Canada.
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University at Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - David Robinson
- Division of Rheumatology, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
| | - Robert W Simms
- Division of Rheumatology, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Richard M Silver
- Division of Rheumatology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, 29425, USA.
| | - Tracy M Frech
- Division of Rheumatology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
| | - Barri J Fessler
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1825 University Boulevard, Birmingham, AB, 35294, USA.
| | - Marvin J Fritzler
- Division of Rheumatology, University of Calgary Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Jerry A Molitor
- Division of Rheumatology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Barbara M Segal
- Division of Rheumatology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Malahat Movahedian
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - Javier Martín
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Cientıficas, C/Ventanilla 11, 18001, Granada, Spain.
| | - John Varga
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, 240 East Huron Street, Chicago, IL, 60611, USA.
| | - Maureen D Mayes
- Division of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
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Alsolaimani RS, Bhavsar SV, Khalidi NA, Pagnoux C, Mandzia JL, Tay K, Barra LJ. Severe Intracranial Involvement in Giant Cell Arteritis: 5 Cases and Literature Review. J Rheumatol 2016; 43:648-56. [DOI: 10.3899/jrheum.150143] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 10/22/2022]
Abstract
Objective.Involvement of intracranial arteries in giant cell arteritis (GCA) is rare. We describe the neurologic complications of intracranial GCA (IC GCA) and available treatment options.Methods.We describe 5 IC GCA cases from 3 Canadian vasculitis centers and review the literature. We searched English-language publications reporting similar patients meeting American College of Rheumatology (ACR) criteria for GCA and having intracranial artery involvement diagnosed by autopsy, magnetic resonance angiography, computed tomography angiography, or conventional angiography.Results.All 5 cases of IC GCA met ACR criteria for GCA; 4 cases had a temporal artery biopsy that was consistent with GCA. All cases experienced cerebrovascular accident(s). Arteritis involved the following vessels: intracranial internal carotid (n = 1), vertebrobasilar arteries (n = 1), or both (n = 3). All cases received aspirin and oral prednisone (preceded by intravenous methylprednisone in 3 cases), combined with an immunosuppressant in 4 cases. All patients survived; 2 had complete neurological recovery, 3 had residual neurologic sequelae. The literature review included 42 cases from 28 publications. The clinical features of the reported cases were similar to those of our 5 cases. However, mortality was 100% in untreated cases (n = 2), 58% in those treated with corticosteroid alone (n = 31), and 40% in those treated with corticosteroid and an immunosuppressant (n = 10).Conclusion.IC GCA appears to be associated with neurologic complications and mortality. In some cases corticosteroid alone was not sufficient to prevent neurologic complications. The role of additional immunosuppressive agents needs further investigation.
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Renauer PA, Saruhan-Direskeneli G, Coit P, Adler A, Aksu K, Keser G, Alibaz-Oner F, Aydin SZ, Kamali S, Inanc M, Carette S, Cuthbertson D, Hoffman GS, Akar S, Onen F, Akkoc N, Khalidi NA, Koening C, Karadag O, Kiraz S, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Ozbalkan Z, Ates A, Karaaslan Y, Duzgun N, Monach PA, Ozer HTE, Erken E, Ozturk MA, Yazici A, Cefle A, Onat AM, Kisacik B, Pagnoux C, Kasifoglu T, Seyahi E, Fresko I, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Cobankara V, Cunninghame-Graham DS, Vyse TJ, Pamuk ON, Tunc SE, Dalkilic E, Bicakcigil M, Yentur SP, Wren JD, Merkel PA, Direskeneli