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Guellec D, Cornec-Le Gall E, Groh M, Hachulla E, Karras A, Charles P, Dunogué B, Abad S, Alvarez F, Gérard F, Devauchelle-Pensec V, Pers JO, Puéchal X, Guillevin L, Saraux A, Cornec D. ANCA-associated vasculitis in patients with primary Sjögren's syndrome: detailed analysis of 7 new cases and systematic literature review. Autoimmun Rev 2015; 14:742-50. [PMID: 25916811 DOI: 10.1016/j.autrev.2015.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/13/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To describe the clinical presentation, management and prognosis of patients diagnosed with both primary Sjögren's syndrome (pSS) and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS French nation-wide survey completed by a systematic literature review. RESULTS This work identified 7 new cases of coexisting pSS and AAV: 2 microscopic polyangiitis (MPA), 2 granulomatosis with polyangiitis (GPA), 2 anti-myeloperoxidase (MPO)-ANCA renal-limited AAV, and 1 eosinophilic granulomatosis with polyangiitis (EGPA). The systematic literature search identified 15 previously published cases. Among the 22 patients, 19 were females. Mean age at diagnosis of AAV was 63.9±9.8years. All individuals with available information experienced at least one extra-glandular manifestation attributable to pSS. p-ANCA with anti-MPO specificity were found in 76.2% (16/21), c-ANCA with anti-PR3 specificity in 14.3% (3/21) and isolated c-ANCA in 13.6% (3/22). Vasculitis involved kidneys (n=13), lungs (n=8), skin (n=6), peripheral nerves (n=5), central nervous system (n=2), small bowel (n=1), muscle (n=1), ear chondritis (n=1) and sinuses (n=1). The mean AAV follow-up was 73.5 (±120.0) months. While on treatment, disease remission occurred in 77.3% of cases, and one death was reported in the first 6months after diagnosis. CONCLUSION This work shows that AAV may occur in patients with pSS. These are most commonly p-ANCA associated vasculitis with anti-MPO specificity. AAV may reveal an underlying pSS or arise during its evolution, but did not precede pSS in any of these cases. AAV occurrence appears to be correlated with extra-glandular manifestations of pSS.
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Affiliation(s)
| | | | - Matthieu Groh
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Eric Hachulla
- Service de Médecine Interne, Hôpital Claude Huriez, Université de Lille II, Lille, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Pierre Charles
- Service de Médecine Interne, Institut Mutualiste Montsouris, Paris, France
| | | | - Sébastien Abad
- Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
| | - Fernand Alvarez
- Service de Médecine Interne, Centre médico-chirurgical de Kourou, French Guiana
| | | | - Valérie Devauchelle-Pensec
- Service de Rhumatologie, CHRU Brest, France; EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France
| | - Jacques-Olivier Pers
- EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Alain Saraux
- Service de Rhumatologie, CHRU Brest, France; EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU Brest, France; EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France.
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