Presentation, Diagnosis, and Management of Subglottic and Tracheal Stenosis During Systemic Inflammatory Diseases.

Autor:	Catano J; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France., Uzunhan Y; Department of Pneumology, Reference Center for Rare Pulmonary Diseases, Hôpital Avicenne, AP-HP, INSERM U1272, Université Paris Nord, Bobigny, France., Paule R; Department of Internal Medicine, Hôpital Foch, Suresnes, France., Dion J; Department of Clinical Immunology, Oncopôle, Toulouse, France., Régent A; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France., Legendre P; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France., Gonin F; Department of Thoracic Surgery, Hôpital Foch, Suresnes, France., Martinod E; Department of Thoracic Surgery, Hôpital Avicenne, AP-HP, Bobigny, France., Cohen P; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France., Puéchal X; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France., Le Guern V; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France., Mouthon L; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France., Coste A; Department of Otolaryngology, Hôpital Intercommunal, Créteil, France., Lorut C; Department of Pneumology, Hôpital Cochin, France., La Croix C; Department of Otolaryngology, Hôpital Cochin, France., Périé S; Department of Otolaryngology (S. Périé), Clinique Hartmann, Neuilly-Sur-Seine, France., Terrier B; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France. Electronic address: benjamin.terrier@aphp.fr.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2022 Jan; Vol. 161 (1), pp. 257-265. Date of Electronic Publication: 2021 Jul 26.
DOI:	10.1016/j.chest.2021.07.037
Abstrakt:	Background: Subglottic stenosis (SGS) and tracheal stenosis (TS) are characterized by a narrowing of the airways. The goal of this study was to describe the characteristics and prognosis of nontraumatic and nontumoral SGS or TS. Research Question: What are the inflammatory etiologies of SGS and TS, and what are their characteristics and prognosis? Study Design and Methods: This multicenter, observational retrospective study was performed in patients with SGS or TS that was neither traumatic nor tumoral. Results: Eighty-one patients were included, 33 (41%) with granulomatosis with polyangiitis (GPA) and 21 (26%) with relapsing polychondritis (RP). GPA-related stenoses exhibited circumferential subglottic narrowing in 85% of cases, without calcifications. In contrast, RP-related stenoses displayed anterior involvement in 76%, in a longer distance from vocal cords (4 cm), with calcifications in 62%, and extension to bronchi in 86%. Other diagnoses included bullous dermatoses (n = 3), amyloidosis (n = 3), sarcoidosis (n = 2), and Crohn's disease (n = 2); the remaining stenoses (n = 15) were idiopathic. SGS/TS was the initial manifestation of the disease in 66% of cases, with a median interval from stenosis to disease diagnosis of 12 months (interquartile range, 0-48 months). Despite the use of glucocorticoids in 80%, combined with methotrexate in 49%, endoscopic procedures were required in 68% of patients. Relapses of stenoses occurred in 76% without any difference between causes (82% in GPA, 67% in RP, and 75% in idiopathic SGS/TS). Three patients died due to the stenosis, two of RP and one of GPA. Interpretation: These data show that GPA and RP are the two main inflammatory diseases presenting with SGS/TS. GPA-related stenoses are mostly subglottic and circumferential, whereas RP-related stenoses are mostly tracheal, anterior, and calcified with a frequent extension to bronchi. Relapses of stenoses are common, and relapse rates do not differ between causes. Diagnosis and management of SGS/TS require a multidisciplinary approach. (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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