H, Sawalha AH. Identification of Susceptibility Loci in IL6, RPS9/LILRB3, and an Intergenic Locus on Chromosome 21q22 in Takayasu Arteritis in a Genome-Wide Association Study. Arthritis Rheumatol 2015; 67:1361-8. [PMID: 25604533 DOI: 10.1002/art.39035] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/13/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Takayasu arteritis is a rare large vessel vasculitis with incompletely understood etiology. This study was undertaken to perform the first unbiased genome-wide association analysis of Takayasu arteritis. METHODS Two independent cohorts of patients with Takayasu arteritis from Turkey and North America were included in our study. The Turkish cohort consisted of 559 patients and 489 controls, and the North American cohort consisted of 134 patients and 1,047 controls of European ancestry. Genotyping was performed using the Omni1-Quad and Omni2.5 genotyping arrays. Genotyping data were subjected to rigorous quality control measures and subsequently analyzed to discover genetic susceptibility loci for Takayasu arteritis. RESULTS We identified genetic susceptibility loci for Takayasu arteritis with a genome-wide level of significance in IL6 (rs2069837) (odds ratio [OR] 2.07, P = 6.70 × 10(-9)), RPS9/LILRB3 (rs11666543) (OR 1.65, P = 2.34 × 10(-8)), and an intergenic locus on chromosome 21q22 (rs2836878) (OR 1.79, P = 3.62 × 10(-10)). The genetic susceptibility locus in RPS9/LILRB3 lies within the leukocyte receptor complex gene cluster on chromosome 19q13.4, and the disease risk variant in this locus correlates with reduced expression of multiple genes including the inhibitory leukocyte immunoglobulin-like receptor gene LILRB3 (P = 2.29 × 10(-8)). In addition, we identified candidate susceptibility genes with suggestive levels of association (P < 1 × 10(-5)) with Takayasu arteritis, including PCSK5, LILRA3, PPM1G/NRBP1, and PTK2B. CONCLUSION Our findings indicate novel genetic susceptibility loci for Takayasu arteritis and uncover potentially important aspects of the pathophysiology of this form of vasculitis.
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Kermani TA, Warrington KJ, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Seo P, Merkel PA, Ytterberg SR. Disease Relapses among Patients with Giant Cell Arteritis: A Prospective, Longitudinal Cohort Study. J Rheumatol 2015; 42:1213-7. [PMID: 25877501 DOI: 10.3899/jrheum.141347] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the frequency, timing, and clinical features of relapses in giant cell arteritis (GCA). METHODS Patients with GCA enrolled in a prospective, multicenter, longitudinal study were included in the analysis. Relapse was defined as either new disease activity after a period of remission or worsening disease activity. RESULTS The study included 128 subjects: 102 women (80%) and 26 men (20%). Mean ± SD age at diagnosis of GCA was 69.9 ± 8.6 years. Mean followup for the cohort was 21.4 ± 13.9 months. Median (interquartile range) duration of disease at study enrollment was 4.6 months (1.2, 16.8). During followup, 59 relapses were observed in 44 patients (34%). Ten patients (8%) experienced 2 or more relapses. The most common symptoms at relapse were headache (42%) and polymyalgia rheumatica (51%), but ischemic (some transient) manifestations (visual symptoms, tongue or jaw claudication, and/or limb claudication) occurred in 29% of relapses (12% cohort). Forty-three relapses (73%) occurred while patients were taking glucocorticoid therapy at a median (range) prednisone dose of 7.5 (0-35) mg. In 21% of relapses, both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal. Among 69 patients enrolled in the cohort with newly diagnosed disease, 24% experienced a first relapse within 12 months after diagnosis. CONCLUSION Among patients with GCA, relapses are common, often occurring during treatment. ESR and CRP are frequently normal at times of clinical relapse, highlighting the need for better biomarkers to assess disease activity in GCA. There remains a need for effective therapeutic alternatives to glucocorticoids in GCA.
