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Schirmer JH, Sanchez-Alamo B, Hellmich B, Jayne D, Monti S, Luqmani RA, Tomasson G. Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV): part 1-treatment of granulomatosis with polyangiitis and microscopic polyangiitis. RMD Open 2023; 9:e003082. [PMID: 37479496 PMCID: PMC10364171 DOI: 10.1136/rmdopen-2023-003082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/16/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To summarise and update evidence to inform the 2022 update of the EULAR recommendations for the management of antineutrophil cytoplasm antibody-associated vasculitis (AAV). METHODS A systematic literature review (SLR) was performed to identify current evidence regarding treatment of AAV. PubMed, EMBASE and the Cochrane library were searched from 1 February 2015 to 25 February 2022. The evidence presented here is focused on the treatment of granulomatosis with polyangiitis and microscopic polyangiitis. RESULTS 3517 articles were screened and 175 assessed by full-text review. Ninety articles were included in the final evidence synthesis. Cyclophosphamide and rituximab (RTX) show similar efficacy for remission induction (level of evidence (LoE) 1a) but RTX is more effective in relapsing disease (LoE 1b). Glucocorticoid (GC) protocols with faster tapering result in similar remission rates but lower rates of serious infections (LoE 1b). Avacopan can be used to rapidly taper and replace GC (LoE 1b). Data on plasma exchange are inconsistent depending on the analysed trial populations but meta-analyses based on randomised controlled trials demonstrate a reduction of the risk of end-stage kidney disease at 1 year but not during long-term follow-up (LoE 1a). Use of RTX for maintenance of remission is associated with lower relapse rates compared with azathioprine (AZA, LoE 1b). Prolonged maintenance treatment results in lower relapse rates for both, AZA (LoE 1b) and RTX (LoE 1b). CONCLUSION This SLR provides current evidence to inform the 2022 update of the EULAR recommendations for the management of AAV.
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Affiliation(s)
- Jan Henrik Schirmer
- Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Beatriz Sanchez-Alamo
- Nephrology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
- Nephrology, Skåne University Hospital, Lund, Sweden
| | - Bernhard Hellmich
- Department of Internal Medicine, Rheumatology and Immunology, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, University of Pavia; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raashid Ahmed Luqmani
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gunnar Tomasson
- Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland
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Is There Still a Role of Plasma Exchange in the Current Management of ANCA-Associated Vasculitides? Curr Rheumatol Rep 2022; 24:111-117. [PMID: 35316496 PMCID: PMC9005426 DOI: 10.1007/s11926-022-01064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/13/2022]
Abstract
Purpose of Review Plasma exchange (PLEX) is often recommended as an adjunctive therapy for patients with ANCA-associated vasculitis (AAV) in the setting of rapidly progressive glomerulonephritis or diffuse alveolar haemorrhage. Since ANCAs are pathogenic, it seems a reasonable and justified approach to remove them through therapeutic PLEX, as despite advances in immunosuppressive therapy regimens, AAV is associated with significant morbidity and death. However, the association between ANCA levels and mortality or disease activity is uncertain. In addition, any treatment must be judged on the potential risks and benefits of its use. Here, we summarise the current data on PLEX usage in patients with AAV. Recent Findings The largest randomised trial to date the Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis (PEXIVAS) study failed to show added benefit for PLEX on the prevention of death or end-stage renal failure (ESRF) for the management of patients with severe AAV. However, there is a possibility that PLEX delays dialysis dependence and ESRF in the early stages of the disease. Regardless of whether this is only for 3 to 12 months, this could be of clinical significance and a substantial improvement in patient’s quality of life. Summary Cost utility analysis and trials including patient-centred outcomes are required to evaluate the use of PLEX. Furthermore, ascertaining those at high risk of developing ESRF could help identify those who may benefit from PLEX the most, and further insights are required in setting of diffuse alveolar haemorrhage.
