1
|
Borowiec A, Rosinska M, Kowalik I, Rybski S, Chwyczko T, Jankowski J, Życińska K. Cardiac valvular involvement in granulomatosis with polyangiitis in long-term observation. Rev Port Cardiol 2024; 43:97-103. [PMID: 38122897 DOI: 10.1016/j.repc.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis and is characterized by inflammation of blood vessels. The aim of the present study was to assess cardiac valvular changes in patients with GPA in a cohort of 105 patients followed for a mean of six years. METHODS We followed 105 patients (mean age 50.4 years, 67 female) for a mean of 6.2±1.3 years. Echocardiography and laboratory tests were performed in all patients. RESULTS At baseline, 43% of patients were diagnosed with aortic regurgitation (AR), which was the most common valvular lesion. Moreover, it was the only valvular involvement that significantly increased during observation (p=0.01). In a multivariate model, only D-dimer level was a predictor of AR in this group of patients (OR 8.0 (95% CI: 1.7-38.2, p=0.01). CONCLUSIONS Involvement of the heart valves is a common finding in patients with GPA, but significant valvular disease is a rare complication. The most common valvular disease in this group of patients is AR. Aortic valves are also the most prone to degeneration in the course of the vasculitis.
Collapse
Affiliation(s)
- Anna Borowiec
- Medical University of Warsaw, Warsaw, Poland; National Institute of Oncology, Warsaw, Poland.
| | | | | | | | | | | | - Katarzyna Życińska
- Medical University of Warsaw, Warsaw, Poland; Central Clinical Hospital of Ministry of MSWiA, Warsaw, Poland
| |
Collapse
|
2
|
Mansour M, Ehrenberg S, Mahroum N, Tsur AM, Fisher L, Amital H. The existence of a bidirectional link between ischemic heart disease and fibromyalgia. Coron Artery Dis 2024; 35:99-104. [PMID: 38206805 DOI: 10.1097/mca.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
STUDY OBJECTIVES Fibromyalgia (FM) is one of the most common causes of chronic widespread musculoskeletal pain, but also sleep disturbances, cognitive and psychological disorders. It has been suggested that FM may have a correlation with cardiovascular events. In this study, we aimed to assess the association between FM and ischemic heart disease (IHD). METHODS A population-based cross-sectional study was conducted utilizing data retrieved from the largest medical records database in Israel, Clalit Health Services. Patients were defined as having FM or IHD when there were at least two such documented diagnoses in their medical records. The occurrence of IHD was compared between FM and age- and sex-frequency-matched healthy controls. A logistic regression model was used to estimate this association following an adjustment for conventional cardiovascular risk factors and depression. RESULTS An overall population of 18 598 FM patients and 36 985 age- and gender-matched controls were included in the study. The proportion of IHD amongst FM patients was increased in comparison to controls (9.2% and 6.2%, respectively; P < 0.001). Furthermore, FM demonstrated an independent association with IHD on multivariate analysis (odds ratio [OR], 1.43; 95% confidence intervals [CI], 1.33-1.54; P < 0.0001). Finally, IHD was also found to be independently associated with the diagnosis of FM (OR, 1.40; CI, 1.31-1.51; P < 0.0001). CONCLUSION Our data suggest a bidirectional link between FM and IHD even after the adjustment for conventional cardiovascular risk factors. These findings should be considered when treating patients with either FM or IHD, and their routine interactional screening may be of clinical importance.
Collapse
Affiliation(s)
- Mahmoud Mansour
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Scott Ehrenberg
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Naim Mahroum
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Avishai M Tsur
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer
- Faculty of Medicine, Tel-Aviv University, Israel
- Israel Defense Forces, Medical Corps, Tel-Hashomer, Ramat-Gan, Israel
| | - Lior Fisher
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer
- Faculty of Medicine, Tel-Aviv University, Israel
| |
Collapse
|
3
|
Hara A, Sada KE, Wada T, Amano K, Dobashi H, Atsumi T, Sugihara T, Hirayama K, Banno S, Murakawa Y, Hasegawa M, Yamagata K, Arimura Y, Makino H, Harigai M. Predictors of damage accrual in patients with antineutrophil cytoplasmic antibody-associated vasculitis: A nationwide prospective study. Mod Rheumatol 2024; 34:382-390. [PMID: 36988333 DOI: 10.1093/mr/road029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES This study elucidated the prognosis and risk factors associated with damage accrual during long-term remission maintenance therapy for patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS We obtained data from 120 patients registered in a nationwide prospective cohort study on remission induction therapy in Japanese patients with AAV and rapidly progressive glomerulonephritis (RemIT-JAV-RPGN), who achieved remission at 24 months after treatment initiation and were followed up for additional 24 months. The primary outcome was the vasculitis damage index (VDI) score at Month 48, and the secondary outcome included risk factors associated with increased total VDI at Month 48. RESULTS The understudied patients comprised 52 men and 68 women aged 68 ± 13 years. Between Months 25 and 48, the patients' survival rate was 95% (114/120). End-stage renal disease developed in seven patients by Month 48, and 64 cases had increased VDI. The multivariable analysis results revealed that oral prednisolone (PSL) doses at Month 24 were associated with damage accrual between Months 24 and 48. CONCLUSIONS VDI accrual was observed in more than half of patients with AAV during maintenance therapy, and increased VDI scores were associated with oral PSL doses 24 months after initiating remission induction therapy in Japan.
Collapse
Affiliation(s)
- Akinori Hara
- Department of Hygiene and Public Health, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiko Sugihara
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
| | - Shogo Banno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Yohko Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshihiro Arimura
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
- Kichijoji Asahi Hospital, Tokyo, Japan
| | | | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|
4
|
Tabakovic D, Smith R, Jayne D, Mohammad AJ. High risk of stroke in ANCA-associated vasculitis-a population-based study. Rheumatology (Oxford) 2023; 62:2806-2812. [PMID: 36440920 PMCID: PMC10393431 DOI: 10.1093/rheumatology/keac669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/19/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE To determine the incidence rate, predictors and outcome of stroke in a population-based cohort of individuals with ANCA-associated vasculitis (AAV). METHODS The study included 325 patients diagnosed with AAV from 1997 through 2016 in a defined geographic area of Sweden. Patients who suffered a stroke were identified from Riksstroke, a national Swedish stroke register established in 1994, and the Skåne Healthcare Register (SHR), which includes data for all inhabitants of Skåne since 1998. Case record review was carried out to confirm the diagnosis of stroke in AAV patients identified in the SHR. The incidence rate of stroke was calculated per 1000 person-years of follow-up. Using data from the Swedish general population, the standardized incidence ratio (SIR) of stroke was estimated. Cox regression analysis was utilized to investigate survival and predictors of stroke. RESULTS Twenty-five subjects (8%) suffered a stroke during 2206 person-years of follow-up. The incidence rate of stroke in AAV was 11.3/1000 person-years (95% CI 6.9, 15.8). Patients with AAV showed an increased risk of stroke compared with the general population [SIR 1.85 (95% CI 1.27, 2.59)], with a greater risk for those <65 years of age [SIR 3.19 (95% CI 1.53, 5.88)]. Higher platelet count at AAV diagnosis was an independent predictor of stroke [hazard ratio 1.14 (95% CI 1.00, 1.29)]. There were no differences in survival or other outcome measures between AAV patients with and without stroke. CONCLUSIONS The incidence rate of stroke in AAV is higher than in the general population. High platelet count at AAV diagnosis was associated with an increased risk of stroke.
Collapse
Affiliation(s)
- Dennis Tabakovic
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Rona Smith
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - David Jayne
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
5
|
Kim JS, Park YB, Lee SW. Acute coronary syndrome in antineutrophil cytoplasmic antibody-associated vasculitis: a Korean single-centre cohort study. J Rheum Dis 2023; 30:106-115. [PMID: 37483476 PMCID: PMC10324932 DOI: 10.4078/jrd.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 07/25/2023]
Abstract
Objective This study investigated the incidence and patterns of the acute coronary syndrome (ACS) after AAV diagnosis and searched for the predictors of ACS in a single-centre cohort of Korean patients diagnosed with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods A total of 262 patients with AAV were included in this study. ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA) were defined as ACS in this study. Only ACS that occurred during or after AAV diagnosis was counted. Results The incidence of ACS in patients with AAV was 2.7% (7 patients), and the most common type of ACS was NSTEMI regardless of the affected site or the number of coronary arteries. Five patients with ACS were diagnosed with microscopic polyangiitis (MPA) and all of them had myeloperoxidase (MPO)-ANCA (or perinuclear [P]-ANCA), whereas the remaining two patients were diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). Of the seven patients, 2 patients experienced ACS within the first year after AAV diagnosis, and 2 experienced ACS 5 years after AAV diagnosis. Among clinical variables, only the male sex was a predictor of ACS during the follow-up period in patients diagnosed with AAV. Conclusion The incidence of ACS was 2.7%, and the most common type of ACS was NSTEMI in Korean patients with AAV.
Collapse
Affiliation(s)
- Jin Seok Kim
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Ahn JK, Hwang J, Choi CB, Seo GH. Risk of acute myocardial infarction, stroke, and venous thromboembolism among patients with anti-neutrophil cytoplasmic antibody-associated vasculitis in South Korea: A nationwide population-based study. Joint Bone Spine 2023; 90:105498. [PMID: 36423779 DOI: 10.1016/j.jbspin.2022.105498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/22/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the incidence and risk of cerebro-cardiovascular comorbidities (stroke, acute myocardial infarction, venous thromboembolism, and pulmonary embolism) in anti-neutrophil cytoplasmic antibody-associated vasculitis using nationwide Korean population-based medical claims data. METHODS We identified 1905 patients with newly diagnosed anti-neutrophil cytoplasmic antibody-associated vasculitis during 2009-2019. Incidence rates and hazard ratios with 95% confidence intervals were calculated to estimate the risk of cerebro-cardiovascular comorbidities in these patients and compared to age- and sex-matched controls (1:10) using the Cox proportional hazards model. RESULTS Most patients had microscopic polyangiitis (42.5%), followed by granulomatosis with polyangiitis (29.1%) and eosinophilic granulomatosis with polyangiitis (28.4%). The annual incidence rate of anti-neutrophil cytoplasmic antibody-associated vasculitis in 2019 was 0.55 per 100,000 person-years. Cerebro-cardiovascular comorbidities occurred in 12.6%. Stroke was most common (64.6%), followed by venous thromboembolism (34.6%), pulmonary embolism (18.3%), and acute myocardial infarction (5.4%). Korean patients with anti-neutrophil cytoplasmic antibody-associated vasculitis were at a significantly (2.3 times) higher overall risk for cerebro-cardiovascular comorbidities than the general population (adjusted hazard ratios, 4.5, 3.1, and 2.0 times higher for pulmonary embolism, venous thromboembolism, and stroke, respectively). These findings were similar for patients with each subtype of anti-neutrophil cytoplasmic antibody-associated vasculitis. CONCLUSIONS This is the first nationwide population-based study to demonstrate a significant risk of cerebro-cardiovascular comorbidities as complications of anti-neutrophil cytoplasmic antibody-associated vasculitis in Korean patients. Knowing these risks may enable personalized patient care and improve overall survival.