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Affiliation(s)
- Tanaz A Kermani
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Kenneth J Warrington
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - David Cuthbertson
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Simon Carette
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Gary S Hoffman
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Nader A Khalidi
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Curry L Koening
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Carol A Langford
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Kathleen Maksimowicz-McKinnon
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Carol A McAlear
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Paul A Monach
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Philip Seo
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
| | - Peter A Merkel
- From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
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Carmona F, Mackie S, Martín JE, Taylor J, Vaglio A, Eyre S, Bossini-Castillo L, Castañeda S, Cid M, Hernández-Rodríguez J, Prieto-González S, Solans R, Ramentol-Sintas M, González-Escribano M, Ortiz-Fernández L, Morado I, Narváez J, Miranda-Filloy J, Beretta L, Lunardi C, Cimmino MA, Gianfreda D, Santilli D, Ramirez GA, Soriano A, Muratore F, Pazzola G, Addimanda O, Wijmenga C, Witte T, Schirmer JH, Moosig F, Schönau V, Franke A, Palm Ø, Molberg Ø, Diamantopoulos AP, Carette S, Cuthbertson D, Forbess LJ, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland L, Monach PA, Pagnoux C, Seo P, Spiera R, Sreih AG, Warrington KJ, Ytterberg SR, Gregersen PK, Pease CT, Gough A, Green M, Hordon L, Jarrett S, Watts R, Levy S, Patel Y, Kamath S, Dasgupta B, Worthington J, Koeleman BP, de Bakker PI, Barrett JH, Salvarani C, Merkel PA, González-Gay MA, Morgan AW, Martín J, Martínez-Berriochoa A, Unzurrunzaga A, Hidalgo-Conde A, Madroñero-Vuelta A, Fernández-Nebro A, Ordóñez-Cañizares M, Escalante B, Marí-Alfonso B, Sopeña B, Magro C, Raya E, Grau E, Román J, de Miguel E, López-Longo F, Martínez L, Gómez-Vaquero C, Fernández-Gutiérrez B, Rodríguez-Rodríguez L, Díaz-López J, Caminal-Montero L, Martínez-Zapico A, Monfort J, Tío L, Sánchez-Martín J, Alegre-Sancho J, Sáez-Comet L, Pérez-Conesa M, Corbera-Bellalta M, García-Villanueva M, Fernández-Contreras M, Sanchez-Pernaute O, Blanco R, Ortego-Centeno N, Ríos-Fernández R, Callejas J, Fanlo-Mateo P, Martínez-Taboada V. A large-scale genetic analysis reveals a strong contribution of the HLA class II region to giant cell arteritis susceptibility. Am J Hum Genet 2015; 96:565-80. [PMID: 25817017 DOI: 10.1016/j.ajhg.2015.02.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/12/2015] [Indexed: 02/08/2023] Open
Abstract
We conducted a large-scale genetic analysis on giant cell arteritis (GCA), a polygenic immune-mediated vasculitis. A case-control cohort, comprising 1,651 case subjects with GCA and 15,306 unrelated control subjects from six different countries of European ancestry, was genotyped by the Immunochip array. We also imputed HLA data with a previously validated imputation method to perform a more comprehensive analysis of this genomic region. The strongest association signals were observed in the HLA region, with rs477515 representing the highest peak (p = 4.05 × 10(-40), OR = 1.73). A multivariate model including class II amino acids of HLA-DRβ1 and HLA-DQα1 and one class I amino acid of HLA-B explained most of the HLA association with GCA, consistent with previously reported associations of classical HLA alleles like HLA-DRB1(∗)04. An omnibus test on polymorphic amino acid positions highlighted DRβ1 13 (p = 4.08 × 10(-43)) and HLA-DQα1 47 (p = 4.02 × 10(-46)), 56, and 76 (both p = 1.84 × 10(-45)) as relevant positions for disease susceptibility. Outside the HLA region, the most significant loci included PTPN22 (rs2476601, p = 1.73 × 10(-6), OR = 1.38), LRRC32 (rs10160518, p = 4.39 × 10(-6), OR = 1.20), and REL (rs115674477, p = 1.10 × 10(-5), OR = 1.63). Our study provides evidence of a strong contribution of HLA class I and II molecules to susceptibility to GCA. In the non-HLA region, we confirmed a key role for the functional PTPN22 rs2476601 variant and proposed other putative risk loci for GCA involved in Th1, Th17, and Treg cell function.