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Philip R, Dumont A, Martin Silva N, de Boysson H, Aouba A, Deshayes S. ANCA and anti-glomerular basement membrane double-positive patients: A systematic review of the literature. Autoimmun Rev 2021; 20:102885. [PMID: 34242834 DOI: 10.1016/j.autrev.2021.102885] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Double-positive patients (DPP) exhibiting anti-glomerular basement membrane (GBM) and anti-neutrophil cytoplasmic antibodies (ANCAs) belong to an entity that is newly and poorly described, mainly in short series. We aimed to better characterize the epidemiological features, clinical presentation and therapeutic outcomes of these patients through a systematic review. METHODS We performed a systematic review of English-, German-, Spanish- and French-written publications from February 1987 to March 2020 reporting cases of DPP using the following databases: PubMed, Scielo, ScienceDirect, Google Scholar, The Cochrane Library, Open Grey, The Grey Literature Report, Clinicaltrials.gov and International Clinical Trial Registry Platform of the World Health Organization. RESULTS In total, 538 DPP were identified from 90 articles. Their clinical presentations were often severe, and the majority exhibited acute kidney failure (91.8%) with a median initial serum creatinine level of 873 μmol/L; 50.7% had alveolar haemorrhage. Other manifestations were present in 30.3% of DPP, mainly ear, nose, throat and articular manifestations. ANCAs were predominantly directed against MPO (n = 377/523; 72.1%) compared to PR3 (n = 107/523; 20.5%), with rare cases of triple positivity (n = 15/538; 2.9%). Although most patients received initial immunosuppressive therapy (n = 285/317; 89.9%), the one-year overall, renal and relapse-free survival rates were 64.8%, 38.7% and 71.1%, respectively. CONCLUSION DPP are associated with the characteristics of two eponymous vasculitis types, responsible for a poor overall and renal prognosis. Thus, simultaneous testing of both antibodies and systematic renal biopsy should be recommended in every patient with rapidly progressive glomerulonephritis to recognize this difficult-to-treat and rare disease.
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Affiliation(s)
- Rémi Philip
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, 14000 Caen, France
| | - Anael Dumont
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Nicolas Martin Silva
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, 14000 Caen, France
| | - Hubert de Boysson
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Achille Aouba
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France.
| | - Samuel Deshayes
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
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Systemic manifestations - do not forget the small bowel. Curr Opin Gastroenterol 2021; 37:234-244. [PMID: 33606400 DOI: 10.1097/mog.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Systemic diseases can afflict the small bowel (SB) but be challenging to diagnose. In this review, we aim to provide a broad overview of these conditions and to summarise their management. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) is an important modality to investigate pathology in the SB. SB imaging can be complementary to SBCE for mural and extramural involvement and detection of multiorgan involvement or lymphadenopathy. Device assisted enteroscopy provides a therapeutic arm, to SBCE enabling histology and therapeutics to be carried out. SUMMARY SB endoscopy is essential in the diagnosis, management and monitoring of these multi-system conditions. Collaboration across SB centres to combine experience will help to improve the management of some of these rarer SB conditions.
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Tret’yakov AY, Radenska-Lopovok SG, Novikov PI, Tret’yakova VA, Zakharchenko SP. Pulmonary embolism and diffuse alveolar bleeding: combination options and therapy features. TERAPEVT ARKH 2021; 93:311-319. [DOI: 10.26442/00403660.2021.03.200657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
The analysis of the mechanisms of the formation of a rare clinical combination of pulmonary embolism (PE) and diffuse alveolar hemorrhage (DAH), which are complications of systemic vasculitis associated with antibodies to the cytoplasm of neutrophils (primarily granulomatosis with polyangiitis), systemic lupus erythematosus and secondary antiphlogistic syndrome primary antiphospholipid syndrome and Goodpastures syndrome. Taking into account the chronological sequence of the occurrence of PE and DAH, 3 variants of the onset of these potentially fatal additions to the underlying disease were considered: the anticipatory DAH development of PE, delayed from DAH PE and joint (within 24 hours) formation of PE and DAH. A review of single descriptions of such a combination of complications of granulomatosis with polyangiitis is carried out, criteria are indicated, a working classification of severity is given and, taking this into account, a modern program of therapy for DAH as an independent event and in combination with PE.