Collapse
|
7
|
Nygaard L, Polcwiartek C, Nelveg-Kristensen KE, Carlson N, Kristensen S, Torp-Pedersen C, Gregersen JW. Long-term cardiovascular outcomes and temporal trends in patients diagnosed with ANCA-associated vasculitis: a Danish nationwide registry study. Rheumatology (Oxford) 2023; 62:735-746. [PMID: 35788270 DOI: 10.1093/rheumatology/keac386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To examine long-term cardiovascular outcomes and temporal trends among patients with ANCA-associated vasculitis (AAV) using Danish nationwide registries. METHODS Using a cohort design, we examined patients with granulomatosis with polyangiitis (ICD-10: DM31.3) and microscopic polyangiitis (ICD-10: DM3.17) in Denmark from 1996-2018. Hazard ratios (HRs) of cardiovascular outcomes were compared between patients with AAV and age and gender-matched controls. Counterfactual G-estimation of HRs was performed to estimate 5-year absolute risks. Temporal trends were obtained by grouping cohorts into evenly distributed tertiles according to inclusion year. RESULTS A total of 2306 patients with AAV (median age: 62.9yrs, 52.6% male) were matched with 6918 controls. Median follow-up was 9.5yrs. Patients with AAV had a higher rate of ischaemic heart disease [HR 1.86 (1.62-2.15)], myocardial infarction [HR 1.62 (1.26-2.09)], coronary angiogram [HR 1.64 (1.37-1.96)], percutaneous coronary intervention [HR 1.56 (1.17-2.07)] and ventricular arrhythmias/implantable-cardioverter-defibrillator (ICD)-implantations [HR 2.04 (1.16-3.57)]. Similarly, an increased rate of heart failure [HR 2.12 (1.77-2.54)], deep vein thrombosis [HR 3.13 (2.43-4.05)], pulmonary embolism [HR 4.04 (3.07-5.32)], atrial fibrillation [HR 2.08 (1.82-2.39)], ischaemic stroke [HR 1.58 (1.31-1.90)] and in-hospital cardiac arrest [HR 2.27 (1.49-3.48)] was observed. The 5-year risk of all outcomes were significantly higher (excluding ventricular arrhythmia/ICD-implantations). For temporal trends among patients with AAV, a decreased 3-year risk of cardiovascular mortality was observed over time. CONCLUSIONS Patients with AAV are at increased risk of heart failure, atrial-/ventricular arrhythmias, venous thrombotic events, ischaemic stroke and myocardial infarction. Furthermore, patients with AAV were more frequently examined with coronary procedures and underwent more coronary revascularizations. No temporal changes in ischaemic cardiovascular outcomes were observed, albeit the cardiovascular mortality has decreased over time.
Collapse
Affiliation(s)
- Louis Nygaard
- Department of Nephrology.,SLE and Vasculitis Clinic, Aalborg University Hospital.,Department of Clinical Medicine, Aalborg University
| | - Christoffer Polcwiartek
- Department of Clinical Medicine, Aalborg University.,Department of Cardiology, Aalborg University Hospital, Aalborg
| | | | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital, Copenhagen.,Research Department, The Danish Heart Foundation
| | - Salome Kristensen
- SLE and Vasculitis Clinic, Aalborg University Hospital.,Department of Clinical Medicine, Aalborg University.,Department of Rheumatology, Aalborg University Hospital, Aalborg
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød.,Department of Public Health, Univerity of Copenhagen, Copenhagen, Denmark
| | - Jon Waarst Gregersen
- Department of Nephrology.,SLE and Vasculitis Clinic, Aalborg University Hospital.,Department of Clinical Medicine, Aalborg University
| |
Collapse
|
8
|
Krall M, Gollmer J, Pollheimer MJ, Reiter C, Kolland M, Kirsch AH, Kronbichler A, Eller K, Rosenkranz AR, Odler B. Myocardial infarction with non-obstructive coronary arteries in a patient double-seropositive for anti-glomerular basement membrane and anti-neutrophil cytoplasmic antibodies: A case report. Front Cardiovasc Med 2022; 9:893742. [PMID: 36211562 PMCID: PMC9537632 DOI: 10.3389/fcvm.2022.893742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
We report a case of a patient double-seropositive for anti-glomerular basement membrane (anti-GBM) and anti-neutrophil cytoplasmic antibodies (ANCA) who reported retrosternal chest pain during a regular hemodialysis session associated with ST-segment depression in electrocardiogram and an increase of serum high-sensitivity troponin T. Urgent coronary angiography excluded obstructive coronary artery disease, suggesting the diagnosis of ischemia with non-obstructive coronary arteries. This case illustrates an unusual presentation of cardiovascular involvement in a patient with double-positive ANCA/anti-GBM disease, emphasizing the possible relevance of coronary microvascular dysfunction and the need for close cardiovascular follow-up in this patient population.
Collapse
Affiliation(s)
- Marcell Krall
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Gollmer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Kolland
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander H. Kirsch
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Balazs Odler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- *Correspondence: Balazs Odler,
| |
Collapse
|
9
|
Charaf H, Zahraoui R, Soualhi M, Rguig N, Bourkadi JE, Mohamed DA, Ittimad N. Vascular thromboses with retroperitoneal fibrosis: a case report. J Med Case Rep 2022; 16:47. [PMID: 35078515 PMCID: PMC8790920 DOI: 10.1186/s13256-021-03235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Granulomatosis with polyangiitis is a systemic inflammatory disease characterized by necrotizing vasculitis that affects small- and medium-sized blood vessels. Granulomatous inflammation affects the lungs, ears, nose, and throat, and commonly affects the kidneys, although the retroperitoneal tissue is rarely affected. Several studies have reported an increased risk of venous thromboembolism. Early diagnosis and treatment are of vital importance due to the rapid progression of the disease.
Case presentation
We present the case of a 66-year-old Moroccan man followed for bilateral jugular thrombosis. Cavitary pulmonary nodules and retroperitoneal fibrosis with thrombosis involving several vascular territories were detected on thoracoabdominopelvic computerized tomography scan. Laboratory analyses revealed that the patient was positive for cytoplasmic antineutrophilic antibodies. The diagnosis of granulomatosis with polyangiitis was retained. Treatment with glucocorticoids and immunosuppressive agents resulted in significant clinical and radiological improvement over the following months.
Conclusions
We describe the diagnostic steps and the difficulty of managing this patient. Rare manifestations, such as retroperitoneal fibrosis, have been reported in the literature in association with granulomatosis with polyangiitis, and should not delay the diagnosis and treatment of granulomatosis with polyangiitis owing to its severity.
Collapse
|
10
|
Floyd L, Morris AD, Woywodt A, Dhaygude A. Cardiovascular disease and ANCA-associated vasculitis: Are we missing a beat? Clin Kidney J 2022; 15:618-623. [PMID: 35371453 PMCID: PMC8967680 DOI: 10.1093/ckj/sfac009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
The association between cardiovascular (CV) disease and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is well documented. The recent work by Massicotte-Azarniouch et al. confirms the risk and adds to the existing evidence by describing the highest risk in the first 3 months after diagnosis. In this review, we aim to put their findings into perspective and formulate implications for the care of AAV patients. We discuss mechanisms for increased CV disease in AAV, including the impact of traditional risk factors and disease-related risks such as renal impairment and anti-myeloperoxidase (MPO) ANCA serotype. We also provide a brief primer on the impact of inflammatory-driven endothelial dysfunction and platelet activation on accelerated atherosclerosis in AAV patients. These features alongside the impact of disease activity and systemic inflammation provide potential explanations to why the incidence of CV events is highest in the first 3 months from diagnosis. We suggest future avenues of research, provide some suggestions to address and treat CV risk based on current evidence, and highlight the importance of addressing this topic early on. Addressing modifiable risk factors, dialogue with patients, patient information and a structured approach overall will be key to improve CV outcomes in AAV.
Collapse
Affiliation(s)
- Lauren Floyd
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Adam D Morris
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ajay Dhaygude
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| |
Collapse
|
11
|
Chevenon M, Robles N, Elizer S, Ellsworth E, Pophal S, Sabati A. Multiple Giant Coronary Artery Aneurysms in a Pediatric Patient with Granulomatosis with Polyangiitis. Pediatr Cardiol 2022; 43:1392-1395. [PMID: 35396672 PMCID: PMC8993586 DOI: 10.1007/s00246-022-02875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is characterized by necrotizing vasculitis of small and medium sized vessels and is rarely present in the pediatric population. Cardiac manifestations in pediatric patients with GPA are extremely uncommon, with only two known reported cases associated with coronary artery aneurysms (Rehani and Nelson in Pediatrics 147:e20200932, 2021, https://doi.org/10.1542/peds.2020-0932 ;Aghaei Moghadam et al. in Case Rep Cardiol 2020:3417910, 2020, https://doi.org/10.1155/2020/3417910 ). We report a case of a 14-year-old male who presented with a 1 month history of fatigue and shortness of breath. He ultimately was found to have multiple giant coronary aneurysms in both the left and right coronaries including a giant aneurysm in the posterior descending; this has not been previously reported. The case highlights the need for complete multi-modality imaging of the coronary arteries in patients with GPA.
Collapse
Affiliation(s)
- Marie Chevenon
- Division of Cardiology, Phoenix Children's Hospital, Phoenix, USA. .,The Heart Center, 1919 East Thomas Road, Phoenix, AZ, 85016, USA.
| | - Nicholas Robles
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Sydney Elizer
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Erik Ellsworth
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Stephen Pophal
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Arash Sabati
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| |
Collapse
|
12
|
Dahlqvist J, Ekman D, Sennblad B, Kozyrev SV, Nordin J, Karlsson Å, Meadows JRS, Hellbacher E, Rantapää-Dahlqvist S, Berglin E, Stegmayr B, Baslund B, Palm Ø, Haukeland H, Gunnarsson I, Bruchfeld A, Segelmark M, Ohlsson S, Mohammad AJ, Svärd A, Pullerits R, Herlitz H, Söderbergh A, Rosengren Pielberg G, Hultin Rosenberg L, Bianchi M, Murén E, Omdal R, Jonsson R, Eloranta ML, Rönnblom L, Söderkvist P, Knight A, Eriksson P, Lindblad-Toh K. Identification and Functional Characterization of a Novel Susceptibility Locus for Small Vessel Vasculitis with MPO-ANCA. Rheumatology (Oxford) 2021; 61:3461-3470. [PMID: 34888651 PMCID: PMC9348767 DOI: 10.1093/rheumatology/keab912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify and characterize genetic loci associated with the risk of developing anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). METHODS Genetic association analyses were performed after Illumina sequencing of 1,853 genes and subsequent replication with genotyping of selected SNPs in a total cohort of 1110 Scandinavian cases with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) and 1589 controls. A novel AAV-associated SNP was analysed for allele-specific effects on gene expression using luciferase reporter assay. RESULTS Proteinase 3 ANCA positive (PR3-ANCA+) AAV was significantly associated with two independent loci in the HLA-DPB1/A1 region (rs1042335, p= 6.3 x 1 0 -61, Odds ratio (OR)= 0.10; rs9277341, p= 1.5 x 1 0 -44, OR = 0.22) and with rs28929474 in the SERPINA1 gene (p= 2.7 x 1 0 -10, OR = 2.9). Myeloperoxidase (MPO)-ANCA+ AAV was significantly associated with the HLA-DQB1/HLA-DQA2 locus (rs9274619, p= 5.4 x 1 0 -25, OR = 3.7) and with a rare variant in the BACH2 gene (rs78275221, p= 7.9 x 1 0 -7, OR = 3.0), the latter a novel susceptibility locus for MPO-ANCA+ GPA/MPA. The rs78275221-A risk allele reduced luciferase gene expression in endothelial cells, specifically, as compared with the non-risk allele. CONCLUSION We identified a novel susceptibility locus for MPO-ANCA+ AAV and propose that the associated variant is of mechanistic importance, exerting a regulatory function on gene expression in specific cell types.