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Pagnoux C, Carette S, Khalidi NA, Walsh M, Hiemstra TF, Cuthbertson D, Langford C, Hoffman GS, Koening CL, Monach PA, Moreland L, Mouthon L, Seo P, Specks U, Ytterberg S, Westman K, Hoglund P, Harper L, Flossmann O, Luqmani R, Savage C, Rasmussen N, de Groot K, Tesar V, Jayne D, Merkel PA, Guillevin L. Comparability of patients with ANCA-associated vasculitis enrolled in clinical trials or in observational cohorts. Clin Exp Rheumatol 2015; 33:S-83. [PMID: 26016754 PMCID: PMC4525702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To analyse the differences between patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) entered into randomised clinical trials (RCTs) and those followed in large observational cohorts. METHODS The main characteristics and outcomes of patients with generalised and/or severe GPA or MPA with a five-factor score ≥ 1 enrolled in the French Vasculitis Study Group (FVSG) or the US-Canadian-based Vasculitis Clinical Research Consortium cohorts were compared to those enrolled in one of 2 FVSG clinical RCTs (WEG91, WEGENT) or 3 European Vasculitis Society clinical trials (CYCLOPS, CYCAZAREM, IMPROVE). RESULTS 657 patients (65.3% with GPA) in RCTs were compared to 437 in cohorts (90.6% with GPA). RCT patients were older at diagnosis than the cohort patients (56.6 ± 13.9 vs. 46.8 ± 17.3 years), had higher Birmingham vasculitis activity score (19.5 ± 9.1 vs. 16.9 ± 7.4), and more frequent kidney disease (84.0% vs. 54.9%) but fewer ear, nose, and throat symptoms (56.8% vs. 72.2%). At 56 months post-diagnosis, mortality and relapse rates, adjusted for age and renal function, were higher for patients with GPA in RCTs vs. cohorts (10.7% vs. 2.5% [p=0.001] and 22.5% vs. 15.6% [p=0.03], respectively) but similar for patients with MPA (6.2% vs. 6.6% [p=0.92] and 16.6% vs. 10.1% [p=0.39], respectively). CONCLUSIONS Patients with GPA or MPA in RCTs and those in observational cohorts show important differences that should be remembered when interpreting results based on these study populations.
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Affiliation(s)
- Christian Pagnoux
- Division of Rheumatology, University of Toronto, Toronto, Canada
- Department of Internal Medicine, National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, Department of Internal Medicine, Hôpital Cochin, University Paris-Descartes, Paris, France
| | - Simon Carette
- Division of Rheumatology, University of Toronto, Toronto, Canada
| | | | - Michael Walsh
- Division of Nephrology and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Thomas F. Hiemstra
- University of Cambridge and Lupus and Vasculitis Unit, Addenbrookes Hospital, Cambridge, UK
| | - David Cuthbertson
- Department of Biostatistics, University of South Florida, Tampa, USA
| | | | | | - Curry L. Koening
- Division of Rheumatology, University of Utah, Salt Lake City, USA
| | | | - Larry Moreland
- Vasculitis Center, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, Department of Internal Medicine, Hôpital Cochin, University Paris-Descartes, Paris, France
| | - Phil Seo
- Boston University Vasculitis Center, Boston, USA
| | - Ulrich Specks
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | | | - Kerstin Westman
- Department of Nephrology and Transplantation, Lund University, Skane University Hospital Malmö, Sweden
| | - Peter Hoglund
- Competence Centre for Clinical Research, Skane University, Lund, Sweden
| | - Lorraine Harper
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Oliver Flossmann
- Department of Nephrology, Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Raashid Luqmani
- Department of Nephrology, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Caroline Savage
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Niels Rasmussen
- Department of Ear, Nose and Throat, Rigshospitalet, Copenhagen, Denmark
| | | | - Vladimir Tesar
- Department of Nephrology, Charles University and General University Hospital First Faculty of Medicine, Prague, Czech Republic
| | - David Jayne
- University of Cambridge and Lupus and Vasculitis Unit, Addenbrookes Hospital, Cambridge, UK
| | - Pater A. Merkel
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, USA
| | - Loic Guillevin
- Department of Internal Medicine, National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, Department of Internal Medicine, Hôpital Cochin, University Paris-Descartes, Paris, France
