Muscle biopsy in anti-neutrophil cytoplasmic antibody–associated vasculitis: diagnostic yield depends on anti-neutrophil cytoplasmic antibody type, sex and neutrophil count
| Autor: | Christian Agard, Mohamed Hamidou, Maxime Leroy, Julie Graveleau, Alexandra Espitia-Thibault, Nowenn Le Lan, Claire Toquet, Antoine Néel, Mathieu Lacou, Agathe Masseau, Jean-Marie Mussini, Christelle Volteau |
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| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Neutrophils Biopsy Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis Gastroenterology Antibodies Antineutrophil Cytoplasmic Leukocyte Count 03 medical and health sciences Sex Factors 0302 clinical medicine Rheumatology Recurrence Internal medicine medicine Humans Pharmacology (medical) Muscle Skeletal Survival analysis Aged Retrospective Studies Anti-neutrophil cytoplasmic antibody 030203 arthritis & rheumatology medicine.diagnostic_test business.industry Incidence Middle Aged Prognosis medicine.disease 030104 developmental biology Absolute neutrophil count Female France Renal biopsy Granulomatosis with polyangiitis Microscopic polyangiitis Vasculitis business Algorithms |
| Zdroj: | Rheumatology. 60:699-707 |
| ISSN: | 1462-0332 1462-0324 |
| Popis: | Objectives This study aimed to examine the sensitivity of muscle biopsy (MB) in ANCA-associated vasculitis (AAV), identify factors predicting MB positivity and assess the prognostic value of a positive MB. Methods We conducted a single-centre retrospective study of AAV with an MB performed at diagnosis. AAV classification [granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA)] followed the European Medicines Agency algorithm. A logistic regression model was used to identify the factors associated with MB positivity. Survival curves were generated using the Kaplan–Meier method. Results Among 276 AAV patients (1995–2018), 101 had an MB. Seventy-eight patients were included: 33 with GPA, 25 with MPA and 20 with EGPA. MB samples were positive in 45 cases (58%): 17 GPA, 16 MPA and 12 EGPA. Univariate analysis focussed on GPA and MPA, revealed that the MB yield was higher in females [22/31 (71%) vs 11/27 (41%); P = 0.02] and in anti-MPO patients [25/37 (68%) vs 6/19 (32%) for anti-PR3; P = 0.01]. By multivariate analysis, three factors predicted MB positivity: anti-MPO ANCA [odds ratio (OR) 10.67 (CI 2.09, 81.68)], female sex [OR 5.3 (CI 1.16, 32.35)] and neutrophil count [OR 1.33 (CI 1.07, 1.8)]. MB positivity had no impact on relapse, death or end-stage renal disease–free survival. Conclusions MB is a safe and efficient diagnostic tool for AAV. Predictors of MB yield include ANCA type, sex and neutrophil count. MB cannot substitute for kidney biopsy when indicated, but should be considered in other cases. |
| Databáze: | OpenAIRE |
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