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Jebali H, Khadhar M, Mami I, Beji S, Sellami M, Hassen M, Hmida FB, Chermiti M, Ghabi H, Salem TB, Houman H, Raies L, Zouaghi MK. Predictors of renal outcomes in anti-neutrophil cytoplasmic antibody glomerulonephritis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:182-190. [PMID: 32129212 DOI: 10.4103/1319-2442.279939] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glomerulonephritis associated with anti-neutrophil cytoplasmic antibody (ANCA) vasculitis still has a high prevalence of end-stage renal disease (ESRD), particularly in patients with advanced renal failure at presentation. This study aims to evaluate the clinical and histo- pathological features of renal involvement and investigate factors associated with ESRD. Patients with renal biopsy-proven ANCA-associated glomerulonephritis were included retrospectively over a period of nine years (June 2007 to March 2016). The renal survival, defined as time to reach ESRD, was evaluated based on clinical parameters, histopathological classification, and renal risk score. A total of 37 patients with crescentic glomerulonephritis were included in the study. The average age was 54 ± 16 years (range: 17-80) and 51.3% were female. Twenty-two patients were diagnosed with microscopic polyangiitis and 15 had granulomatosis with polyangiitis. The median glomerular filtration rate at presentation was 16.73 mL/min/1.73 m2. Thirty-five patients (94.5%) had renal failure at presentation and 23 patients (62.1%) required initial hemodialysis (HD) therapy. The pattern of glomerular injury was categorized as sclerotic in 48.6% of cases, crescentic in 24.3%, mixed in 24.3%, and focal class in 2.7%. Regarding renal risk score, we had five patients with low risk, 17 with intermediate risk and 15 with high risk. ESRD occurred in 47% of intermediate-risk group and 66% of the high risk group. During follow-up, 17 patients (45.9%) developed ESRD. Tobacco addiction (P = 0.02), alveolar hemorrhage (P = 0.04), hypertension (P = 0.04), initial HD (P = 0.04), and sclerotic class (P = 0.004) were associated with ESRD. In our patients, a sclerotic class was associated with a higher risk of ESRD, suggesting that histo- pathological classification is potentially an important parameter to predict outcomes in renal disease secondary to ANCA-associated vasculitis.
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Affiliation(s)
- Hela Jebali
- Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
| | - Meriem Khadhar
- Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
| | - Ikram Mami
- Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
| | - Soumaya Beji
- Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
| | - Meriem Sellami
- Department of Immunology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
| | - Mohaned Hassen
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hmida
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Hiba Ghabi
- Department of Nephrology, Kef Hospital, Kef, Tunisia
| | | | - Hbib Houman
- Department of Internal Medicine, La Rabta Hospital, Tunis, Tunisia
| | - Lamia Raies
- Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Karim Zouaghi
- Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
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Bellos I, Michelakis I, Nikolopoulos D. The role of plasma exchange in antineutrophil cytoplasmic antibody-associated vasculitis: a meta-analysis. Clin Rheumatol 2020; 40:1447-1456. [PMID: 32935248 DOI: 10.1007/s10067-020-05390-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Plasma exchange (PLEX) in addition to standard immunosuppressive treatment in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AVV) remains controversial. The aim of this study is to evaluate the effect of PLEX on AVV outcomes. METHODS Literature search was performed using Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov databases, and Google Scholar. The statistical meta-analysis and leave-one-out analysis were conducted using the Review Manager 5.3 and Open Meta-Analyst software, respectively. RESULTS Ten studies were included in the meta-analysis comprising 1235 patients; 633 received conventional treatment and 602 were treated with PLEX in conjunction with induction therapy. PLEX was not associated with lower rates of either mortality at 3 (RR: 0.79, 95% CI: 0.19-3.25) and 12 months (RR: 0.73, 95% CI: 0.40-1.34) or ESRD at 3 (RR: 0.30, 95% CI: 0.30-2.42) and 12 months (RR: 1.32, 95% CI: 0.53-3.25). Similarly, no differences were captured concerning disease relapses (RR: 0.92, 95% CI: 0.62-1.36), the incidence of infections (RR: 1.05, 95% CI: 0.63-1.76), and severe adverse effects (RR: 1.04, 95% CI: 0.59-1.81). Time-to-event analysis revealed lower incidence of ESRD (HR: 0.71, 95% CI: 0.55-0.92) among patients who received PLEX, while the overall mortality was similar (HR: 0.96, 95% CI: 0.72-1.29) between the two groups. CONCLUSION The present meta-analysis does not support the wide use of PLEX for the management of AAV in routine clinical practice. Future well-designed randomized controlled trials focusing on specific disease-related manifestations are necessary to reach firm conclusions about the potential efficacy of PLEX. Key Points • PLEX is not widely recommended for the management of ANCA-associated vasculitis. • PLEX performance may reduce the overall incidence of ESRD in severe ANCA-associated vasculitis. • Well-designed randomized controlled trials focusing on specific disease-related manifestations are necessary to reach firm conclusions about the potential efficacy of PLEX on AAV-related outcome.