Collapse
Affiliation(s)
- Johanna Dahlqvist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Diana Ekman
- Department of Biochemistry and Biophysics, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Stockholm University, Sweden
| | - Bengt Sennblad
- Department of Cell and Molecular Biology, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Sergey V Kozyrev
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Jessika Nordin
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Åsa Karlsson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Jennifer R S Meadows
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Erik Hellbacher
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Ewa Berglin
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Baslund
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Hilde Haukeland
- Department of Rheumatology, Martina Hansens Hospital, Oslo, Norway
| | - Iva Gunnarsson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Mårten Segelmark
- Department of Clinical Sciences, Division of Nephrology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Sophie Ohlsson
- Department of Clinical Sciences, Division of Nephrology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Anna Svärd
- Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Rille Pullerits
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Herlitz
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Annika Söderbergh
- Department of Rheumatology, Örebro University Hospital, Örebro, Sweden
| | - Gerli Rosengren Pielberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Lina Hultin Rosenberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Matteo Bianchi
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Eva Murén
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Lars Rönnblom
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Söderkvist
- Department of Biomedical and Clinical Sciences, Division of Cell Biology, Linköping University, Linköping, Sweden
| | - Ann Knight
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Per Eriksson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| |
Collapse
|
13
|
Massicotte-Azarniouch D, Petrcich W, Walsh M, Canney M, Hundemer GL, Milman N, Hladunewich MA, Fairhead T, Sood MM. Association of anti-neutrophil cytoplasmic antibody-associated vasculitis and cardiovascular events: a population-based cohort study. Clin Kidney J 2021; 15:681-692. [PMID: 35464192 PMCID: PMC9022464 DOI: 10.1093/ckj/sfab229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is implicated in elevating the risk for cardiovascular (CV) disease; whether the elevated risk applies to all types of CV diseases or specific types is unclear. This study examined the association of AAV and adverse CV outcomes compared with the non-AAV population.
Methods
We conducted a population-based, retrospective cohort study of adults (mean age 61 years, 51% female) with a new diagnosis of AAV in Ontario, Canada from 2007 to 2017. Weighted models were used to examine the association of AAV (n = 1520) and CV events in a matched (1:4) control cohort (n = 5834). The main outcomes were major adverse CV events (MACE), defined as myocardial infarction (MI), stroke or CV death, its components, atrial fibrillation (AF) and congestive heart failure (CHF).
Results
Over a mean follow-up of 3.8 years, AAV (compared with non-AAV) was associated with a higher risk of stroke: cumulative incidence 7.0% versus 5.2%, sub-distribution hazard ratio (sHR) 1.49 [(95% confidence interval (95% CI) 1.10–2.02]; AF: cumulative incidence 16.4% versus 11.5%, sHR 1.51, 95% CI 1.30–1.75; and CHF: cumulative incidence 20.8% versus 13.3%, sHR 1.41, 95% CI 1.22–1.62; but not for MACE, MI or CV death. The risks for all CV events, except CV death, were significantly elevated in the early period after AAV diagnosis, in particular AF (365-day sHR 2.06, 95% CI 1.71–2.48; 90-day sHR 3.33, 95% CI 2.66–4.18) and CHF (365-day sHR 1.75, 95% CI 1.48–2.07; 90-day sHR 2.65, 95% CI 2.15–3.26).
Conclusion
AAV is associated with a high risk of certain types of CV events, particularly in the early period following diagnosis.
Collapse
Affiliation(s)
| | - William Petrcich
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Michael Walsh
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Mark Canney
- Division of Nephrology, The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Gregory L Hundemer
- Division of Nephrology, The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Nataliya Milman
- Division of Rheumatology, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Todd Fairhead
- Division of Nephrology, The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Manish M Sood
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Division of Nephrology, The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
14
|
Laustrup H, Voss A, Lund PE. Granulomatosis with polyangiitis and cardio vascular co-morbidity in Denmark. A registry-based study of 21 years of follow-up. J Transl Autoimmun 2021; 4:100136. [PMID: 34901815 PMCID: PMC8637641 DOI: 10.1016/j.jtauto.2021.100136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To describe the epidemiology of granulomatosis with polyangiitis (GPA) in Denmark. To investigate if cardiovascular (CV) related comorbidity and death were increased among Danish AAV patients registered with a diagnosis of granulomatosis with polyangiitis (GPA) in Denmark. To investigate if there was a temporal relation between diagnosis of GPA and CV disease and death. METHODS A population-based cohort study was performed using the Danish Civil Registration System, the Danish National Patient Registry and the Danish Cause of Death Register in the period January 1, 1995, to December 31, 2015. Patients registered twice or more with a diagnosis of GPA were included. Annual incidence rate (IR), point prevalence (PP) and standardized mortality rate (SMR) were calculated. The entire adult population in Denmark served as control population. CV morbidity and death caused by CV disease was registered. RESULTS We identified 1829 individuals with GPA. The median annual IR was 20.5/1,000,000 and PP increased from 64 to 277/1,000,000 in 2015. Overall SMR was 2.14. Among patients with GPA 171 had a hospital diagnosis of acute myocardial infarction (AMI). Compared to the control population, the hazard ratio (HR) of AMI was 2.47 (95% CI 1.24-4.94) during the first 3 months after the GPA diagnosis. From 3 months to one year declining to 1.41 (95%CI 0.80-2.49) and after 10 years the HR was still slightly increased to 1.64 (95%CI 1.20-2.23). The risk of a diagnosis of heart failure (HF) was markedly increased with a HR at 7.22 (95% CI 4.55-11.46) during the first 3 months after a GPA diagnosis, after three months up to one year 2.94 (95%CI 1.87-4.69), and 2.07 (95% CI 1.54-2.78) after 10 years. The total number of CV deaths in the GPA cohort was 307. During the first three months after a GPA diagnosis, the HR was increased to 9.51 (95%CI 7.12-12.70) declining to 2.51 (95% CI 1.77-3.58) after one year, but still increased to 1.56 (95% CI 1.23-1.98) after 10 years. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation. CONCLUSION In a population-based study on GPA, we found stable incidence, increasing prevalence and an overall increased SMR. The risk of CV comorbidity and of CV death among patients with a register diagnosis of GPA was increased.
Collapse
Affiliation(s)
- Helle Laustrup
- Department of Rheumatology, Odense University Hospital, Denmark
| | - Anne Voss
- Department of Rheumatology, Odense University Hospital, Denmark
| | - Peter Enemark Lund
- Master of Science: Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
15
|
Sun G, Yafasova A, Baslund B, Faurschou M, Schou M, Shams-Eldin A, Kristensen SL, Weeke PE, Torp-Pedersen C, Fosbøl EL, Køber L, Butt JH. Long-term Risk of Heart Failure and Other Adverse Cardiovascular Outcomes in Granulomatosis With Polyangiitis: a Nationwide Cohort Study. J Rheumatol 2021; 49:291-298. [PMID: 34782450 DOI: 10.3899/jrheum.210677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the long-term rates of heart failure and other adverse cardiovascular outcomes in a nationwide cohort of patients diagnosed with granulomatosis with polyangiitis (GPA) compared with the background population. METHODS Using Danish nationwide registries, patients with first-time diagnosed GPA were identified and matched 1:4 by age, sex, and comorbidities with subjects from background population. Outcomes were compared using Cox regression. Due to violation of the proportional hazard assumption, landmark analyses for the first year and from one year were performed. RESULTS Of the 1,923 patients with GPA, 1,781 patients (median age 59 years, 47.9% men) were matched with 7,124 subjects from the background population. The median follow-up was 6.4 years. The absolute 10-year risk of HF was 6.8% (95%CI, 5.5-8.2%) for GPA patients and 5.9% (5.3-6.6%) for the background population. During the first year after diagnosis, GPA was associated with a significantly higher rate of HF (HR 3.60 [95%CI, 2.28-5.67]) and other adverse outcomes, including atrial fibrillation/flutter (HR 6.50 [4.43-9.55]) and ischemic stroke (HR 3.24 [1.92-5.48]), compared with the background population. After the first year, GPA was not associated with higher rates of HF or other cardiovascular outcomes than the background population, except atrial fibrillation/flutter (HR 1.38 [1.12-1.70]). CONCLUSION During the first year after diagnosis, the rates of HF and other cardiovascular outcomes were higher in patients with GPA compared with the background population. However, after the first year, the rates of HF and other cardiovascular outcomes, except atrial fibrillation/flutter, were similar to those in the background population.
Collapse
Affiliation(s)
- Guoli Sun
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Bo Baslund
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Mikkel Faurschou
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Morten Schou
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Abdulrahman Shams-Eldin
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Søren Lund Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Peter E Weeke
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Christian Torp-Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. The Capital Region of Denmark approved this study (approval number: P-2019-348) in accordance with the General Data Protection Regulation. In Denmark, registry-based studies in which individuals cannot be identified do not require ethical approval or informed consent. Address for Correspondence: Jawad Haider Butt, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:
| |
Collapse
|
16
|
Kauffmann M, Bobot M, Robert T, Burtey S, Couvrat-Desvergnes G, Lavainne F, Puéchal X, Terrier B, Quéméneur T, Faguer S, Karras A, Brunet P, Couchoud C, Jourde-Chiche N. Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis. Clin J Am Soc Nephrol 2021; 16:1665-1675. [PMID: 34750159 PMCID: PMC8729406 DOI: 10.2215/cjn.03190321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Kidney impairment of ANCA-associated vasculitides can lead to kidney failure. Patients with kidney failure may suffer from vasculitis relapses but are also at high risk of infections and cardiovascular events, which questions the maintenance of immunosuppressive therapy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with ANCA-associated vasculitides initiating long-term dialysis between 2008 and 2012 in France registered in the national Renal Epidemiology and Information Network registry and paired with the National Health System database were included. We analyzed the proportion of patients in remission off immunosuppression over time and overall and event-free survival on dialysis (considering transplantation as a competing risk). We compared the incidence of vasculitis relapses, serious infections, cardiovascular events, and cancers before and after dialysis initiation. RESULTS In total, 229 patients were included: 142 with granulomatous polyangiitis and 87 with microscopic polyangiitis. Mean follow-up after dialysis initiation was 4.6±2.7 years; 82 patients received a kidney transplant. The proportion of patients in remission off immunosuppression increased from 23% at dialysis initiation to 62% after 5 years. Overall survival rates on dialysis were 86%, 69%, and 62% at 1, 3, and 5 years, respectively. Main causes of death were infections (35%) and cardiovascular events (26%) but not vasculitis flares (6%). The incidence of vasculitis relapses decreased from 57 to seven episodes per 100 person-years before and after dialysis initiation (P=0.05). Overall, during follow-up, 45% of patients experienced a serious infection and 45% had a cardiovascular event, whereas 13% experienced a vasculitis relapse. CONCLUSIONS The proportion of patients with ANCA-associated vasculitis in remission off immunosuppression increases with time spent on dialysis. In this cohort, patients were far less likely to relapse from their vasculitis than to display serious infectious or cardiovascular events. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN03190321.mp3.
