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Lhote R, Chilles M, Groh M, Puéchal X, Guilpain P, Ackermann F, Amoura Z, Annesi-Maesano I, Barba T, Catherinot E, Cohen-Aubart F, Cohen P, Cottin V, Couderc LJ, De Boysson H, Delbrel X, Dominique S, Duhaut P, Fain O, Hachulla E, Hamidou M, Kahn JE, Legendre C, Le Quellec A, Lhote F, Lifermann F, Mathian A, Néel A, Nunes H, Subra JF, Terrier B, Mouthon L, Diot E, Guillevin L, Brillet PY, Tcherakian C. Spectrum and Prognosis of Antineutrophil Cytoplasmic Antibody-associated Vasculitis-related Bronchiectasis: Data from 61 Patients. J Rheumatol 2020; 47:1522-1531. [PMID: 31787599 DOI: 10.3899/jrheum.190313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To report on a large series of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and bronchiectasis, with a specific focus on the timeline of occurrence of both features. METHODS Retrospective nationwide multicenter study of patients diagnosed with both AAV and bronchiectasis. RESULTS Sixty-one patients were included, among whom 27 (44.25%) had microscopic polyangiitis (MPA), 27 (44.25%) had granulomatosis with polyangiitis (GPA), and 7 (11.5%) had eosinophilic GPA. Thirty-nine (64%) had myeloperoxidase (MPO)-ANCA and 13 (21%) had proteinase 3-ANCA. The diagnosis of bronchiectasis either preceded (n = 25; median time between both diagnoses: 16 yrs, IQR 4-54 yrs), was concomitant to (n = 12), or followed (n = 24; median time between both diagnoses: 1, IQR 0-6 yrs) that of AAV. Patients in whom bronchiectasis precedes the onset of AAV (B-AAV group) have more frequent mononeuritis multiplex, MPA, MPO-ANCA, and a 5-fold increase of death. The occurrence of an AAV relapse tended to be protective against bronchiectasis worsening (HR 0.6, 95% CI 0.4-0.99, P = 0.049), while a diagnosis of bronchiectasis before AAV (HR 5.8, 95% CI 1.2-28.7, P = 0.03) or MPA (HR 18.1, 95% CI 2.2-146.3, P = 0.01) were associated with shorter survival during AAV follow-up. CONCLUSION The association of bronchiectasis with AAV is likely not accidental and is mostly associated with MPO-ANCA. Patients in whom bronchiectasis precedes the onset of AAV tend to have distinct clinical and biological features and could carry a worse prognosis.
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Affiliation(s)
- Raphael Lhote
- R. Lhote, MD, Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220, and Sorbonne Université, University of Pierre and Marie Curie (UPMC), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris
| | - Marie Chilles
- M. Chilles, MD, Department of Internal Medicine, Orléans, and Department of Internal Medicine, CHU, Tours
| | - Matthieu Groh
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Xavier Puéchal
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Philippe Guilpain
- Philippe Guilpain, MD, PhD, A. Le Quellec, MD, PhD, Department of Internal Medicine, Saint Eloi Hospital, Montpellier
| | - Félix Ackermann
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Zahir Amoura
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Isabella Annesi-Maesano
- I. Annesi-Maesano, MD, PhD, Sorbonne Université, UPMC, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris
| | - Thomas Barba
- T. Barba, MD, V. Cottin, MD, PhD, Department of Pulmonology, Louis Pradel Hospital, Lyon
| | - Emilie Catherinot
- E. Catherinot, MD, PhD, L.J. Couderc, MD, C. Tcherakian, MD, PhD, 1Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220
| | - Fleur Cohen-Aubart
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Pascal Cohen
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Vincent Cottin
- T. Barba, MD, V. Cottin, MD, PhD, Department of Pulmonology, Louis Pradel Hospital, Lyon
| | - Louis-Jean Couderc
- E. Catherinot, MD, PhD, L.J. Couderc, MD, C. Tcherakian, MD, PhD, 1Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220
| | - Hubert De Boysson
- H. De Boysson, MD, Departments of Internal Medicine, University Hospital, Caen
| | - Xavier Delbrel
- X. Delbrel, MD, Department of Internal Medicine, François Mitterand Hospital, Pau
| | - Stéphane Dominique
- S. Dominique, MD, Department of Pulmonology Department, Charles Nicolle University Hospital, Rouen
| | - Pierre Duhaut
- P. Duhaut, MD, PhD, Department of Internal Medicine, University Hospital, Amiens
| | - Olivier Fain
- Olivier Fain, MD, PhD, Department of Internal Medicine, Saint Antoine Hospital, Paris
| | - Eric Hachulla
- E. Hachulla, MD, PhD, Department of Internal Medicine, Centre de Reference des Maladies Auto-immunes Systémique Rares du Nord et du Nord-Ouest de France (CeRAINO), CHRU de Lille, Université de Lille, Lille