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Grayson PC, Monach PA, Pagnoux C, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, Seo P, Specks U, Ytterberg SR, Merkel PA. Value of commonly measured laboratory tests as biomarkers of disease activity and predictors of relapse in eosinophilic granulomatosis with polyangiitis. Rheumatology (Oxford) 2014; 54:1351-9. [PMID: 25406357 DOI: 10.1093/rheumatology/keu427] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the clinical value of absolute eosinophil count, serum IgE, ESR and CRP as longitudinal biomarkers of disease activity and predictors of relapse in eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA). METHODS Patients were selected from an observational EGPA cohort. Absolute eosinophil count, IgE, ESR and CRP were measured quarterly. Disease activity was defined by validated assessment tools. The association of tests with disease activity was assessed via regression models, adjusting for repeated measures and treatment status. Survival analysis was used to determine if laboratory tests were predictive of the 3 month future flare risk. RESULTS Seventy-four per cent of 892 study visits in 141 patients occurred while patients were on treatment, mostly during remission or mild disease activity, defined as a BVAS for Wegener's granulomatosis (BVAS/WG) of 1 or 2. Correlations between absolute eosinophil count, IgE, ESR and CRP were mostly low or non-significant (r = -0.08 to 0.44). There were few weak associations with disease activity [absolute eosinophil count: OR) 1.01/100 U (95% CI 1.01, 1.02); ESR: OR 1.15/10 mg/l increase (95% CI 1.04, 1.27)]. When BVAS/WG ≥1 defined active disease, the absolute eosinophil count [hazard ratio (HR) 1.01/100 U (95% CI 1.01, 1.02)] was weakly predictive of flare. When BVAS/WG ≥3 defined active disease, ESR was weakly predictive of flare [HR 1.52/10 mm/h increase (95% CI 1.17, 1.67)]. CONCLUSION The absolute eosinophil count, IgE, ESR and CRP have limitations as longitudinal biomarkers of disease activity or predictors of flare in EGPA. These findings suggest that novel biomarkers of disease activity for EGPA are needed.
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Affiliation(s)
- Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | | | | | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Gary S Hoffman
- Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Carol A Langford
- Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic of Medicine, Rochester
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN and
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
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Carmona R, Harish S, Linda DD, Ioannidis G, Matsos M, Khalidi NA. MR Imaging of the Spine and Sacroiliac Joints for Spondyloarthritis: Influence on Clinical Diagnostic Confidence and Patient Management. Radiology 2013; 269:208-15. [DOI: 10.1148/radiol.13121675] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Grayson PC, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, Monach PA, Seo P, Specks U, Ytterberg SR, Merkel PA. New features of disease after diagnosis in 6 forms of systemic vasculitis. J Rheumatol 2013; 40:1905-12. [PMID: 23908447 DOI: 10.3899/jrheum.121473] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify the occurrence of features of vasculitis that initially present after diagnosis in 6 types of primary vasculitis. METHODS Standardized collection of data on 95 disease manifestations in 6 vasculitides, including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (Churg-Strauss; EGPA), polyarteritis nodosa (PAN), giant cell arteritis (GCA), and Takayasu arteritis (TAK), was obtained within a set of multicenter longitudinal, observational cohorts. For each form of vasculitis, the frequency of disease-specific manifestations at diagnosis was compared to the cumulative frequency of each manifestation. The percentage of patients who initially developed severe manifestations after diagnosis, defined as organ- or life-threatening in the small and medium vessel vasculitides (GPA, MPA, EGPA, PAN) and as ischemic/vascular in the large vessel vasculitides (GCA, TAK), was reported. RESULTS Out of 838 patients with vasculitis, 490 (59%) experienced ≥ 1 new disease manifestation after diagnosis. On average, patients with vasculitis experienced 1.3 new manifestations after diagnosis (GPA = 1.9, MPA = 1.2, EGPA = 1.5, PAN = 1.2, GCA = 0.7, and TAK = 1.0). New severe manifestations occurred after diagnosis in 224 (27%) out of 838 patients (GPA = 26%, MPA = 19%, EGPA = 21%, PAN = 23%, GCA = 24%, and TAK = 44%). Timing of onset of new manifestations was not significantly associated with disease duration. CONCLUSION A majority of patients with vasculitis develop new disease features after diagnosis, including a substantial number of new, severe manifestations. Ongoing assessment of patients with established vasculitis should remain broad in scope.
