The complexity of classifying ANCA-associated small-vessel vasculitis in actual clinical practice: data from a multicenter retrospective survey

Autor: Javier Del-Pino-Montes, Elvira González-Vázquez, Damian Mora-Peña, Jose Luis Lerma-Márquez, Alicia Rivas-Lamazares, Ismael Calero-Paniagua, Laura Pérez-Garrido, Ivan Cusacovich, Alba Quesada-Moreno, Ana González-Fernández, Luis Corral-Gudino
Rok vydání: 2019
Předmět:
Lung Diseases
Male
Eye Diseases
Gastrointestinal Diseases
Microscopic Polyangiitis
Disease
Churg-Strauss Syndrome
Severity of Illness Index
0302 clinical medicine
Recurrence
Immunology and Allergy
030212 general & internal medicine
Medical diagnosis
Nose
Peripheral Nervous System Diseases
Middle Aged
Prognosis
Primary Prevention
Epistaxis
medicine.anatomical_structure
Hypertension
Female
Kidney Diseases
Vasculitis
Granulomatosis with polyangiitis
Microscopic polyangiitis
medicine.medical_specialty
Myeloblastin
Immunology
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Skin Diseases
Antibodies
Antineutrophil Cytoplasmic
03 medical and health sciences
Rheumatology
Internal medicine
medicine
Humans
Mortality
Sinusitis
Aged
Peroxidase
Proportional Hazards Models
Retrospective Studies
030203 arthritis & rheumatology
business.industry
Granulomatosis with Polyangiitis
medicine.disease
Peripheral neuropathy
Kidney Failure
Chronic
business
Zdroj: Rheumatology International. 40:303-311
ISSN: 1437-160X
0172-8172
Popis: The different sets of criteria for diagnosis or classification of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) lead to numerous overlapping and reclassified diagnoses in clinical practice. We designed this study to assess the difficulties in classifying patients with AAV. As a secondary objective, different variables were tested to predict prognosis. We conducted a retrospective chart review in a Western Spain multicentre survey. A total of 115 adult patients diagnosed with AAV from 2002 to 2013 and followed for at least 3 years were included. They were classified according to (1) Chapel Hill Consensus Conference (CHCC), (2) European Medicines Agency algorithm and (3) French Vasculitis Study Group/European Vasculitis Society phenotypes. Fifty-three patients (46%) had neither distinctive histopathological data of a single AAV definition nor any surrogate markers for granulomatous inflammation and thus did not fulfill any diagnostic criteria. Ocular, ear, nose, throat, skin, and lung involvement were more frequent with proteinase 3 (PR3) antibodies, whereas peripheral neuropathy was more frequent with myeloperoxidase (MPO) antibodies. When the disease was severe at diagnosis, the HR for mortality was 10.44. When induction treatment was not given in accordance with the guidelines, the HR for mortality was 4.00. For maintenance treatment, the HR was 5.49 for mortality and 2.48 for relapse. AAV classification is difficult because many patients had neither specific clinical data nor distinctive histological features of a single CHCC definition. A structured clinical assessment of patient severity is the best tool to guide the management of AAV.
Databáze: OpenAIRE
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