| | - Mohamed Hamidou
- M. Hamidou, MD, PhD, A. Néel, MD, PhD, Department of Internal Medicine, CHU, Nantes
| | - Jean-Emmanuel Kahn
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Christophe Legendre
- Christophe Legendre, MD, PhD, Department of Nephrology, Necker Enfants Malades Hospital, Paris
| | - Alain Le Quellec
- Philippe Guilpain, MD, PhD, A. Le Quellec, MD, PhD, Department of Internal Medicine, Saint Eloi Hospital, Montpellier
| | - François Lhote
- F. Lhote, MD, Department of Internal Medicine, Delafontaine Hospital, Saint Denis
| | | | - Alexis Mathian
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Antoine Néel
- M. Hamidou, MD, PhD, A. Néel, MD, PhD, Department of Internal Medicine, CHU, Nantes
| | - Hilario Nunes
- H. Nunes, MD, PhD, Department of Pulmonology, Avicenne Hospital, Bobigny
| | - Jean-François Subra
- J.F. Subra, MD, PhD, Department of Nephrology-Dialysis-Transplantation, Angers University Hospital, Angers
| | - Benjamin Terrier
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Luc Mouthon
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Elisabeth Diot
- E. Diot, MD, PhD, Department of Internal Medicine, CHU, Tours
| | - Loïc Guillevin
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Pierre-Yves Brillet
- P.Y. Brillet, MD, PhD, Department of Radiology, Avicenne Hospital, Bobigny, France
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Kida T, Tanaka T, Yokota I, Tamagaki K, Sagawa T, Kadoya M, Yamada T, Fujioka K, Wada M, Kohno M, Hiraoka N, Omoto A, Fukuda W, Kawahito Y. Association between preexisting lung involvements and the risk of diffuse alveolar hemorrhage in patients with microscopic polyangiitis: A multi-center retrospective cohort study. Mod Rheumatol 2019; 30:338-344. [DOI: 10.1080/14397595.2019.1601855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Takashi Kida
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tadashi Tanaka
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Keiichi Tamagaki
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoya Sagawa
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | | | | | - Kazuki Fujioka
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Wada
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masataka Kohno
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Atsushi Omoto
- Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Wataru Fukuda
- Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yutaka Kawahito
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Pearce FA, Lanyon PC, Watts RA, Grainge MJ, Abhishek A, Hubbard RB. Novel insights into the aetiology of granulomatosis with polyangiitis-a case-control study using the Clinical Practice Research Datalink. Rheumatology (Oxford) 2018; 57:1002-1010. [PMID: 29529281 PMCID: PMC5965083 DOI: 10.1093/rheumatology/kex512] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/01/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives We aimed to provide insights into the aetiology of granulomatosis with polyangiitis (GPA), by conducting a large case-control study using a general population-based, prospectively collected database of healthcare records. Methods We compared all incident cases of GPA in the Clinical Practice Research Datalink 1990-2014, with up to 10 age-, sex- and general practice-matched controls. We identified potential risk factors, recorded numbers of cases and controls exposed to each, and calculated odds ratios (ORs) using conditional logistic regression. Our main analysis excluded data recorded during 1 year before diagnosis, to prevent early symptoms being mistaken for risk factors. Results We identified 757 people with GPA and matched 7546 controls. People with GPA were five times more likely to have a previous diagnosis of bronchiectasis (OR = 5.1, 95% CI: 2.7, 9.4; P < 0.0001), and these effects remained stable in diagnoses recorded >5 years prior to diagnosis. People with GPA were two to three times more likely than controls to have previous diagnoses of autoimmune diseases or chronic renal impairment, and these effects also remained stable >5 years prior to diagnosis. People with GPA were more likely to have a diagnosis of pulmonary fibrosis (OR = 5.7, 95% CI: 1.7, 19.5; P = 0.01) and sinus infections (OR = 2.7, 95% CI: 1.8, 4.2; P < 0.0001) recorded in the 3 years before diagnosis, but not before this. We also found former smoking, some medications and higher socio-economic status significantly, but less strongly, associated. Conclusion We found novel long-term associations between GPA and pre-existing bronchiectasis and autoimmune diseases.