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Affiliation(s)
- Peter C Grayson
- From The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Biostatistics, University of South Florida, Tampa, Florida; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; and the Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio; Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Lieberthal JG, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, Seo P, Specks U, Ytterberg SR, Merkel PA, Monach PA. urinary biomarkers in relapsing antineutrophil cytoplasmic antibody-associated vasculitis. J Rheumatol 2013; 40:674-83. [PMID: 23547217 DOI: 10.3899/jrheum.120879] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Glomerulonephritis (GN) is common in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but tools for early detection of renal involvement are imperfect. We investigated 4 urinary proteins as markers of active renal AAV: alpha-1 acid glycoprotein (AGP), kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein-1 (MCP-1), and neutrophil gelatinase-associated lipocalin (NGAL). METHODS Patients with active renal AAV (n = 20), active nonrenal AAV (n = 16), and AAV in longterm remission (n = 14) were identified within a longitudinal cohort. Urinary biomarker concentrations (by ELISA) were normalized for urine creatinine. Marker levels during active AAV were compared to baseline remission levels (from 1-4 visits) for each patient. Areas under receiver-operating characteristic curves (AUC), sensitivities, specificities, and likelihood ratios (LR) comparing disease states were calculated. RESULTS Baseline biomarker levels varied among patients. All 4 markers increased during renal flares (p < 0.05). MCP-1 discriminated best between active renal disease and remission: a 1.3-fold increase in MCP-1 had 94% sensitivity and 89% specificity for active renal disease (AUC = 0.93, positive LR 8.5, negative LR 0.07). Increased MCP-1 also characterized 50% of apparently nonrenal flares. Change in AGP, KIM-1, or NGAL showed more modest ability to distinguish active renal disease from remission (AUC 0.71-0.75). Hematuria was noted in 83% of active renal episodes, but also 43% of nonrenal flares and 25% of remission samples. CONCLUSION Either urinary MCP-1 is not specific for GN in AAV, or it identifies early GN not detected by standard assessment and thus has potential to improve care. A followup study with kidney biopsy as the gold standard is needed.
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Affiliation(s)
- Jason G Lieberthal
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
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Tomasson G, Boers M, Walsh M, LaValley M, Cuthbertson D, Carette S, Davis JC, Hoffman GS, Khalidi NA, Langford CA, McAlear CA, McCune WJ, Monach PA, Seo P, Specks U, Spiera R, St Clair EW, Stone JH, Ytterberg SR, Merkel PA. Assessment of health-related quality of life as an outcome measure in granulomatosis with polyangiitis (Wegener's). Arthritis Care Res (Hoboken) 2012; 64:273-9. [PMID: 21954229 DOI: 10.1002/acr.20649] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess a generic measure of health-related quality of life (HRQOL) as an outcome measure in granulomatosis with polyangiitis (Wegener's) (GPA). METHODS Subjects were participants in the Wegener's Granulomatosis Etanercept Trial (WGET) or the Vasculitis Clinical Research Consortium Longitudinal Study (VCRC-LS). HRQOL was assessed with the Short Form 36 (SF-36) health survey that includes physical and mental component summary scores (PCS and MCS, respectively). Disease activity was assessed with the Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS/WG). RESULTS The data from 180 subjects in the WGET (median followup 2.3 years, mean number of visits 10) and 237 subjects in the VCRC-LS (median followup 2.0 years, mean number of visits 8) were analyzed. A 1 unit increase in the BVAS/WG corresponded to a 1.15 unit (95% confidence interval [95% CI] 1.02, 1.29) decrease for the PCS and a 0.93 (95% CI 0.78, 1.07) decrease for the MCS in the WGET, and to a 1.16 unit decrease for the PCS (95% CI 0.94, 1.39) and a 0.79 unit decrease for the MCS (95% CI 0.51, 1.39) in the VCRC-LS. In both arms of the WGET study, SF-36 measures improved rapidly during the first 6 weeks of treatment followed by gradual improvement among patients achieving sustained remission (0.5 improvement in PCS per 3 months), but worsened slightly (0.03 decrease in PCS every 3 months) among patients not achieving sustained remission (P = 0.005). CONCLUSION HRQOL, as measured by the SF-36, is reduced among patients with GPA. SF-36 measures are modestly associated with other disease outcomes and discriminate between disease states of importance in GPA.