Collapse
Affiliation(s)
- Maëlis Kauffmann
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
| | - Mickaël Bobot
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
| | - Thomas Robert
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
| | - Stéphane Burtey
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
| | | | - Frédéric Lavainne
- University hospital de Nantes, Department of Nephrology and Clinical Immunology, Nantes, France
| | - Xavier Puéchal
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Paris, France
| | - Benjamin Terrier
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Paris, France
| | - Thomas Quéméneur
- Hospital de Valenciennes, Department of Internal Medicine, Valenciennes, France
| | - Stanislas Faguer
- University hospital de Toulouse, Hôpital Rangueil, Department of Nephrology and Organ Transplantation, Centre de référence des maladies rénales rares, Institut National de la Santé et de la Recherche Médicale, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
| | - Alexandre Karras
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Nephrology, Paris, France
| | - Philippe Brunet
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
| | - Cécile Couchoud
- Agence de la Biomédecine, Registre Renal Epidemiology and Information Network, Saint-Denis, France
| | - Noémie Jourde-Chiche
- Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France,Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
| | | |
Collapse
|
17
|
Borowiec A, Kowalik I, Chwyczko T, Jankowski J, Kandyba P, Życińska K. Predictors of cardiovascular events in patients with primary systemic vasculitis: A 5 years prospective observational study. Eur J Intern Med 2021; 91:70-74. [PMID: 34074580 DOI: 10.1016/j.ejim.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated systemic vasculitis and is characterised by inflammation of blood vessels. Systemic vasculitis exhibits an enhanced cardiovascular morbidity and cardiovascular disease (CVD) has become a leading cause of death in this group of patients. OBJECTIVES The aim of the present study was to assess the prevalence of clinical manifestation of atherosclerosis and its relation with classic risk factors for atherosclerosis, echocardiographic parameters and laboratory findings in GPA patients. PATIENTS AND METHODS The group of consecutive patients with GPA were followed in the study. RESULTS One hundred six patients with GPA (mean age 50.4 ± 14.9 yrs, 67 female) were prospectively followed for 5.1 ± 1.6 yrs. In 19 patients (18%) cardiovascular disease (9 acute coronary syndromes, 4 symptomatic peripheral vascular diseases and 6 strokes) occurred in association with GPA. In a multivariate model, only age was predictive of cardiovascular events in this group of patients (OR=1.078, 95% CI: 1.025-1.134, p = 0.003). During observation in patients without CVD the level of hs-CRP and D-dimer were significantly reduced on the follow-up visit (p = 0.041, p = 0.0002). On the other hand, in patients with CV events there was no significant differences in both markers' concentrations despite clinical remission. CONCLUSIONS The age was the only independent predictor of cardiovascular events. Persistent elevation of inflammatory and prothrombotic markers despite clinical remission of the disease could be an indicator of premature atherosclerosis development in patients with systemic vasculitis.
Collapse
Affiliation(s)
- Anna Borowiec
- Medical University of Warsaw, Stepinska str 19/25, Warsaw, Poland; National Institute of Oncology, Warsaw, Poland.
| | | | | | - Jan Jankowski
- Medical University of Warsaw, Stepinska str 19/25, Warsaw, Poland
| | - Piotr Kandyba
- Medical University of Warsaw, Stepinska str 19/25, Warsaw, Poland
| | - Katarzyna Życińska
- Medical University of Warsaw, Stepinska str 19/25, Warsaw, Poland; Central Clinical Hospital of Ministry of MSWiA, Warsaw, Poland
| |
Collapse
|
18
|
Roubille C, Henriquez S, Mercuzot C, Duflos C, Dunogue B, Briot K, Guillevin L, Terrier B, Fesler P. Impact of Cardiovascular Risk Factors on the Occurrence of Cardiovascular Events in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitides. J Clin Med 2021; 10:jcm10112299. [PMID: 34070514 PMCID: PMC8198638 DOI: 10.3390/jcm10112299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age >50 years in men and >60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age (p = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98–72.68), cardiovascular history (p = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66–25.71), sedentary lifestyle (p = 0.011, OR = 4.50, 95% CI = 1.42–14.29), hypertension (p = 0.017, OR = 5.04, 95% CI = 1.33–19.12), and dyslipidemia (p = 0.03, OR = 3.86, 95% CI = 1.14–13.09). The occurrence of MACEs was associated with the number of CVRFs (p < 0.001), but not with the use of glucocorticoids or cyclophosphamide (p = 0.733 and p = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.
Collapse
Affiliation(s)
- Camille Roubille
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France; (C.M.); (P.F.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34000 Montpellier, France
- Correspondence: ; Tel.: +46-733-8443; Fax: +46-733-8453
| | - Soledad Henriquez
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Cédric Mercuzot
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France; (C.M.); (P.F.)
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Medical Information Department, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France;
| | - Bertrand Dunogue
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Karine Briot
- Université de Paris, 75006 Paris, France;
- Department of Rheumatology, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France
| | - Loic Guillevin
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Benjamin Terrier
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Pierre Fesler
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France; (C.M.); (P.F.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34000 Montpellier, France
| |
Collapse
|
19
|
Bettiol A, Sinico RA, Schiavon F, Monti S, Bozzolo EP, Franceschini F, Govoni M, Lunardi C, Guida G, Lopalco G, Paolazzi G, Vacca A, Gregorini G, Leccese P, Piga M, Conti F, Fraticelli P, Quartuccio L, Alberici F, Salvarani C, Bettio S, Negrini S, Selmi C, Sciascia S, Moroni G, Colla L, Manno C, Urban ML, Vannacci A, Pozzi MR, Fabbrini P, Polti S, Felicetti M, Marchi MR, Padoan R, Delvino P, Caporali R, Montecucco C, Dagna L, Cariddi A, Toniati P, Tamanini S, Furini F, Bortoluzzi A, Tinazzi E, Delfino L, Badiu I, Rolla G, Venerito V, Iannone F, Berti A, Bortolotti R, Racanelli V, Jeannin G, Padula A, Cauli A, Priori R, Gabrielli A, Bond M, Tedesco M, Pazzola G, Tomietto P, Pellecchio M, Marvisi C, Maritati F, Palmisano A, Dejaco C, Willeit J, Kiechl S, Olivotto I, Willeit P, Prisco D, Vaglio A, Emmi G. Risk of acute arterial and venous thromboembolic events in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Eur Respir J 2021; 57:13993003.04158-2020. [PMID: 33833031 DOI: 10.1183/13993003.04158-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Alessandra Bettiol
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Dept of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Renato Alberto Sinico
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Franco Schiavon
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Sara Monti
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Enrica Paola Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Marcello Govoni
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | | | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O.S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | | | - Angelo Vacca
- Dept of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | | | - Pietro Leccese
- Rheumatology Dept of Lucania, San Carlo Hospital, Potenza, Italy
| | - Matteo Piga
- Rheumatology, Dept of Medical Sciences and Public Health, University Clinic, Cagliari, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Dept of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Fraticelli
- Dept of Internal Medicine, Clinica Medica, Ospedali Riuniti, Ancona, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Dept of Medicine (DAME), University of Udine, Udine, Italy
| | - Federico Alberici
- Dept of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvano Bettio
- Rheumatology Unit, Internal Medicine Dept, Cattinara Teaching Hospital (ASUITS), Trieste, Italy
| | - Simone Negrini
- Internal Medicine, Clinical Immunology and Translational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research and Dept of Internal Medicine, University of Genoa, Genoa, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Dept of Clinical and Biological Sciences, University of Turin, Turin, Italy.,SCU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Dept of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Gabriella Moroni
- Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Loredana Colla
- Nephrology, Dialysis and Renal Transplant Division, Dept of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Carlo Manno
- Dept of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplant Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Letizia Urban
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Alfredo Vannacci
- Dept of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Maria Rosa Pozzi
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Paolo Fabbrini
- Nephrology Unit, Hospital San Gerardo Monza, University of Milano Bicocca, Milan, Italy
| | - Stefano Polti
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Mara Felicetti
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Maria Rita Marchi
- Respiratory Pathophysiology Division, University Hospital of Padova, Padova, Italy
| | - Roberto Padoan
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Paolo Delvino
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy.,Dept of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Paola Toniati
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Silvia Tamanini
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Federica Furini
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Alessandra Bortoluzzi
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Elisa Tinazzi
- Dept of Medicine, University of Verona, Verona, Italy
| | | | - Iuliana Badiu
- Allergy and Pneumology Unit, A.O.S. Croce e Carle, Cuneo, Italy
| | - Giovanni Rolla
- Dept of Medical Science, Allergy and Clinical Immunology, University of Torino and AO Ordine Mauriziano Umberto I, Turin, Italy
| | - Vincenzo Venerito
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Alvise Berti
- Dept of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | | | - Vito Racanelli
- Dept of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Guido Jeannin
- Nephrology Unit, ASST Spedali Civili, Brescia, Italy
| | - Angela Padula
- Rheumatology Dept of Lucania, San Carlo Hospital, Potenza, Italy
| | - Alberto Cauli
- Rheumatology, Dept of Medical Sciences and Public Health, University Clinic, Cagliari, Italy
| | - Roberta Priori
- Rheumatology Unit, Dept of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Armando Gabrielli
- Dept of Internal Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Milena Bond
- Dept of Rheumatology, Santa Chiara Hospital, Trento, Italy.,Rheumatology Clinic, Dept of Medicine (DAME), University of Udine, Udine, Italy
| | - Martina Tedesco
- Nephrology Unit, ASST Spedali Civili, Brescia, Italy.,Dept of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Paola Tomietto
- Rheumatology Unit, Internal Medicine Dept, Cattinara Teaching Hospital (ASUITS), Trieste, Italy
| | - Marco Pellecchio
- Struttura Complessa Medicina Interna 1 P.O. Levante, ASL 2 Savona, Savona, Italy
| | - Chiara Marvisi
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Nephrology Unit, University Hospital, Parma, Italy
| | - Federica Maritati
- Dept of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Christian Dejaco
- Hospital of Brunico (SABES-ASDAA), Dept of Rheumatology, Brunico, Italy.,Dept of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Johann Willeit
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iacopo Olivotto
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Peter Willeit
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,These authors contributed equally to this manuscript
| | - Domenico Prisco
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,These authors contributed equally to this manuscript
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy.,Dept of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Firenze, Florence, Italy.,These authors contributed equally to this manuscript
| | - Giacomo Emmi
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,These authors contributed equally to this manuscript
| | | |
Collapse
|
20
|
Abstract
Rhythm and conduction disturbances and sudden cardiac death are important manifestations of cardiac involvement in autoimmune rheumatic diseases (ARD), which have a serious impact on morbidity and mortality. While the underlying arrhythmogenic mechanisms are multifactorial, myocardial fibrosis plays a pivotal role. It accounts for a substantial portion of cardiac mortality and may manifest as atrial and ventricular arrhythmias, conduction system abnormalities, biventricular cardiac failure or sudden death. In patients with ARD, myocardial fibrosis is considered to be the hallmark of cardiac involvement as a result of inflammatory process or to coronary artery occlusive disease. Myocardial fibrosis constitutes the pathological substrates for reentrant circuits. The presence of supraventricular extra systoles, tachyarrhythmias, ventricular activity and conduction disturbances are not uncommon in patients with ARDs, more often in systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, inflammatory muscle disorders and anti-neutrophil cytoplasm antibody-associated vasculitis. In this review, the type, the relative prevalence and the underlying mechanisms of rhythm and conduction disturbances in the emerging field of cardiorheumatology are provided.