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Affiliation(s)
- Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Michelakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysis Nikolopoulos
- Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
- 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Quartuccio L, Bond M, Isola M, Monti S, Felicetti M, Furini F, Murgia S, Berti A, Silvestri E, Pazzola G, Bozzolo E, Leccese P, Raffeiner B, Parisi S, Leccese I, Cianci F, Bettio S, Sainaghi P, Ianniello A, Ravagnani V, Bellando Randone S, Faggioli P, Lomater C, Stobbione P, Ferro F, Colaci M, Alfieri G, Carubbi F, Erre GL, Giollo A, Franzolini N, Ditto MC, Balduzzi S, Padoan R, Bortolotti R, Bortoluzzi A, Cariddi A, Padula A, Di Scala G, Gremese E, Conti F, D'Angelo S, Matucci Cerinic M, Dagna L, Emmi G, Salvarani C, Paolazzi G, Roccatello D, Govoni M, Schiavon F, Caporali R, De Vita S. Alveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors. J Autoimmun 2020; 108:102397. [PMID: 31926833 DOI: 10.1016/j.jaut.2019.102397] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Alveolar haemorrhage (AH) is considered an important cause of morbidity and early mortality in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV). OBJECTIVES The aim of this study was to identify predictors of outcome in patients with AH-AAV and to evaluate outcome and causes of death in this subset. MATERIALS AND METHODS A multicenter retrospective study was conducted in 29 Italian Centers. Clinicians were asked to recruit all patients diagnosed with AAV-associated AH during the last 10 years, from 2007 to 2016. Univariate and multivariable analysis were performed. RESULTS One-hundred and six patients were included (median age at onset of 55 years [IQR 42-67]). The majority were ANCA-positive (PR3 57.1%, MPO 33.7%) and 72.6% had also renal involvement. At presentation, anaemia was shown in 97 (92.4%) patients, hemoptysis in 54 (51.9%), respiratory failure in 68 (66.7%), of whom 48 (70.6%), requiring respiratory support. At the end of the 37 months [IQR 13-77] follow-up, 19/106 (17.9%) patients were dead. The main causes of death were active disease and infections. By stepwise regression analysis, age >65 years (HR 3.66 [95% CI 1.4-9.51], p = 0.008) and the need for respiratory support (HR 4.58 [95% CI 1.51-13.87], p = 0.007) at AH onset were confirmed to be predictive of mortality. CONCLUSIONS Predictors of outcome in AAV-AH were determined. Factors related to the patient's performance status and the severity of the lung involvement strongly influenced the outcome. Balancing harms and benefits for the individual patient in induction and maintenance treatment strategies is crucial.