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Grayson PC, Maksimowicz-McKinnon K, Clark TM, Tomasson G, Cuthbertson D, Carette S, Khalidi NA, Langford CA, Monach PA, Seo P, Warrington KJ, Ytterberg SR, Hoffman GS, Merkel PA. Distribution of arterial lesions in Takayasu's arteritis and giant cell arteritis. Ann Rheum Dis 2012; 71:1329-34. [PMID: 22328740 DOI: 10.1136/annrheumdis-2011-200795] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare patterns of arteriographic lesions of the aorta and primary branches in patients with Takayasu's arteritis (TAK) and giant cell arteritis (GCA). METHODS Patients were selected from two North American cohorts of TAK and GCA. The frequency of arteriographic lesions was calculated for 15 large arteries. Cluster analysis was used to derive patterns of arterial disease in TAK versus GCA and in patients categorised by age at disease onset. Using latent class analysis, computer derived classification models based upon patterns of arterial disease were compared with traditional classification. RESULTS Arteriographic lesions were identified in 145 patients with TAK and 62 patients with GCA. Cluster analysis demonstrated that arterial involvement was contiguous in the aorta and usually symmetric in paired branch vessels for TAK and GCA. There was significantly more left carotid (p=0.03) and mesenteric (p=0.02) artery disease in TAK and more left and right axillary (p<0.01) artery disease in GCA. Subclavian disease clustered asymmetrically in TAK and in patients ≤55 years at disease onset and clustered symmetrically in GCA and patients >55 years at disease onset. Computer derived classification models distinguished TAK from GCA in two subgroups, defining 26% and 18% of the study sample; however, 56% of patients were classified into a subgroup that did not strongly differentiate between TAK and GCA. CONCLUSIONS Strong similarities and subtle differences in the distribution of arterial disease were observed between TAK and GCA. These findings suggest that TAK and GCA may exist on a spectrum within the same disease.
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Affiliation(s)
- Peter C Grayson
- The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
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Grayson PC, Tomasson G, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Langford CA, McAlear CA, Monach PA, Seo P, Warrington KJ, Ytterberg SR, Merkel PA. Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis. J Rheumatol 2011; 39:303-9. [PMID: 22174204 DOI: 10.3899/jrheum.110652] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the utility of the vascular physical examination to detect arteriographic lesions in patients with established large vessel vasculitis (LVV), including Takayasu's arteritis (TAK) and giant cell arteritis (GCA). METHODS In total, 100 patients (TAK = 68, GCA = 32) underwent standardized physical examination and angiography of the carotid, subclavian, and axillary arteries. Sensitivity and specificity were calculated for the association between findings on physical examination focusing on the vascular system (absent pulse, bruit, and blood pressure difference) and arteriographic lesions defined as stenosis, occlusion, or aneurysm. RESULTS We found 67% of patients had at least 1 abnormality on physical examination (74% TAK, 53% GCA). Arteriographic lesions were seen in 76% of patients (82% TAK, 63% GCA). Individual physical examination findings had poor sensitivity (range 14%-50%) and good-excellent specificity (range 71%-98%) to detect arteriographic lesions. Even when considering physical examination findings in combination, at least 30% of arteriographic lesions were missed. Specificity improved (range 88%-100%) if individual physical examination findings were compared to a broader region of vessels rather than specific anatomically correlated vessels and if ≥ 1 physical examination findings were combined. CONCLUSION In patients with established LVV, physical examination alone is worthwhile to detect arterial disease but does not always localize or reveal the full extent of arteriographic lesions. Abnormal vascular system findings on physical examination are highly associated with the presence of arterial lesions, but normal findings on physical examination do not exclude the possibility of arterial disease. Serial angiographic assessment is advisable to monitor arterial disease in patients with established LVV.