Collapse
Affiliation(s)
- Sotiris C Plastiras
- Echocardiography Unit, Bioiatriki SA, Bioiatriki Healthcare Group, Athens, Greece
| | | |
Collapse
|
21
|
Abstract
The prognosis of patients with ANCA-associated vasculitis has improved over the past decades, but overall survival rates are still unsatisfactory. Recent research has focused on complications of immunosuppressive measures and comorbidities of ANCA-associated vasculitis. This review focuses on thromboembolic and cardiovascular events. A considerably increased risk of thromboembolic events has been reported, which is associated with active disease and impaired coagulation factors. There is mounting evidence that a hypercoagulable state is present even in patients in remission, and studies investigating the impact of tailored anticoagulation are needed to reduce the burden of thromboembolism. Cardiovascular mortality is one of the leading causes of death and accelerated atherosclerosis is frequently observed in patients with ANCA-associated vasculitis. A high frequency of patients develops hypertension, diabetes mellitus and hypercholesterolaemia, either as a consequence of immunosuppression or associated with the underlying disease. The current control of modifiable cardiovascular risk factors is insufficient and thorough reviews should be performed periodically. Treatment of these risk factors should be adopted according to current recommendations related to individual cardiovascular risk prediction.
Collapse
Affiliation(s)
- Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Leierer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul.,Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Trivioli G, Terrier B, Vaglio A. Eosinophilic granulomatosis with polyangiitis: understanding the disease and its management. Rheumatology (Oxford) 2021; 59:iii84-iii94. [PMID: 32348510 DOI: 10.1093/rheumatology/kez570] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/15/2019] [Indexed: 12/14/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis is characterized by asthma, blood and tissue eosinophilia and small-vessel vasculitis. The clinical presentation is variable, but two main clinic-pathologic subsets can be distinguished: one hallmarked by positive ANCA and predominant 'vasculitic' manifestations (e.g. glomerulonephritis, purpura and mononeuritis multiplex) and the other by negative ANCA and prominent 'eosinophilic' manifestations (e.g. lung infiltrates and cardiomyopathy). The pathogenesis is not fully understood but probably results from the interplay between T and B cells and eosinophils. Eosinophilic granulomatosis with polyangiitis must be differentiated from several conditions, including hypereosinophilic syndromes and other small-vessel vasculitides. The overall survival is good; however, patients frequently relapse and have persistent symptoms. The recently developed monoclonal antibodies targeting B cells and eosinophilopoietic cytokines such as IL-5 are emerging as valid alternatives to conventional immunosuppressive therapies. In this review, we discuss the essential features of eosinophilic granulomatosis with polyangiitis, with particular respect to the most relevant issues concerning clinical presentation and management.
Collapse
Affiliation(s)
- Giorgio Trivioli
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Firenze, Florence, Italy
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, and Université Paris Descartes, Paris 5, Paris, France
| | - Augusto Vaglio
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Firenze, Florence, Italy
| |
Collapse
|
23
|
Atas DB, Atas H, İzgi TN, Velioglu A, Arikan H, Oner FA, Direskeneli H, Tuglular S, Asicioglu E. The prevalence of metabolic syndrome is increased in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Int Urol Nephrol 2021; 53:1427-1434. [PMID: 33387219 DOI: 10.1007/s11255-020-02736-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Cardiovascular disease is one of the major causes of mortality in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Metabolic syndrome (MetS) is associated with increased cardiovascular risk in the normal population. However, MetS in AAV has not been adequately investigated. We aimed to determine MetS prevalence and associated factors in AAV patients. METHODS Thirty-seven AAV patients and 42 healthy controls were enrolled. MetS was determined by International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. The relationship between clinical features of AAV and MetS was also investigated. RESULTS MetS was significantly higher in AAV patients than controls by NCEP-ATPIII (51.4% vs. 26.2%, p 0.022) and IDF (62.2% vs. 35.7%, p 0.020). When AAV patients with MetS were compared to those without, there were significant differences in age, CRP, GFR and NT-pro-BNP. Age [58 (13) vs. 50 (8) years p: 0.028], CRP [4.0 (3.6) vs. 3.2 (1.0) mg/l, p 0.021] and NT-pro-BNP [173.5 (343.7) vs. 106.0 (103.0) pg/ml, p 0.013] were significantly higher in AAV patients with MetS than those without; GFR was significantly lower [38 (46) vs. 83 (51) ml/min/1.73 m2, p 0.004]. ROC curve analysis showed NT-pro-BNP > 58.0 ng/ml predicted MetS with 87.1% sensitivity and 46.7% specificity (Area under curve: 0.71, CI 0.536-0.902, p 0.041). Multivariate analysis revealed age [OR (95% CI): 1.180 (1.010-1.370), p 0.039] and NT-pro-BNP > 58 pg/ml [OR (95% CI): 5.5 (1.02-30.1) p 0.047] were independent predictors of MetS in AAV patients. CONCLUSION MetS is significantly higher in AAV patients than controls and is associated with age and NT-pro-BNP. Screening and treating MetS may improve prognosis in AAV patients.
Collapse
Affiliation(s)
- Dilek Barutcu Atas
- School of Medicine, Department of Internal Medicine, Division of Nephrology, Marmara University, Istanbul, Turkey
| | - Halil Atas
- School of Medicine, Department of Cardiology, Marmara University, Istanbul, Turkey
| | - Tuba Nur İzgi
- School of Medicine, Department of Internal Medicine, Marmara University, Istanbul, Turkey
| | - Arzu Velioglu
- School of Medicine, Department of Internal Medicine, Division of Nephrology, Marmara University, Istanbul, Turkey
| | - Hakki Arikan
- School of Medicine, Department of Internal Medicine, Division of Nephrology, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz Oner
- School of Medicine, Department of Internal Medicine, Division of Rheumatology, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- School of Medicine, Department of Internal Medicine, Division of Rheumatology, Marmara University, Istanbul, Turkey
| | - Serhan Tuglular
- School of Medicine, Department of Internal Medicine, Division of Nephrology, Marmara University, Istanbul, Turkey
| | - Ebru Asicioglu
- School of Medicine, Department of Internal Medicine, Division of Nephrology, Marmara University, Istanbul, Turkey. .,Pendik Teaching and Training Hospital, Marmara University, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey.
| |
Collapse
|
24
|
Abstract
Granulomatosis with polyangiitis is an antineutrophil cytoplasmic antibody-associated vasculitis that primarily affects small vessels. The disease typically affects the respiratory tract and kidneys but has also been known to involve the gastrointestinal tract, genitourinary tract, thyroid, and liver. Cardiac involvement is rare. Coronary artery aneurysms (CAAs) are an extremely uncommon finding, with only 1 reported case in an adult patient and no pediatric cases reported to date. Here, we report the unique case of a child with granulomatosis with polyangiitis who initially presented with fever of unknown origin and pulmonary and renal symptoms with no cardiac complaints. An echocardiogram revealed severe bilateral fusiform CAAs. Because of the high risk of mortality posed by the severity of her renal and cardiac disease, the patient was managed with intensive induction immunosuppression with steroids, rituximab, and cyclophosphamide. She is maintained on steroids, rituximab, aspirin, and warfarin with improved renal function but no change in her CAAs.
Collapse
Affiliation(s)
- Chavi Rehani
- Department of Surgery, College of Medicine, University of Central Florida, Orlando, Florida; and
| | - Jennifer S Nelson
- Department of Surgery, College of Medicine, University of Central Florida, Orlando, Florida; and .,Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, Florida
| |
Collapse
|
25
|
Abstract
Granulomatosis with polyangiitis (GPA) is a small-vessel vasculitis that is highly associated with anti-neutrophil cytoplasmic antibodies. GPA carries an increased risk of organ infarction, but renal infarction is rare. We herein describe a case of multiple renal infarctions caused by GPA. A 66-year-old man presented with hearing loss, nasal discharge, fatigue, and weight loss for several months. Cross-sectional contrast-enhanced computed tomography images revealed multiple low-attenuation areas in both kidneys. He subsequently developed fever and impaired renal function. Blood serum was positive for cytoplasmic anti-neutrophil cytoplasmic antibody and a renal biopsy showed granulomatous necrotizing vasculitis. He was diagnosed with GPA and treated with high-dose corticosteroids, plasma exchange, and cyclophosphamide. The patient ultimately entered clinical remission.
Collapse
Affiliation(s)
- Xiao Lu
- Nephrology Division, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
| | - ChengYing Yuan
- Nephrology Division, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
| | - RongShan Li
- Nephrology Division, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
26
|
Mercuzot C, Letertre S, Daien CI, Zerkowski L, Guilpain P, Terrier B, Fesler P, Roubille C. Comorbidities and health-related quality of life in Patients with Antineutrophil Cytoplasmic Antibody (ANCA) - associated vasculitis. Autoimmun Rev 2020; 20:102708. [PMID: 33212227 DOI: 10.1016/j.autrev.2020.102708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimization of immunosuppressive therapies has led to a marked improvement in the survival of ANCA-associated vasculitides (AAV). The main issue now appears to be the management of comorbidities and the improvement of quality of life. The objective of this review was to investigate the incidence and the impact of AAV-associated comorbidities, as well as the determinants of health-related quality of life (HRQoL). METHODS We performed a systematic literature review of articles published in Medline from 2001 to 04/28/2020. We selected relevant articles about AAV-associated comorbidities as well as HRQoL and fatigue. For each selected article, data on the incidence of comorbidity were extracted, and factors associated with the Mental component score (MCS) and the Physical component score (PCS) were identified. RESULTS Among the 10,993 references identified, 103 were retained for the final analysis. A significant increase in cardiovascular risk was evidenced, particularly for coronary artery disease and thromboembolic events, especially during the active phase of the disease. AAV was also associated with bronchiectasis, thyroid diseases and osteoporosis. A marked decrease in HRQoL and an increase in fatigue and anxiety were reported. Decrease in PCS and MCS was associated with fatigue, mood disorders, sleep disturbance, and/or unemployment. CONCLUSION The excess mortality of AAV is still a concern, partly in connection with cardiovascular and thromboembolic comorbidities. AAV patients also experiment a reduction in their HRQoL that requires integrated management. Patients with AAV need comorbidity management strategies to improve their quality of life and outcomes.