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Affiliation(s)
- Fiona A Pearce
- Division of Epidemiology and Public Health, University of Nottingham
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham
| | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham
| | | | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham
| | - Abhishek Abhishek
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham
| | - Richard B Hubbard
- Division of Epidemiology and Public Health, University of Nottingham
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Barba T, Khouatra C, Traclet J J, Cordier JF, Cottin V. Diffuse bronchiectasis and airflow obstruction in granulomatosis with polyangiitis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:81-84. [PMID: 32476884 DOI: 10.36141/svdld.v35i1.6298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/26/2017] [Indexed: 11/02/2022]
Abstract
Parenchymal lung nodes and diffuse intra-alveolar hemorrhage are the archetypal pulmonary manifestations of Granulomatosis with Polyangiitis (GPA). The occurrence of diffuse bronchiectasis and airflow obstruction during GPA is unusual. We report here 3 patients with GPA who developed diffuse bronchiectasis during follow-up. The airflow obstruction seemed then to evolve independently from the GPA itself and ultimately led to respiratory insufficiency. Bronchiectases promoted the occurrence of opportunistic infections, especially with atypical mycobacteria. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 81-84).
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Affiliation(s)
- T Barba
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Interne, Lyon, France
| | - C Khouatra
- Hospices Civils de Lyon, Hôpital Louis Pradel, Centre national de référence des maladies pulmonaires rares, Service de pneumologie, Lyon, France, Univ Lyon, Université Lyon I, INRA, UMR754, Lyon, France
| | - J Traclet J
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Interne, Lyon, France.,Hospices Civils de Lyon, Hôpital Louis Pradel, Centre national de référence des maladies pulmonaires rares, Service de pneumologie, Lyon, France, Univ Lyon, Université Lyon I, INRA, UMR754, Lyon, France
| | - J F Cordier
- Hospices Civils de Lyon, Hôpital Louis Pradel, Centre national de référence des maladies pulmonaires rares, Service de pneumologie, Lyon, France, Univ Lyon, Université Lyon I, INRA, UMR754, Lyon, France
| | - V Cottin
- Hospices Civils de Lyon, Hôpital Louis Pradel, Centre national de référence des maladies pulmonaires rares, Service de pneumologie, Lyon, France, Univ Lyon, Université Lyon I, INRA, UMR754, Lyon, France
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5
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Bronchiectasis is highly prevalent in anti-MPO ANCA-associated vasculitis and is associated with a distinct disease presentation. Semin Arthritis Rheum 2017; 48:70-76. [PMID: 29336783 DOI: 10.1016/j.semarthrit.2017.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the prevalence of bronchiectasis in a Western cohort with ANCA-positive granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) and its correlations with disease presentation and outcome. METHODS Retrospective study of ANCA-associated vasculitis (AAV) patients followed at Nantes University Hospital (2005-2015). Clinical, biological, and follow-up data were collected through chart review. Two experienced radiologists blinded to the clinical data interpreted chest high-resolution CTs according to the Feischner Society criteria. RESULTS Fifty-eight patients were included: 30 had MPA (51.7%) and 28 had GPA (48.3%). The median age at AAV diagnosis was 65.5 years. Anti-MPO-ANCA and anti-PR3-ANCA were present in 39 (67.2%) and 19 (32.8%) patients, respectively. Overall, bronchiectasis was found in 22 patients (37.9%), all of whom had anti-MPO ANCA. In multivariate analysis, bronchiectasis was independently associated with anti-MPO-ANCA, female gender and age at AAV diagnosis. Furthermore, anti-MPO ANCA patients with bronchiectasis had more frequent peripheral nerve involvement (54.5 vs. 17.6%, p = 0.019) and less frequent renal involvement than those without bronchiectasis (40.9% vs. 82.3%, p = 0.009). Disease course, survival and risk of severe pulmonary infection were similar in patients with and without bronchiectasis on chest CT. CONCLUSIONS This study shows that bronchiectasis is a highly prevalent pre-existing respiratory condition in Caucasian patients with anti-MPO AAV. This subset of patients exhibits a distinct presentation. Further studies are needed to confirm these findings and clarify the clinical implications of this association. Whether the respiratory tract could be the site of initiation of anti-MPO auto-immunity remains to be investigated.