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Affiliation(s)
- Peter C Grayson
- Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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Khalidi NA. ANCA-associated vasculitides and classification: a conundrum solved? J Rheumatol 2011; 38:971-2. [PMID: 21632685 DOI: 10.3899/jrheum.110146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Haaland DA, Cohen DR, Kennedy CC, Khalidi NA, Adachi JD, Papaioannou A. Closing the osteoporosis care gap: increased osteoporosis awareness among geriatrics and rehabilitation teams. BMC Geriatr 2009; 9:28. [PMID: 19602246 PMCID: PMC2731027 DOI: 10.1186/1471-2318-9-28] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 07/14/2009] [Indexed: 01/06/2023] Open
Abstract
Background A care gap exists between recommendations and practice regarding the diagnosis and treatment of osteoporosis in fracture patients. The current study was designed to determine rates and predictors of in-hospital diagnosis and treatment of osteoporosis in patients admitted with fragility hip fractures, and to assess differences in these rates since the outset of the multipronged "Fracture? Think Osteoporosis" (FTOP) Program, which includes education of geriatrics and rehabilitation teams. Methods This is a retrospective cohort study conducted with data from two Hamilton, Ontario, university-based tertiary-care hospitals, and represents a follow-up to a previous study conducted 8 years earlier. Data pertaining to all 354 patients, age >/= 50, admitted between March 2003 and April 2004, inclusive, with a diagnosis of fragility hip fracture were evaluated. Twelve patients were excluded leaving 342 patients for analysis, with 75% female, mean age 81. Outcomes included: Primary – In-hospital diagnosis of osteoporosis and/or initiation of anti-resorptive treatment ("new osteoporosis diagnosis/treatment"). Secondary – In-hospital mortality, BMD referrals, pre-admission osteoporosis diagnosis and treatment. Results At admission, 27.8% of patients had a pre-existing diagnosis of osteoporosis and/or were taking anti-resorptive treatment. Among patients with no previous osteoporosis diagnosis/treatment: 35.7% received a new diagnosis of osteoporosis, 21% were initiated on anti-resorptive treatment, and 14.3% received a BMD referral. The greatest predictor of new osteoporosis diagnosis/treatment was transfer to a rehabilitation or geriatrics unit: 79.5% of rehabilitation/geriatrics versus 18.5% of patients receiving only orthopedics care met this outcome (p < 0.001). Conclusion New diagnosis of osteoporosis among patients admitted with hip fracture has improved from 1.8% in the mid 1990's to 35.7%. Initiation of bisphosphonate therapy has likewise improved from 0% to 21%. Although multiple factors have likely contributed, the differential response between rehabilitation/geriatrics versus orthopedics patients suggests that education of the geriatric and rehabilitation teams, including one-on-one and group-based sessions, implemented as part of the FTOP Program, has played a role in this improvement. A significant care gap still exists for patients discharged directly from orthopedic units. The application of targeted inpatient and post-discharge initiatives, such as those that comprise the entire FTOP Program, may be of particular value in this setting.
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Affiliation(s)
- Derek A Haaland
- McMaster University, Department of Medicine, Main Street West, Hamilton, Ontario, Canada.
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Carmona RJ, Shaikh S, Khalidi NA. Chikungunya viral polyarthritis. J Rheumatol 2008; 35:935-936. [PMID: 18412299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
Systemic lupus erythematosus (SLE) and sickle cell disease (SCD) are relatively common disorders with comparable prevalence among blacks. The coexistence of these 2 conditions in the same individual appears to be rare. We report 4 cases of coexisting SLE and SCD. These patients displayed a broad spectrum of musculoskeletal, central nervous system, and renal complications that may be associated with either SCD or SLE. Because of a substantial overlap between the clinical manifestations of these 2 disorders, the diagnosis of SLE in patients with SCD may be difficult to establish and is often delayed. Up to 23% of patients with SCD may have antinuclear antibodies. All patients in this series had antecedent SCD but new important complications from SLE.
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Affiliation(s)
- Nader A Khalidi
- Section of Rheumatology, McMaster University, 240 James Street South, Hamilton, Ontario, Canada L8P 3B3.
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