Background/Purpose: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is often linked to previous viral infections. Clinical evidence suggests SARS-CoV-2 virus may follow a similar pattern, with an observed post-pandemic increase in autoimmune disease incidence and flares attributed both to infection and vaccination. This study aims to compare the incidence of vasculitis following ANCA seroconversion before (2019) and after the pandemic onset (2021) and to evaluate whether the profile of patients changed following the SARS-CoV-2 pandemic.

Methods: This retrospective study collected positive ANCA records (ANCAc, ANCAp, anti-MPO, anti-PR3) from 2019 and 2021, reviewing clinical records for the following 2 years or until a vasculitis diagnosis. Included patients had no prior vasculitis diagnosis and had not previously tested positive for the same ANCA, although they could have tested positive for a different antibody. Patients lost to follow-up or who passed away before the 2 year mark without a vasculitis diagnosis were excluded. Data on comorbidities was collected and analyzed using descriptive and inferential statistics.

Results: A total of 380 ANCA-positive records from 138 patients were obtained. 51 patients had previous positive results. 48 had ANCA seroconversion in 2019 (group A), 2 of whom had a second seroconversion with a different antibody in 2021. 39 patients had their first seroconversion in 2021 (group B), along with the two patients who seroconverted both in 2019 and 2021.

Both group A and group B patients had similar comorbidities, with significant differences in the prevalence of previous rheumatological diseases at the time of ANCA seroconversion (p=0.032), 19% in Group A and 39% in Group B. Descriptive analysis showed differences in smoking (42% Group A vs. 22% Group B) and respiratory pathology (38% Group A vs. 20% Group B). Incidence in vasculitis in both groups was similar. Patients who developed vasculitis showed significant differences from those who did not, related to smoking (p=0.004) and previous respiratory pathology (p = 0.005) in both the general cohort and Group A (32.5% smokers in non-vasculitic group vs 100% smokers in vasculitic one). No significant difference in smoking was found in Group B (25% smokers in non-vasculitic group vs. 50% in vasculitic group). A trend towards lower previous respiratory pathology was noted in Group B (25% vs. 80% in Group A) and lower hypothyroidism prevalence (0% in Group B vs. 40% in Group A). In patients who did not develop vasculitis, Group B showed a significantly lower prevalence of ENT pathology at 3% vs. 20% in Group A (p = 0.031). None of the 15 patients with chronic infections (HIV, HCV, Chagas disease) or tumors developed vasculitis. After ANCA seroconversion, 22% of patients in 2019 and 17% in 2021 were diagnosed with a rheumatological, non-ANCA-vasculitis pathology.

Conclusion: Patients who seroconverted for ANCA in 2021 tended to smoke less, have more previous rheumatological pathologies, less previous respiratory pathology, and lower hypothyroidism prevalence. These results highlight the need for further research on the long-term effects of SARS-CoV-2 infection and vaccination on autoimmune conditions such as ANCA-associated vasculitis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-and-patient-profile-changes-in-anca-associated-vasculitis-following-the-sars-cov-2-pandemic/