Collapse
Affiliation(s)
- Cédric Mercuzot
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Simon Letertre
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Claire I Daien
- Department of Rheumatology, Montpellier University Hospital, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Philippe Guilpain
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for Systemic Autoimmune Diseases, Montpellier University Hospital, Montpellier, France; INSERM U 1183, IRMB, Universite Montpellier, INSERM, Montpellier, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin University Hospital, Paris, France; National Referral Centre for Systemic and Autoimmune Diseases, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Fesler
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, Cedex 5, France
| | - Camille Roubille
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, Cedex 5, France.
| |
Collapse
|
27
|
Borowiec A, Hadzik-Błaszczyk M, Kowalik I, Rusinowicz T, Krupa R, Jankowski J, Kandyba P, Józefik E, Gawałkiewicz A, Życińska K. High incidence of venous thromboembolism but not of coronary artery disease in granulomatosis with polyangiitis in first years after diagnosis. Sarcoidosis Vasc Diffuse Lung Dis 2020; 36:202-208. [PMID: 32476955 DOI: 10.36141/svdld.v36i3.8088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/29/2019] [Indexed: 11/02/2022]
Abstract
Objectives Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated vasculitis. In patients with GPA an increased incidence of venous thromboembolism (VTE), mainly during active disease, has been described. The aim of the present study was to assess the incidence of VTE and its relation with classic risk factors for atherosclerosis, presence of coronary artery disease (CAD), echocardiographic parameters and laboratory findings in GPA patients. Methods The group of consecutive patients with GPA were followed in the study. In all patients echocardiography and laboratory tests were performed. Results Ninety six patients with GPA were followed for mean 3 years. In 16 patients (16.6%) VTEs occurred in association with GPA, of which 56% occurred 6 months before or one year after diagnosis of GPA. Classic risk factors for atherosclerosis were present in 77 patients (80.2%) at some moment during follow-up. In patients with VTE there were larger right ventricle diameter (p=0.041) and higher right ventricle systolic pressure (p=0.022) observed. VTEs occurred significantly less frequently in patients treated with cyclophosphamide (p=0.049). In this study group VTE occurred more frequently than CAD: 16 (16.7%) vs. 4 (4.2%); p=0,0049. Patients with VTE were younger than those with CAD (p=0.053) and had higher levels of ANCA-PR 3 (p=0.016). Conclusions Patients with granulomatosis with polyangiitis in first years after diagnosis have higher risk of venous thromboembolism than coronary artery disease. This finding is probably related to hypercoagulability induced by the disease and its therapy.
Collapse
|
28
|
Wallace ZS, Fu X, Liao K, Kallenberg CGM, Langford CA, Merkel PA, Monach P, Seo P, Specks U, Spiera R, St Clair EW, Zhang Y, Choi H, Stone JH. Disease Activity, Antineutrophil Cytoplasmic Antibody Type, and Lipid Levels in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Rheumatol 2019; 71:1879-1887. [PMID: 31162829 DOI: 10.1002/art.41006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/29/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have an elevated risk of cardiovascular disease (CVD). This study was undertaken to develop a clearer understanding of the association between changes in disease activity and lipid levels in AAV, which may inform CVD risk stratification in this population. METHODS Lipid levels were assessed in stored serum samples (obtained at baseline and month 6) from the Rituximab for ANCA-Associated Vasculitis (RAVE) trial, which randomized patients to receive either rituximab or cyclophosphamide followed by azathioprine. Paired t-tests and multivariable linear regression were used to assess changes in lipid levels. RESULTS Of the 142 patients with serum samples available, the mean ± SD age was 52.3 ± 14.7 years, 72 (51%) were male, 95 (67%) were proteinase 3 (PR3)-ANCA positive, 72 (51%) had received a new diagnosis of AAV, and 75 (53%) were treated with rituximab. Several lipid levels increased between baseline and month 6, including total cholesterol (+12.4 mg/dl [95% confidence interval (95% CI) +7.1, +21.0]), low-density lipoprotein (+10.3 mg/dl [95% CI +6.1, +17.1]), and apolipoprotein B (+3.5 mg/dl [95% CI +1.0, +8.3]). These changes were observed among newly diagnosed and PR3-ANCA-positive patients but not among those with relapsing disease or myeloperoxidase-ANCA-positive patients. There was no difference in change in lipid levels between rituximab-treated patients and cyclophosphamide-treated patients. Changes in lipid levels correlated with changes in erythrocyte sedimentation rate but not with other inflammatory markers or glucocorticoid exposure. CONCLUSION Lipid levels increased during remission induction among patients with newly diagnosed AAV and those who were PR3-ANCA positive. Disease activity and ANCA type should be considered when assessing lipid profiles to stratify CVD risk in patients with AAV.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Paul Monach
- VA Boston Health Care System Boston Vet Center, Boston, Massachusetts
| | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Hyon Choi
- Massachusetts General Hospital, Boston
| | | |
Collapse
|
29
|
Schirmer JH, Aries PM, de Groot K, Hellmich B, Holle JU, Kneitz C, Kötter I, Lamprecht P, Müller-Ladner U, Reinhold-Keller E, Specker C, Zänker M, Moosig F. [S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis]. Z Rheumatol 2019; 76:77-104. [PMID: 29204681 DOI: 10.1007/s00393-017-0394-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jan Henrik Schirmer
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - Peer M Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Kirsten de Groot
- Medizinische Klinik III, Sana Klinikum Offenbach, Offenbach, Deutschland
- KfH Nierenzentrum Offenbach, Offenbach, Deutschland
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitiszentrum Süd, Medius Klinik Kirchheim, Kirchheim, Deutschland
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Christian Kneitz
- Klinik für Innere Medizin II, Rheumatologie, klinische Immunologie und Geriatrie, Klinikum Südstadt, Rostock, Deutschland
| | - Ina Kötter
- Abteilung für Rheumatologie, klinische Immunologie und Nephrologie, Asklepios Klinikum Altona, Hamburg, Deutschland
| | - Peter Lamprecht
- Klinik für Rheumatologie und klinische Immunologie, Universität zu Lübeck, Lübeck, Deutschland
| | - Ulf Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Campus Kerckhoff, Justus-Liebig Universität Giessen, Bad Nauheim, Deutschland
| | - Eva Reinhold-Keller
- Klinik für Rheumatologie und klinische Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie und klinische Immunologie, Universitätsmedizin Essen, St. Josef Krankenhaus Werden, Essen, Deutschland
| | - Michael Zänker
- Abteilung für Innere Medizin, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Deutschland
- Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| |
Collapse
|
30
|
Bailey KL, Mantha A, Sanaiha Y, Mathias L, Benharash P, Ebrahimi R. Short-Term Outcomes After Percutaneous Coronary Intervention in Patients With Autoimmune Vasculitides. J Am Coll Cardiol 2019; 74:159-160. [PMID: 31272540 DOI: 10.1016/j.jacc.2019.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
|
31
|
Mourguet M, Chauveau D, Faguer S, Ruidavets J, Béjot Y, Ribes D, Huart A, Alric L, Balardy L, Astudillo L, Adoue D, Sailler L, Pugnet G. Increased ischemic stroke, acute coronary artery disease and mortality in patients with granulomatosis with polyangiitis and microscopic polyangiitis. J Autoimmun 2019; 96:134-141. [DOI: 10.1016/j.jaut.2018.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023]
|
32
|
Becatti M, Emmi G, Bettiol A, Silvestri E, Di Scala G, Taddei N, Prisco D, Fiorillo C. Behçet's syndrome as a tool to dissect the mechanisms of thrombo-inflammation: clinical and pathogenetic aspects. Clin Exp Immunol 2018; 195:322-333. [PMID: 30472725 DOI: 10.1111/cei.13243] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 01/01/2023] Open
Abstract
Behçet's syndrome (BS) is a complex disease with different organ involvement. The vascular one is the most intriguing, considering the existence of a specific group of patients suffering from recurrent vascular events involving the venous and, more rarely, the arterial vessels. Several clinical clues suggest the inflammatory nature of thrombosis in BS, especially of the venous involvement, thus BS is considered a model of inflammation-induced thrombosis. Unique among other inflammatory conditions, venous involvement (together with the arterial one) is currently treated with immunosuppressants, rather than with anti-coagulants. Although many in-vitro studies have suggested the different roles of the multiple players involved in clot formation, in-vivo models are crucial to study this process in a physiological context. At present, no clear mechanisms describing the pathophysiology of thrombo-inflammation in BS exist. Recently, we focused our attention on BS patients as a human in-vivo model of inflammation-induced thrombosis to investigate a new mechanism of clot formation. Indeed, fibrinogen displays a critical role not only in inflammatory processes, but also in clot formation, both in the fibrin network and in platelet aggregation. Reactive oxygen species (ROS)-derived modifications represent the main post-translational fibrinogen alterations responsible for structural and functional changes. Recent data have revealed that neutrophils (pivotal in the pathogenetic mechanisms leading to BS damage) promote fibrinogen oxidation and thrombus formation in BS. Altogether, these new findings may help understand the pathogenetic bases of inflammation-induced thrombosis and, more importantly, may suggest potential targets for innovative therapeutic approaches.
Collapse
Affiliation(s)
- M Becatti
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Firenze, Italy
| | - G Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - A Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Italy.,Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Firenze, Italy
| | - E Silvestri
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - G Di Scala
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - N Taddei
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Firenze, Italy
| | - D Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - C Fiorillo
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Firenze, Italy
| |
Collapse
|
33
|
Kang A, Antonelou M, Wong NL, Tanna A, Arulkumaran N, Tam FWK, Pusey CD. High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol 2018; 46:285-293. [PMID: 30385704 DOI: 10.3899/jrheum.170896] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014. RESULTS There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1-10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE. CONCLUSION Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.
