Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Gastrointestinal (GI) involvement during adult IgA vasculitis (IgAV) occurs in roughly half the cases. In many other systemic vasculitides, GI involvement represents a poor-prognosis factor, leading to the use of immunosuppressive agents combined glucocorticoids. This study was undertaken to describe the first manifestations and prognoses of GI involvement in adult IgAV patients.
This nationwide, retrospective study analyzed the data from 260 adult IgAV patients to describe and compare the initial symptoms and outcomes of those with GI involvement (GI+) vs. those without it (GI–).
Results: Among the 260 patients analyzed, 137 (53%) were GI+ vs. 123 (47%) GI–. The initial GI manifestations included: abdominal pain for 135/137 (99%), intestinal bleeding for 43/137 (31%) and diarrhea for 36/137 (26%). Abdominal computed-tomography (CT) scans and/or ultrasonography were obtained for 65% of GI+ patients. The most frequent imaging finding was thickening of the intestinal wall (61%). Upper and/or lower GI endoscopies of 78 (57%) patients revealed abnormalities in 77%, including mucosal ulceration (53%), erythema (34%) and/or purpura (26%). In contrast, intestinal biopsies were obtained from only 8 (6%) patients. The most frequent histological finding was nonspecific inflammatory infiltrates seen in all biopsies, but specific vasculitis features were rarely described (e.g., fibrinoid necrosis seen in only 1). At diagnosis, GI+ patients vs. GI– patients, respectively, were younger (mean±SD age 46.3±1.5 vs. 54.5±1.7 years; P=0.0004), had more constitutional symptoms (43% vs. 23%; P=0.0005), more frequent joint manifestations (72% vs. 50%; P=0.0002) and higher C-reactive protein (3.7 vs. 1.9 mg/dL; P=0.001). Renal involvement frequency and severity were similar for the 2 groups. Finally, GI+ patients vs. GI– patients, respectively, had comparable overall clinical response rates (80% vs. 76%; P=0.53); minor (12% vs. 13%; P=0.91) or major relapse rates (6% vs. 9%, P=0.54); renal outcomes (1 transplanted vs. 1%, P=1.00; 4 on dialysis vs. 2%, P=0.42); and vasculitis-related mortality (2% vs. 3%; P=0.68). None of the cohort patients had life-threatening GI manifestations at diagnosis, but 2 patients developed GI perforations 1 and 3 months after starting glucocorticoids.
Conclusion: GI involvement is a frequent manifestation of adult IgAV but does not seem to negatively impact overall prognosis. Therapeutic management should not necessarily include immunosuppressive agents as first-line therapy, as for systemic necrotizing vasculitis, but more data are needed to confirm these findings.
To cite this abstract in AMA style:Audemard-Verger A, Baldolli A, Amoura Z, Cacoub P, Sanges S, Maurier F, Lioger B, Martis N, Riviere E, Urbanski G, Pillebout E, Guillevin for the French Vasculitis Study Group L, Terrier B. Gastrointestinal Involvement in Adult IgA Vasculitis (Henoch–Schönlein purpura): Initial Manifestations and Outcomes [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/gastrointestinal-involvement-in-adult-iga-vasculitis-henoch-schonlein-purpura-initial-manifestations-and-outcomes/. Accessed February 18, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gastrointestinal-involvement-in-adult-iga-vasculitis-henoch-schonlein-purpura-initial-manifestations-and-outcomes/