Relapse rate and renal prognosis in ANCA-associated vasculitis according to long-term ANCA patterns

Autor: J. Oristrell, C. Tolosa, Ma. Pau Valenzuela, Ma. José Amengual, Víctor Monsálvez, Roser Solans, Carlos Feijoo, Ana Marin, Jose Loureiro-Amigo, Alfons Segarra
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
Prognostic variable
medicine.medical_specialty
Biopsy
Myeloblastin
Immunology
Microscopic Polyangiitis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Churg-Strauss Syndrome
urologic and male genital diseases
Kidney
Gastroenterology
Antibodies
Antineutrophil Cytoplasmic
03 medical and health sciences
0302 clinical medicine
Recurrence
immune system diseases
Internal medicine
medicine
Humans
Immunology and Allergy
cardiovascular diseases
skin and connective tissue diseases
Peroxidase
Retrospective Studies
Anti-neutrophil cytoplasmic antibody
business.industry
Hazard ratio
Granulomatosis with Polyangiitis
Original Articles
Odds ratio
Middle Aged
Prognosis
medicine.disease
Rheumatology
030104 developmental biology
Chronic Disease
Female
Microscopic polyangiitis
business
Granulomatosis with polyangiitis
Vasculitis
Follow-Up Studies
030215 immunology
Zdroj: Clin Exp Immunol
ISSN: 1365-2249
0009-9104
Popis: Summary Long-term observation of patients with ANCA-associated vasculitis (AAV) allows the identification of different longitudinal patterns of ANCA levels during follow-up. This study aimed to characterize these patterns and to determine their prognostic significance. All ANCA determinations performed in two university hospitals during a 2-year period were retrospectively reviewed. Patients were included in the analysis if they had high titers of anti-myeloperoxidase (anti-MPO) or anti-proteinase 3 (anti-PR3) antibodies at least once, ≥ 5 serial ANCA determinations and AAV diagnosed by biopsy or American College of Rheumatology (ACR) classification criteria. Patients’ time–course ANCA patterns were classified as monophasic, remitting, recurrent or persistent. Associations between ANCA patterns and prognostic variables (relapse rate and renal outcome) were analysed by univariate and multivariate statistics. A total of 99 patients [55 with microscopic polyangiitis (MPA), 36 with granulomatosis with polyangiitis (GPA) and eight with eosinophilic granulomatosis with polyangiitis (EGPA)] were included. Median follow-up was 9 years. Among patients diagnosed with MPA or GPA, recurrent or persistent ANCA patterns were associated with a higher risk of clinical relapse [hazard ratio (HR) = 3·7, 95% confidence interval (CI) = 1·5–9·1 and HR = 2·9, 95% CI = 1·1–8·0, respectively], independently of clinical diagnosis or ANCA specificity. In patients with anti-MPO antibodies, the recurrent ANCA pattern was associated with worsening renal function [odds ratio (OR) = 5·7, 95% CI = 1·2–26·0]. Recurrent or persistent ANCA patterns are associated with a higher risk of clinical relapse. A recurrent ANCA pattern was associated with worsening renal function in anti-MPO-associated vasculitis.
Databáze: OpenAIRE
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