Collapse
Affiliation(s)
- Amy Kang
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Marilina Antonelou
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Nikki L Wong
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Anisha Tanna
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Nishkantha Arulkumaran
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Frederick W K Tam
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Charles D Pusey
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK. .,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London.
| |
Collapse
|
34
|
O’Shaughnessy MM, Liu S, Montez-Rath ME, Lafayette RA, Winkelmayer WC. Cause of kidney disease and cardiovascular events in a national cohort of US patients with end-stage renal disease on dialysis: a retrospective analysis. Eur Heart J 2018; 40:887-898. [DOI: 10.1093/eurheartj/ehy422] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michelle M O’Shaughnessy
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Sai Liu
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Richard A Lafayette
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, One Baylor Plaza, ABBR R705, Houston, TX, USA
| |
Collapse
|
35
|
Pacholczak R, Bazan-Socha S, Iwaniec T, Zaręba L, Kielczewski S, Walocha JA, Musiał J, Dropiński J. Endothelial dysfunction in patients with granulomatosis with polyangiitis: a case-control study. Rheumatol Int 2018; 38:1521-1530. [PMID: 29850964 PMCID: PMC6060787 DOI: 10.1007/s00296-018-4061-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023]
Abstract
Background Granulomatosis with polyangiitis (GPA) is a rare granulomatous vasculitis affecting small- and medium-sized blood vessels. In optimally treated patients with long-standing disease, the common cause of death is atherosclerosis even in the absence of typical risk factors. Objective To evaluate endothelial dysfunction in GPA patients. Methods 44 patients (21 men and 23 women) diagnosed with GPA and 53 controls matched for age, sex, BMI and typical risk factors for cardiovascular diseases (22 men and 31 women) were enrolled in the study. We measured each participant’s serum levels of vascular cell adhesion molecule-1 (VCAM-1), interleukin 6 (IL-6), and thrombomodulin. We also studied flow-mediated dilatation (FMD) of the brachial artery, intima-media thickness (IMT) of the common carotid artery and aortic stiffness using echocardiography. Results Patients with GPA showed a 15.9% increase in serum levels of VCAM-1 (p = 0.01), 66% of IL-6 (p < 0.001) and 50.9% of thrombomodulin (p < 0.001) compared to controls. FMD% was 48.9% lower in patients with GPA in comparison to controls (p < 0.001), after adjustment for potential confounders, with no differences regarding IMT or aortic stiffness. FMD% was negatively associated with duration of the disease (β = − 0.18 [95% CI: − 0.32 to − 0.04]), C-reactive protein (β = − 0.17 [95% CI: − 0.27 to − 0.07]), IL-6 (β = − 0.29 [95% CI: − 0.39 to − 0.19]), blood creatinine level (β = − 0.2 [95% CI: − 0.3 to − 0.1]), and IMT (β = − 0.14 (− 0.24 to − 0.04). In a multiple linear regression model, kidney function, IMT, pack-years of smoking, diabetes and level of VCAM-1 were independent predictors of lower FMD%. Conclusion GPA is characterized by endothelial dysfunction. FMD is a useful tool for the detection of endothelial injury. Electronic supplementary material The online version of this article (10.1007/s00296-018-4061-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Renata Pacholczak
- Department of Anatomy, Jagiellonian University, Medical College, Cracow, Poland.,Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Stanisława Bazan-Socha
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland
| | - Teresa Iwaniec
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland
| | - Lech Zaręba
- Faculty of Mathematics and Natural Sciences, University of Rzeszow, Rzeszow, Poland
| | - Stan Kielczewski
- Department of Anatomy, Jagiellonian University, Medical College, Cracow, Poland
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University, Medical College, Cracow, Poland
| | - Jacek Musiał
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland
| | - Jerzy Dropiński
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland.
| |
Collapse
|
36
|
Berti A, Matteson EL, Crowson CS, Specks U, Cornec D. Risk of Cardiovascular Disease and Venous Thromboembolism Among Patients With Incident ANCA-Associated Vasculitis: A 20-Year Population-Based Cohort Study. Mayo Clin Proc 2018; 93:597-606. [PMID: 29588079 PMCID: PMC6057792 DOI: 10.1016/j.mayocp.2018.02.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the cardiovascular disease (CVD) and venous thromboembolism (VTE) risks among patients with newly diagnosed antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). PATIENTS AND METHODS A population-based incident AAV cohort of 58 patients diagnosed between 1996 and 2015 in Olmsted County, MN, was identified by medical record review. For each patient, 3 age- and sex-matched non-AAV comparators were randomly selected from the same population and assigned an index date corresponding to the AAV incidence date. Medical records of cases and comparators were reviewed for CVD events, which included cardiac events (coronary artery disease, heart failure, and atrial fibrillation), cerebrovascular accidents (CVA), peripheral vascular disease (PVD), and VTE, which included deep vein thrombosis (DVT) and pulmonary embolism (PE). RESULTS Baseline total cholesterol, high-density lipoprotein, and current smoking rate were lower in AAV than in comparators (P=.03, P=.01, and P=.04, respectively), whereas other CVD risk factors and Framingham risk score were not significantly different between the 2 groups. The CVD events developed in 13 patients and 17 comparators, corresponding to a more than 3-fold increased risk (hazard ratio [HR], 3.15; 95% CI, 1.51-6.57). By subtypes, risks were increased for cardiac events (HR, 2.96; 95% CI, 1.42-6.15) and CVA (HR, 8.16; 95% CI, 2.45-27.15), but not for PVD. The HR for VTE was 3.26 (95% CI, 0.84-12.60), significantly increased for DVT (HR, 6.25; 95% CI, 1.16-33.60), but not for PE (HR, 1.33; 95% CI, 0.23-7.54). CONCLUSION Despite a similar prevalence of CVD risk factors at baseline, the risk of CVD is more than 3-fold higher and for CVA 8-fold higher in patients with incident AAV than in matched comparator subjects.
Collapse
Affiliation(s)
- Alvise Berti
- Division of Pulmonary and Critical Care Medicine, Rochester, MN; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Santa Chiara Hospital, Trento, Italy
| | - Eric L Matteson
- Division of Rheumatology, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Rochester, MN.
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN; Division of Rheumatology, Rochester, MN
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Rochester, MN
| | - Divi Cornec
- Division of Pulmonary and Critical Care Medicine, Rochester, MN; INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, CHU de Brest, Brest, France
| |
Collapse
|
37
|
Bai YH, Li ZY, Chang DY, Chen M, Kallenberg CGM, Zhao MH. The BVAS is an independent predictor of cardiovascular events and cardiovascular disease-related mortality in patients with ANCA-associated vasculitis. Semin Arthritis Rheum 2018; 47:524-529. [DOI: 10.1016/j.semarthrit.2017.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/08/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
|
38
|
Mourguet M, Chauveau D, Ruidavets J, Bejot Y, Ribes D, Huart A, Alric L, Balardy L, Astudillo L, Adoue D, Sailler L, Pugnet G. Étude du risque cardiovasculaire chez les patients atteints de vascularites associées aux ANCA. Incidence, mortalité et facteurs prédictifs. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
39
|
|
40
|
Li L, Neogi T, Jick S. A cohort study of comorbidity in patients with granulomatosis with polyangiitis. Rheumatology (Oxford) 2017; 57:291-299. [DOI: 10.1093/rheumatology/kex379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Indexed: 11/14/2022] Open
|
41
|
Houben E, Penne EL, Voskuyl AE, van der Heijden JW, Otten RHJ, Boers M, Hoekstra T. Cardiovascular events in anti-neutrophil cytoplasmic antibody-associated vasculitis: a meta-analysis of observational studies. Rheumatology (Oxford) 2017; 57:555-562. [DOI: 10.1093/rheumatology/kex338] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Eline Houben
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Erik L Penne
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | | | - René H J Otten
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Centre, Amsterdam, The Netherlands
- Department of Epidemiology & Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Tiny Hoekstra
- Department of Nephrology, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
42
|
Moog P, Eren O, Kossegg S, Valda K, Straube A, Grünke M, Schulze-Koops H, Witt M. Pupillary autonomic dysfunction in patients with ANCA-associated vasculitis. Clin Auton Res 2017; 27:385-392. [PMID: 28864843 DOI: 10.1007/s10286-017-0463-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/23/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess autonomic function by infrared dynamic pupillometry in patients with ANCA-vasculitis (AAV) in correlation to autonomic symptoms, disease specific clinical parameters and cardiovascular reflex tests. METHODS Patients with AAV and healthy controls underwent pupillometry at rest and after sympathetic stimulation (cold pressor test). Three parasympathetic parameters (amplitude, relative amplitude, maximum constriction velocity) and one sympathetic parameter (late dilatation velocity) were assessed. Results were correlated with clinical parameters, symptoms of autonomic dysfunction (COMPASS31 questionnaire), heart rate variability during deep breathing test and blood pressure response to pain. RESULTS 23 patients and 18 age-matched controls were enrolled. Patients had a smaller amplitude (1.44 vs. 1.70 mm; p = 0.009) and a slower constriction velocity (4.15 vs. 4.71 mm/s; p = 0.028) at baseline and after sympathetic stimulation (1.47 vs. 1.81 mm, p = 0.001; 4.38 vs. 5.19 mm/s, p = 0.006, respectively). Relative amplitude was significantly smaller in patients after sympathetic stimulation (28.6 vs. 32.5%; p = 0.043), but not at baseline. There was no difference in sympathetic pupillary response between the groups. In patients, parasympathetic pupil response was correlated negatively with age and positively with parasympathetic cardiac response. After adjusting for age, no significant correlation was observed with clinical parameters. However, there was a trend towards a negative correlation with disease duration, vasculitis damage index and CRP. CONCLUSION Patients with AAV exhibit parasympathetic pupillary autonomic dysfunction. Although correlations were weak and not significant, pupillary autonomic dysfunction is rather linked to chronic damage than to active inflammation or symptoms of autonomic dysfunction.
Collapse
Affiliation(s)
- Philipp Moog
- Medizinische Klinik IV, Rheumaeinheit, Klinikum der Universität München, Munich, Germany. .,Abteilung für Nephrologie, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - O Eren
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - S Kossegg
- Medizinische Klinik IV, Rheumaeinheit, Klinikum der Universität München, Munich, Germany
| | - K Valda
- Medizinische Klinik IV, Rheumaeinheit, Klinikum der Universität München, Munich, Germany
| | - A Straube
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - M Grünke
- Medizinische Klinik IV, Rheumaeinheit, Klinikum der Universität München, Munich, Germany
| | - H Schulze-Koops
- Medizinische Klinik IV, Rheumaeinheit, Klinikum der Universität München, Munich, Germany
| | - M Witt
- Medizinische Klinik IV, Rheumaeinheit, Klinikum der Universität München, Munich, Germany
| |
Collapse
|
43
|
Abstract
Bilirubin is the final product of heme catabolism in the systemic circulation. For decades, increased serum/plasma bilirubin levels were considered an ominous sign of an underlying liver disease. However, data from recent years convincingly suggest that mildly elevated bilirubin concentrations are associated with protection against various oxidative stress-mediated diseases, atherosclerotic conditions being the most clinically relevant. Although scarce data on beneficial effects of bilirubin had been published also in the past, it took until 1994 when the first clinical study demonstrated an increased risk of coronary heart disease in subjects with low serum bilirubin levels, and bilirubin was found to be a risk factor for atherosclerotic diseases independent of standard risk factors. Consistent with these results, we proved in our own studies, that subjects with mild elevation of serum levels of unconjugated bilirubin (benign hyperbilirubinemia, Gilbert syndrome) have much lower prevalence/incidence of coronary heart as well as peripheral vascular disease. We have also demonstrated that this association is even more general, with serum bilirubin being a biomarker of numerous other diseases, often associated with increased risk of atherosclerosis. In addition, very recent data have demonstrated biological pathways modulated by bilirubin, which are responsible for observed strong clinical associations.
