Session Information
Date: Sunday, November 8, 2015
Title: Vasculitis Poster I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Clinical characteristics of elderly patients with ANCA- associated vasculitis (AAV) have not been fully elucidated. Advancing age is a risk factor for treatment-related side effects and mortality in AAV patients. Also comorbidities at time of AAV diagnosis have been associated with reduced patients and renal survival. Our objective was to analyze clinical features and outcomes in older patients with AAV compared with younger ones.
Methods: All patients seen at our hospital between years 2000 and 2014 with diagnosis of Granulomatosis with polyangiitis (GPA), Eosinophilic granulomatosis with polyangiitis (EGPA), Microscopic polyangiitis (MPA) and renal-limited ANCA vasculitis (RLV) were included. Patients were divided in an elderly group (age >=65 years) and a younger group (age <65 years). Clinical features, comorbidities, treatments, renal outcome and mortality were analyzed.
Results: one hundred patients were included (females 70%, mean age at diagnosis 58.4, SD 18.8). Younger patients (n=55) were compared with older ones (n=45) (table 1). Vasculitis renal involvement was significantly more frequent in older patients (p=0.045). No other clinical differences were found between both groups. Hypertension and dyslipidemia were more frequent in patients over 65 years. While relapses were more frequent in the younger group (p=0.02), mortality was increased in the older group (p=0.03). In a logistic regression analysis, chronic renal insufficiency was the only variable associated with mortality (OR 7, CI 1.18-41.7, p=0.032).
Conclusion: elderly patients with AAV had more renal involvement, hypertension and dyslipidemia and increased mortality. Relapses were more frequent in younger patients. Chronic renal insufficiency was independently associated with mortality in the whole group.
Table 1. Comparison between young and elderly patients with ANCA associated vasculitis
|
|
Young ANCA- associated Vasculitis group (< 65 y) (n=55 ) |
Elderly ANCA- associated Vasculitis group (>= 65 y) (n= 45) |
P value |
|
Females, % (CI) |
69% (56.5-81.7) |
71.1% (57.3-84.9) |
0.83 |
|
Age at diagnosis, mean (SD) |
45.2 (14.9) |
74.6 (6.2) |
<0.0001 |
|
Type of vasculitis, n (%) – GPA – MPA – EGPA – RLV |
24 (43.6) 7 (12.7) 10 (18.2) 14 (25.5) |
14 (31.1) 12 (26.7) 5 (11.1) 14 (31.1) |
0.23 0.11 0.35 0.49 |
|
ANCA positivity, n (%) – C ANCA – P ANCA |
17 (32.7) 27 (51.9) |
17 (38.6) 24 (53.3) |
0.54 0.89 |
|
Follow-up, years median (IQR) |
3.9 (1.7-9.3) |
7.6 (3.2-9.4) |
0.15 |
|
Comorbidities, % (CI 95) – Hypertension – Diabetes – Dyslipidemia – Ever Smoker |
38.2 (25.1-51.3) 3.6 (1.4-8.7) 14.5 (5-24) 25.9 (14-37.9) |
71.1 (57.6-84.7) 11.1 (1.7-20.5) 42.2 (27.4-57) 15.6 (4.7-26.4) |
0.001 0.15 0.002 0.21 |
|
Initial involvement – Renal – Pulmonar infiltrates – Alveolar hemorrhage – Fever – Constitutional – Sinusal – Eye – Hearing loss – Arthritis – Cutaneous – Mono or polyneuropathy
|
56.4 (43-69.8) 27.3 (15.2-39.3) 10.9 (2.5-19.3) 18.2 (7.8-28.6) 25.5 (13.7-37.2) 38 (25-51.3) 5.5 (0.7-11.6) 14.6 (5-24) 18.2 (7.8-28.6) 9.1 (1.3-16.9) 14.5 (5-24) |
75.6 (62.7-88.4) 31.1 (17.3-45) 6.7 (0.8-14.1) 26.7 (13.4-39.9) 40 (25.3-54.7) 22.2 (9.8-34.7) 4.4 (1.7-10.6) 11.1 (1.7-20.5) 8.9 (0.4-17.4) 15.6 (4.7-26.4) 13.3 (3.2-23.5) |
0.045 0.67 0.46 0.31 0.12 0.09 0.82 0.61 0.18 0.32 0.98 |
|
Initial treatment, % (CI) – Methylprednisolone IV – Plasmapheresis – Cyclophosphamide – Dyalisis at diagnosis |
70.9 (58.6-83.2) 10.9 (2.5-19.3) 76.4 (65-87.8) 14.6 (5-24) |
73.3 (60.1-86.6) 6.8 (0.8-14.4) 81.9 (70.1-93.4) 15.9 (4.8-27) |
0.66 0.48 0.51 0.85 |
|
Duration of corticosteroids treatment, months, median (IQR) |
36 (15-60) |
15 (8-30) |
0.0006 |
|
Major cardiovascular event during follow up, % (CI) |
5.5 (0.6-11.6) |
13.3 (0.3-23.5) |
0.17 |
|
Cancer development during follow up, % (CI) |
5.5 (0.6-11.6) |
4.4 (1.7-10.6) |
0.82 |
|
Infections requiring hospitalization or IV antibiotics during follow up, % (CI) |
20 (9.2-30.8) |
31.1 (17.3-45) |
0.2 |
|
Relapses, % (CI) |
36.4 (23.4-49.4) |
15.6 (4.7-26.4) |
0.02 |
|
Renal outcome, % (CI) – Chronic renal insufficiency – End stage renal disease |
30.9 (18.4-43.4) 9.1 (1.3-16.9) |
44.4 (29.6-59.3) 4.4 (1.7-10.6) |
0.16 0.37 |
|
Vasculitis Damage Index at the end of follow up, media (SD) |
1.3 (1.4) |
1.7 (1.4) |
0.14 |
|
Mortality, % (CI) |
6.1 (0.8-13) |
22.2 (8.2-36.2) |
0.03 |
To cite this abstract in AMA style:
Gallardo MDLA, Scolnik M, Pompermayer LE, Scaglioni V, Soriano ER. Elderly Versus Younger Patients with ANCA-Associated Vasculitis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/elderly-versus-younger-patients-with-anca-associated-vasculitis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/elderly-versus-younger-patients-with-anca-associated-vasculitis/