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Vascularites à ANCA ; impact clinique et évolutif des dilatations des bronches. Une étude multicentrique de 61 patients. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Mohammad AJ, Mortensen KH, Babar J, Smith R, Jones RB, Nakagomi D, Sivasothy P, Jayne DRW. Pulmonary Involvement in Antineutrophil Cytoplasmic Antibodies (ANCA)-associated Vasculitis: The Influence of ANCA Subtype. J Rheumatol 2017; 44:1458-1467. [PMID: 28765242 DOI: 10.3899/jrheum.161224] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe pulmonary involvement at time of diagnosis in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV), as defined by computed tomography (CT). METHODS Patients with thoracic CT performed on or after the onset of AAV (n = 140; 75 women; granulomatosis with polyangiitis, n = 79; microscopic polyangiitis MPA, n = 61) followed at a tertiary referral center vasculitis clinic were studied. Radiological patterns of pulmonary involvement were evaluated from the CT studies using a predefined protocol, and compared to proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA specificity. RESULTS Of the patients, 77% had an abnormal thoracic CT study. The most common abnormality was nodular disease (24%), of which the majority were peribronchial nodules, followed by bronchiectasis and pleural effusion (19%, each), pulmonary hemorrhage and lymph node enlargement (14%, each), emphysema (13%), and cavitating lesions (11%). Central airways disease and a nodular pattern of pulmonary involvement were more common in PR3-ANCA-positive patients (p < 0.05). Usual interstitial pneumonitis (UIP) and bronchiectasis were more prevalent in MPO-ANCA-positive patients (p < 0.05). Alveolar hemorrhage, pleural effusion, lymph node enlargement, and pulmonary venous congestion were more frequent in MPO-ANCA-positive patients. CONCLUSION Pulmonary involvement is frequent and among 140 patients with AAV who underwent a thoracic CT study, almost 80% have pulmonary abnormalities on thoracic CT. Central airway disease occurs exclusively among patients with PR3-ANCA while UIP were mainly seen in those with MPO-ANCA. These findings may have important implications for the investigation, management, and pathogenesis of AAV.
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Affiliation(s)
- Aladdin J Mohammad
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK. .,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
| | - Kristian H Mortensen
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Judith Babar
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Rona Smith
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Rachel B Jones
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Daiki Nakagomi
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Pasupathy Sivasothy
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - David R W Jayne
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
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Tashiro H, Takahashi K, Tanaka M, Komiya K, Nakamura T, Kimura S, Tada Y, Sueoka-Aragane N. Characteristics and prognosis of microscopic polyangiitis with bronchiectasis. J Thorac Dis 2017; 9:303-309. [PMID: 28275478 DOI: 10.21037/jtd.2017.02.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Major pulmonary manifestations associated with microscopic polyangiitis (MPA) include diffuse alveolar hemorrhage (DAH) and interstitial pneumonia (IP).We previously showed bronchiectasis (BE) was one of the pulmonary complications of MPA. However, clinical features of BE patients with MPA are not fully understood. We investigated the characteristics and prognosis of BE patients with MPA. METHODS Forty-five MPA patients were retrospectively studied. The patients were divided into two groups: patients with BE and those without BE. RESULTS Thirty-one of 45 patients (69%) had pulmonary involvement including IP (23/45, 51%), BE (7/45, 16%), and DAH (5/45, 11%). There were no differences between the patients with BE versus those without with regard to clinical characteristics and initial treatments. However, the prognosis for patients with BE was better than those without BE during the first year after diagnosis, but it was worse between 1 and 5 years, which was statistically significant. Two BE patients died between 1 and 5 years as a result of pneumonia. CONCLUSIONS BE as a complication of MPA might be related to lower mortality in the acute phase and higher mortality in the chronic phase compared to other pulmonary manifestations. More attention to pulmonary infection is needed for patients with BE during the chronic phase.
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Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan
| | - Masahide Tanaka
- Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazutoshi Komiya
- Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshifumi Tada
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan
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