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Affiliation(s)
- Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy.
| | - Milena Bond
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Miriam Isola
- Institute of Statistics, Department of Medical Area, University of Udine, Udine, Italy
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy; University of Pavia, PhD in Experimental Medicine, Pavia, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Federica Furini
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Stefano Murgia
- CMID-Center of Research of Nephrology, Rheumatology, and Rare Diseases Interregional Coordinating Center of the Network of Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-net Member) G. Bosco Hospital, and University of Turin, Italy
| | - Alvise Berti
- Department of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Italy
| | - Enrica Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pietro Leccese
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Bernd Raffeiner
- Rheumatology Unit, Department of Medicine, Centrale Hospital of Bolzano, Italy
| | - Simone Parisi
- S.C. Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ilaria Leccese
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - Francesco Cianci
- Rheumatology Institute, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvano Bettio
- Rheumatology Unit, Internal Medicine Department, University Hospital of Cattinara, Trieste, Italy
| | - Pierpaolo Sainaghi
- Rheumatology Unit, CAAD and DiMet, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Aurora Ianniello
- Day Hospital Multidisciplinare, Ospedale di Borgomanero, ASL-NO Novara, Novara, Italy
| | | | - Silvia Bellando Randone
- Department of Experimental and Clinical Medicine University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Paola Faggioli
- ASST Ovest Milanese, UOC Internal Medicine, Legnano, Italy
| | | | | | | | - Michele Colaci
- Dept Clinical and Experimental Medicine University of Catania, Catania, Italy
| | | | | | | | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | | | - Maria Chiara Ditto
- S.C. Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy; University of Padua, PhD Program in Clinical and Experimental Sciences, Padua, Italy
| | - Silvia Balduzzi
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | | | - Alessandra Bortoluzzi
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angela Padula
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisa Gremese
- Rheumatology Institute, Università Cattolica del Sacro Cuore, Rome, Italy; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | | | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Italy
| | | | - Dario Roccatello
- CMID-Center of Research of Nephrology, Rheumatology, and Rare Diseases Interregional Coordinating Center of the Network of Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-net Member) G. Bosco Hospital, and University of Turin, Italy
| | - Marcello Govoni
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Roberto Caporali
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
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Al Hamzi HA, Al-Mayouf SM, Al Shaikh AA, Al-Sheikh HA, Alshomar AA, Al Humaidan HA, Al Dalaan AN, Al Saleh SS. Early and late effects of therapeutic plasma exchange in patients with systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis: A single-center experience. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:775-780. [PMID: 31464233 DOI: 10.4103/1319-2442.265452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Therapeutic plasma exchanges (TPE) is considered as one of the treatment modalities that is used in systemic autoimmune diseases. This study aimed to describe the early and late effect of TPE in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) presented with acute kidney injury (AKI). Retrospective study comprised patients with SLE and AAV with AKI seen between January 2000 and June 2014 at King Faisal Specialist Hospital and Research Center in Riyadh. All patients underwent TPE. Retrospectively, all patients were assessed for early and late renal outcome at 12- month and 24-month intervals. Renal outcome was assessed according to serum creatinine level, glomerular filtration rate, active urine sediment, and proteinuria. P <0.05 was considered significant. A total of 68 patients were included, 58 patients (51 females) had SLE and 10 patients (7 females) had AAV completed TPE. All patients had active disease and had AKI. At the first 12 months, 18 patients (17 SLE and 1 AAV) showed complete response and 14 patients had partial response while 22 patients did not show therapeutic benefit. The nonresponders (22 patients) entered the late assessment interval (24 months) without any therapeutic response. Statistically, there was no significant difference between the patient's response to TPE at the first and second assessment intervals and the baseline serum creatinine level. TPE might be an alternative rescue treatment in lupus nephritis with AKI.
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Affiliation(s)
- Hanan A Al Hamzi
- Department of Medicine, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Sulaiman M Al-Mayouf
- Department of Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmad A Al Shaikh
- Adult Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Haifa A Al-Sheikh
- Adult Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmad A Alshomar
- Adult Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hind A Al Humaidan
- Blood Bank and Transfusion Services; Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah N Al Dalaan
- Adult Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Salman S Al Saleh
- Adult Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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10
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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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11
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Apaydin S. The treatment of ANCA-associated rapidly-progressive glomerulonephritis and Goodpasture syndrome with therapeutic apheresis. Transfus Apher Sci 2018; 57:8-12. [PMID: 29503131 DOI: 10.1016/j.transci.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Therapeutic plasma aphresis (plasmapheresis) is one form of treatment that is frequently used in practice of Nephrology. Plasmapheresis is the most important part of the therapies for Goodpasture's syndrome and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis which are causes of rapidly progressive glomerulonephritis. The reason why the effectiveness of plasmapheresis therapy cannot be clearly demonstrated in renal involvement in these diseases is that it does not appear to be possible to recruit an adequate number of patients and plasmapheresis is not effective in advanced disease if early treatment is not initiated.
