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Abstract Number: 1764

Clinical and Other Differences Observed Between Cocaine Induced and Non-Cocaine Induced Anti-Neutrophil Cytoplasmic Antibody Positive Vasculitis

Santhi Penmetsa1, N. Suzanne Emil2, Joshua Duchesne1, Wilmer Sibbitt Jr.3, Arthur Bankhurst4 and Roderick Fields5, 1Rheumatology, University of New Mexico Health sciences center, Albuquerque, NM, 2Rheumatology, Presbyterian Medical Group, Rio Rancho, NM, 3Rheumatology, University of New mexico health sciences center, Albuquerque, NM, 4Rheum/ MSC 105550, University of NM Med Ctr, Albuquerque, NM, 5Division of Rheumatology, University of New Mexico health Sciences center, Albuquerque, NM

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ANCA, antibodies and vasculitis

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Session Information

Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose

Objective: To compare various factors including clinical manifestations, laboratory data and mortality in between two groups of patients with anti-neutrophil cytoplasmic antibody (ANCA) positive vasculitis: with cocaine use and without cocaine use. The goal of this study is to evaluate clinical differences and similarities between these two groups as there are no previous studies per literature review. This also may help clinicians to better understand these two disease processes and to further aid in diagnostic and management approaches.

Methods: Adult patients with a diagnosis of ANCA positive vasculitis between 2000 and 2012 were selected and a total 46 patients were included in this study of which 22 Patients were cocaine users (age range 26-61) and 24 patients (age range 17-80) with no history of cocaine use. Clinical manifestations, laboratory data, pertinent serology, skin biopsy and other diagnostic data were gathered and were analyzed in each category. Each of these factors was compared between the Cocaine use and non-cocaine use group.

Results: Cocaine-associated ANCA positive vasculitis group had   higher proportion of the patients with abnormal perinuclear ANCA (pANCA) (86% vs 66.7%, P=0.084), myeloperoxidase (MPO), (100% vs 66%), abnormal both MPO and proteinase 3 (PR3) antibodies (32% vs 4.2%, P=0.015) compared with non-cocaine use group. This group also has higher concentrations of anti- phospholipid antibodies (50% vs 4%) compared to non-cocaine use group. Skin lesions were significantly more frequent in cocaine use group (81.8% vs 33.3%, P=0.0009) with female sex preponderance for facial lesions. Pulmonary renal involvement and complications as well as mortality (12.5% vs none) were higher in non-cocaine use group compared to cocaine associated vasculitis group.

Conclusion: ANCA positive vasculitis, the cocaine-associated and non-cocaine associated have their own distinctive clinical, laboratory and other diagnostic characteristics as well as complications. It is important for clinicians to be aware of these differences in order to recognize cocaine-associated ANCA positive vasculitis in high-risk populations since management and long term prognosis differ. More studies are needed to evaluate the significance of the presence of the related antibodies in pathogenesis, follow up and management of ANCA positive vasculitis with immunosuppressive therapy in long term.


Disclosure:

S. Penmetsa,
None;

N. S. Emil,
None;

J. Duchesne,
None;

W. Sibbitt Jr.,
None;

A. Bankhurst,
None;

R. Fields,
None.

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