Collapse
Affiliation(s)
- L Vítek
- Fourth Department of Internal Medicine and Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| |
Collapse
|
44
|
Bramlage CP, Kröplin J, Wallbach M, Minguet J, Smith KH, Lüders S, Schrader J, Patschan S, Gross O, Deutsch C, Bramlage P, Müller GA, Koziolek M. Management of cardiovascular risk factors in patients with ANCA-associated vasculitis. J Eval Clin Pract 2017; 23:747-754. [PMID: 28205311 DOI: 10.1111/jep.12709] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is accompanied by increased cardiovascular (CV) risk. Treatment of AAV patients includes the management of conventional CV risk factors, primarily hypertension and hypercholesterolemia, while lipoprotein(a) (LP(a)) is an emerging potential target. METHODS We performed a multicenter, retrospective study in Germany. Patients were considered if they were between 18 and 90 years old and presented with AAV. Patients with arterial hypertension but no autoimmune disease were used as a control group (HTN reference group). RESULTS Compared to the reference group (n = 52), CV disease burden was significantly greater in patients with AAV (n = 53). Hypercholesterolemia was also more common in the AAV patients (71.7% vs 46.2% for the HTN; P = .008). Lipoprotein(a) levels were elevated in both groups, with 11.3% and 17.3% of the AAV and HTN groups, respectively, displaying a level above 0.6 g/l (P = .083). Guideline-recommended targets for low-density lipoprotein cholesterol and blood pressure levels were rarely met. According to Kidney Disease: Improving Global Outcomes guidelines, 72.5% of the patients with AAV should have been taking statins and/or ezetimibe for treatment of hyperlipidemia; however, only 24.3% of them were receiving such treatment. Blood pressure below ≤140/90 mmHg was reached in 78.6% of the patients with chronic kidney disease. However, for patients with chronic kidney disease and an albumin excretion rate of >30 mg/day, the recommended blood pressure is ≤130/80 mmHg, a value that was not reached in 65% of the AAV patients. CONCLUSION Patients with AAV are at high CV risk, but management of the associated risk factors is poor. In addition to improving the treatment of hypercholesterolemia and hypertension, lipoprotein(a) is a further potential target for reducing CV risk in individuals with AAV.
Collapse
Affiliation(s)
- Carsten Paul Bramlage
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.,Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Juliane Kröplin
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Joan Minguet
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.,Institute for Research and Medicine Advancement (IRM), Terrassa, Spain
| | | | - Stephan Lüders
- Department of Internal Medicine, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany
| | - Joachim Schrader
- Department of Internal Medicine, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany
| | - Susan Patschan
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Oliver Gross
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Gerhard Anton Müller
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Michael Koziolek
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| |
Collapse
|
45
|
Tsoukas A, Bernatsky S, Joseph L, Buckeridge DL, Bélisle P, Pineau CA. Clinically Apparent Arterial Thrombosis in Persons with Systemic Vasculitis. Int J Rheumatol 2017; 2017:3572768. [PMID: 28713428 DOI: 10.1155/2017/3572768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/14/2017] [Accepted: 03/07/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To estimate the incidence rate of clinically apparent arterial thrombotic events and associated comorbidities in patients with primary systemic vasculitis. Methods Using large cohort administrative data from Quebec, Canada, we identified patients with vasculitis, including polyarteritis nodosa (PAN) and granulomatosis with polyangiitis (GPA). Incident acute myocardial infarctions (AMIs) and cerebrovascular accidents (CVAs) after the diagnosis of vasculitis were ascertained in the PAN and GPA group via billing and hospitalization data. These were compared to rates of a general population comparator group. The incidences of comorbidities (type 2 diabetes mellitus, dyslipidemia, and hypertension) were also collected. Results Among the 626 patients identified with vasculitis, 19.7% had PAN, 2.9% had Kawasaki disease, 23.8% had GPA, 52.4% had GCA, and 1.3% had Takayasu arteritis. The AMI rate was substantially higher in males aged 18–44 with PAN, with rates up to 268.1 events per 10,000 patient years [95% CI 67.1–1070.2], approximately 30 times that in the age- and sex-matched control group. The CVA rate was also substantially higher, particularly in adults aged 45–65. Patients with vasculitis had elevated incidences of diabetes, dyslipidemia, and hypertension versus the general population. Conclusion Atherothrombotic rates were elevated in patients identified as having primary systemic vasculitis. While incident rates of cardiovascular comorbidities were also increased, the substantial elevation in AMIs seen in young adults suggests a disease-specific component which requires further investigation.
Collapse
|
46
|
|
47
|
Slot MC, Kroon AA, Damoiseaux JGMC, Theunissen R, Houben AJHM, de Leeuw PW, Tervaert JWC. CD4 +CD28 null T Cells are related to previous cytomegalovirus infection but not to accelerated atherosclerosis in ANCA-associated vasculitis. Rheumatol Int 2017; 37:791-798. [PMID: 28084533 PMCID: PMC5397454 DOI: 10.1007/s00296-016-3643-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Abstract
Previous studies have suggested an increased risk for cardiovascular events in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). We analyzed the presence of atherosclerotic damage in patients with AAV in relation to the presence of CD4+CD28null T cells and antibodies against cytomegalovirus (CMV) and human Heat-Shock Protein 60 (hHSP60). In this cross-sectional study, patients with inactive AAV were compared with healthy controls (HC). Carotid intima-media thickness (IMT) and aortic pulse-wave velocity (PWV) were measured. In addition, CD4+CD28null T cells, anti-CMV, and anti-hHSP60 levels were determined. Forty patients with AAV were included. Patients’ spouses were recruited as HC (N = 38). CD4+CD28null T cells are present in patients with AAV in a higher percentage (median 3.1, range 0.01–85) than in HC (0.28, 0–36, P < 0.0001). No significant difference in IMT (mm) between patients and controls was detected (mean 0.77 ± standard deviation 0.15 and 0.73 ± 0.11, respectively, P = 0.20). PWV standardized for MAP was increased in AAV patients (9.80 ± 2.50 m/s, compared to 8.72 ± 1.68 in HC, P = 0.04). There was a strong association between a previous CMV infection and the presence and percentage of CD4+CD28null T cells (0.33 vs 13.8, P < 0.001). There was no relationship between CD4+CD28null T cells and/or a previous CMV infection and IMT or PWV. There was no relation between anti-hHSP60 and CD4+CD28null T cells. Increased PWV values suggest atherosclerotic damage in patients with AAV. Plaque size, as determined by IMT, did not differ. CD4+CD28null T cells are increased in AAV and related to the previous CMV infection.
Collapse
Affiliation(s)
- Marjan C Slot
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands. .,Department of Internal Medicine, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Abraham A Kroon
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Jan G M C Damoiseaux
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Ruud Theunissen
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Alfons J H M Houben
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Jan Willem Cohen Tervaert
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
| |
Collapse
|
48
|
Aviña-Zubieta JA, Mai A, Amiri N, Dehghan N, Ann Tan J, Sayre EC, Choi HK. Risk of Myocardial Infarction and Stroke in Patients With Granulomatosis With Polyangiitis (Wegener's): A Population-Based Study. Arthritis Rheumatol 2016; 68:2752-2759. [DOI: 10.1002/art.39762] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 05/17/2016] [Indexed: 12/27/2022]
Affiliation(s)
- J. Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, British Columbia, Canada, and University of British Columbia; Vancouver British Columbia Canada
| | - Alice Mai
- University of British Columbia; Vancouver British Columbia Canada
| | - Neda Amiri
- University of British Columbia; Vancouver British Columbia Canada
| | - Natasha Dehghan
- University of British Columbia; Vancouver British Columbia Canada
| | - Ju Ann Tan
- Arthritis Research Canada; Richmond British Columbia Canada
| | - Eric C. Sayre
- Arthritis Research Canada; Richmond British Columbia Canada
| | - Hyon K. Choi
- Arthritis Research Canada, Richmond, British Columbia, Canada, and Harvard Medical School; Boston Massachusetts
| |
Collapse
|
49
|
Moog P, Eren O, Witt M, Rauschel V, Kossegg S, Straube A, Grünke M, Schulze-koops H. Assessment of autonomic function in a cohort of patients with ANCA-associated vasculitis. Clin Auton Res 2016; 26:279-85. [DOI: 10.1007/s10286-016-0364-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
|
50
|
Wilde B, Mertens A, Arends SJ, Rouhl RP, Bijleveld R, Huitema J, Timmermans SA, Damoiseaux J, Witzke O, Duijvestijn AM, van Paassen P, van Oostenbrugge RJ, Cohen Tervaert JW. Endothelial progenitor cells are differentially impaired in ANCA-associated vasculitis compared to healthy controls. Arthritis Res Ther 2016; 18:147. [PMID: 27338585 PMCID: PMC4918016 DOI: 10.1186/s13075-016-1044-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/06/2016] [Indexed: 01/16/2023] Open
Abstract
Background Endothelial progenitor cells (EPC) are of major importance in vascular repair under healthy circumstances. Vascular injury in need of repair occurs frequently in ANCA-associated vasculitis (AAV). A specialized T cell subset enhancing EPC function and differentiation has recently been described. These angiogenic T cells (Tang) may have an important impact on the vascular repair process. Therefore, the aim of our study was to investigate EPC and Tang in AAV. Methods Fifty-three patients suffering from AAV and 29 healthy controls (HC) were enrolled in our study. Forty-four patients were in remission, nine patients were in active state of disease. Patients were either untreated or were under monotherapy with low-dose steroids (max. 5 mg/day) at the time of sampling. Circulating EPC and Tang were determined by flow cytometry (FACS). The functional capacity of EPC was assessed by established cell culture methods. Results Circulating EPC were significantly decreased in AAV as compared to HC. The capacity of EPC to differentiate and proliferate was differentially impaired in patients as compared to HC. The outgrowth of endothelial colony-forming cells (ECFC) was severely decreased in patients whereas colony-forming units-endothelial cell (CFU-EC) outgrowth was unaffected. ECFC and CFU-EC differentiation was strictly T cell-dependent. Patients with a relapsing disease course had an impaired ECFC outgrowth and expansion of Tang as compared to patients with a stable, nonrelapsing disease. Conclusions The differentiation process of EPC is impaired in AAV. This may favor insufficient vascular repair promoting a relapsing disease course. Finally, these factors may explain a higher cardiovascular morbidity as has been previously documented in AAV.
Collapse
Affiliation(s)
- B Wilde
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Nephrology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - A Mertens
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
| | - S J Arends
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - R P Rouhl
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
| | - R Bijleveld
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J Huitema
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S A Timmermans
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - O Witzke
- Department of Nephrology, University Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Infectious Diseases, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - A M Duijvestijn
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - P van Paassen
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - R J van Oostenbrugge
- Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
| | - J W Cohen Tervaert
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| |
Collapse
|