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Affiliation(s)
- Suheyla Apaydin
- University of Health Sciences, Medical Faculty, Internal Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Center, Nephrology Department, Istanbul, Turkey.
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12
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Tan L, Jiao A, Chen J, Feng X, Xu L, He S, Tan F, Jiang Y, Luo H, Li H, Wu Y, Tian Y, Zeng T, Yu J, Cao L, Zheng J, Xu H, Wei M, Gan W, Peng W, Liu Y, Hou J, Xu J, Shuai L, Huang W, Huang J, Lin Y, Liu J. Analysis of Antineutrophil Cytoplasm Antibody from 118 730 Patients in Tertiary Hospitals in Jiangxi Province, China. Med Sci Monit 2017; 23:4312-4320. [PMID: 28878204 PMCID: PMC5600193 DOI: 10.12659/msm.905880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/13/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The discovery of antineutrophil cytoplasm antibody (ANCA) makes the early diagnosis of primary vasculitis possible, and also has important guiding significance for the diagnosis and treatment of secondary vasculitis. This study aimed to investigate the clinical significance of ANCA. MATERIAL AND METHODS ANCA was detected by indirect immunofluorescence assay (IIF), and anti-myeloperoxidase (MPO) antibody, and anti-proteinase 3 (PR3) antibody were detected by ELISA. The results were analyzed retrospectively. RESULTS Among 118 730 patients, a total of 5853 (4.93%) were positive for ANCA. In the positive cases, 3.98% were male and 6.33% were female, with significant differences (χ²=123.38, P<0.01). For ANCA, the department with the highest positive rate (15.06%) was the Department of Rheumatology, followed by 7.78% in the Department of Dermatology, 6.79% in the Department of Nephrology, and 5.72% in the Department of Traditional Chinese Medicine (TCM). Anti-PR3 and cANCA were highly specific in primary vasculitis (P<0.01). Anti-MPO and pANCA had high specificity for other autoimmune diseases (P<0.01). CONCLUSIONS ANCA has important guiding significance for vasculitis-related diseases. Therefore, it is important in the diagnosis and treatment of this disease and has value in clinical practice.
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Affiliation(s)
- Liming Tan
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Anjun Jiao
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Juanjuan Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Xiaojing Feng
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Liuyue Xu
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Siqi He
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Fuyan Tan
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yongqing Jiang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Heng Luo
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Hua Li
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yang Wu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yongjian Tian
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Tingting Zeng
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Jianlin Yu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Liping Cao
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Jianfeng Zheng
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Hui Xu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Ming Wei
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Wen Gan
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Weihua Peng
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yanming Liu
- Department of Clinical Laboratory, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, P.R. China
| | - Jing Hou
- Department of Clinical Laboratory, Jiangxi Provincial Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi, P.R. China
| | - Jiangxia Xu
- Department of Clinical Laboratory, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - LiHua Shuai
- Department of Clinical Laboratory, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi, P.R. China
| | - Wenzhi Huang
- Department of Clinical Laboratory, Yichun People’s Hospital of Jiangxi Province, Yichun, Jiangxi, P.R. China
| | - Junyun Huang
- Department of Clinical Laboratory, The Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, P.R. China
| | - Yan Lin
- Department of Clinical Laboratory, Ganzhou People’s Hospital of Jiangxi Province, Ganzhou, Jiangxi, P.R. China
| | - Jianrong Liu
- Department of Clinical Laboratory, Pingxiang People’s Hospital of Jiangxi Province, Pingxiang, Jiangxi, P.R. China
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