Late-Onset IgA Vasculitis in Adult Patients Exhibits Distinct Clinical Characteristics and Outcomes

Seokchan Hong¹, Soo Min Ahn¹, Doo-Ho Lim², Byeongzu Ghang³, Wook Jang Seo⁴, Yong-Gil Kim¹, Chang-Keun Lee¹ and Bin Yoo², ¹Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea, ²Division of Rheumatology, Department of Internal Medicine, Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea, ³Division of Rheumatology, Department of Internal Medicine, Univerisy of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea, ⁴Internal Medicine, Seoul Veterans Hospital, Seoul, South Korea

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Elderly, Henoch-Schönlein purpura, outcomes and renal disease

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:

To determine whether adult IgA vasculitis patients who developed disease at an older age differ from early-onset patients in terms of clinical features and outcomes.

Methods:

All consecutive adult patients who were diagnosed with IgA vasculitis between January 1997 and December 2014 were reviewed retrospectively. Patients who developed the disease at an older age (¡Ã60 years) were compared with those with an earlier onset of disease. Renal insufficiency was defined as an estimated glomerular filtration rate <60 ml/minute.

Results:

In total, 100 adult patients were diagnosed with IgA vasculitis (mean age, 45.61 ¡¾ 17.24 years), of whom 31 (31%) had late-onset disease. Compared to early-onset patients, late-onset patients were less likely to have a preceding upper respiratory tract infection (0/31, 0.0% vs. 14/69, 20.3%; p=0.004), and more likely to have renal insufficiency at presentation (14/31, 45.2% vs. 7/69, 10.1%; p=0.000). At the last follow-up visit, late-onset patients were more likely to have chronic renal insufficiency, including end-stage renal disease (18/28, 64.3% vs. 7/62, 11.3%; p=0.000). Multivariate Cox analysis revealed that late-onset was a significant risk factor for renal insufficiency at follow-up (odds ratio, 12.886, 95% confidence intervals, 3.653–45.457; p=0.000) (Table 1).

Conclusion:

Patients with late-onset IgA vasculitis in adults exhibit distinct clinical features characterized by greater renal involvement and worse renal outcomes. Thus, more intensive treatment might be needed for adult IgA vasculitis patients, in particular those with late-onset disease.

Table 1. Clinical factors that predict the development of chronic renal insufficiency, as measured by multivariate analysis

	OR	95% CI	P-value
Renal insufficiency at presentation^a	1.947	0.760–4.991	0.165
Proteinuria (>1g/day) at presentation	0.611	0.233–1.601	0.316
Hematuria at presentation^b	10.854	1.348¡©–87.393	0.025
Late-onset disease (¡Ã60 years)	12.886	3.653¡©–45.457	0.000

^aRenal insufficiency was defined as an estimated glomerular filtration rate <60 mL/minute.

^bHematuria was defined as ¡Ã10 red blood cells per high-power field in urine analysis.

CI: confidence interval; OR: odds ratio.

Disclosure: S. Hong, None; S. M. Ahn, None; D. H. Lim, None; B. Ghang, None; W. J. Seo, None; Y. G. Kim, None; C. K. Lee, None; B. Yoo, None.

To cite this abstract in AMA style:

Hong S, Ahn SM, Lim DH, Ghang B, Seo WJ, Kim YG, Lee CK, Yoo B. Late-Onset IgA Vasculitis in Adult Patients Exhibits Distinct Clinical Characteristics and Outcomes [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/late-onset-iga-vasculitis-in-adult-patients-exhibits-distinct-clinical-characteristics-and-outcomes/. Accessed .

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