Background/Purpose: ANCA-associated vasculitis (AAV) is a systemic small-vessel vasculitis comprising granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), and renal-limited vasculitis (RLV). Currently, data is limited and conflicting regarding racial and ethnic differences in disease severity and outcomes. Previous studies reported Hispanic patients with AAV presented with more severe disease and had higher damage indices compared to Caucasian patients¹, while others showed no difference in the outcomes between African American and Caucasian patients with AAV². The purpose of this study was to investigate for racial and ethnic differences in disease severity in patients with AAV at a tertiary care center.

Methods: This retrospective chart review was conducted using the electronic medical record at Rush. Inclusion criteria were: age > 18; diagnosis of AAV, GPA, MPA, EGPA or RLV; and evaluation by a rheumatologist between 2010 and 2020. Patients with drug-induced AAV, any other form of vasculitis, or concurrent chronic infection were excluded. Demographics, diagnosis, organ involvement, laboratory data, and hospitalization data were collected. Birmingham Vasculitis Activity Scores (BVAS)³ were calculated at presentation, 6 months, and 12 months after diagnosis. Data was analyzed using independent samples t-tests and Chi-square in SPSS. Hispanic and Black patients were grouped together and compared to the non-Hispanic non-Black patients.

Results: Of the 56 patients who met inclusion criteria, 38 were non-Hispanic non-Black (37 Caucasian patients and 1 Asian patient with 12 males and 16 females), and 18 were Hispanic or Black (8 Black patients and 10 Hispanic patients with 4 males and 14 females). Lower respiratory involvement (p = 0.041) and hospital admission at presentation (p = 0.027) were more common in Hispanic or Black patients, while neurologic involvement was more common in the non-Hispanic non-Black group (p = 0.035) as seen in Table 1. As seen in Table 2, mean time to diagnosis was shorter in the Hispanic or Black cohort (3.2 months) compared to the non-Hispanic non-Black cohort (10.5 months) although the difference did not reach statistical significance (p = 0.130). Mean peak C-reactive protein (CRP) level was higher among Hispanic or Black patients (89.9 mg/L) compared to the non-Hispanic non-Black group (40.3 mg/L) although the difference did not reach statistical significance (p = 0.69). BVAS values at presentation, 6 months, and 12 months were similar between the two groups.

Conclusion: Hispanic and Black patients with AAV had a significantly higher rate of hospitalization at presentation and significantly more lower respiratory involvement. These findings suggest Hispanic and Black patients with AAV present with higher disease acuity at presentation, potentially due to more severe lung involvement such as diffuse alveolar hemorrhage and/or acute respiratory failure, compared to non-Hispanic non-Black patients with AAV. The study also showed higher peak CRP values and shorter time to diagnosis although these findings were not statistically significant. Further study is needed to confirm these findings with a larger sample size.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-disease-acuity-at-presentation-and-increased-lower-respiratory-involvement-in-hispanic-and-black-patients-with-anca-associated-vasculitis/