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: pathogenesis of ANCA-associated vasculitis (AAV) is multifactorial and most likely involves the interaction of environmental and genetic factors. Environmental seasonal exposures may play a role in the manifestation of the disease and incidence of relapses. Our objective was to investigate whether there are different clinical manifestations according to the seasonal period of the beginning of symptoms and if frequency of relapses differs in seasons in patients with ANCA vasculitis.
Methods: Patients with diagnosis of ANCA vasculitis (Chapel Hill 2012) (Granulomatosis with polyangiitis [GPA], Eosinophilic granulomatosis with polyangiitis [EGPA], Microscopic polyangiitis [MPA], and renal limited ANCA vasculitis [RLV]) seen between years 2000 and 2014 were included. Medical records we reviewed and dates of beginning of symptoms (symptoms included in the Birmingham vasculitis activity score attributed to the disease) and dates of relapses (recurrence of symptoms or new symptom attributed to vasculitis) were identified. Clinical and serological manifestations of ANCA vasculitis in patients beginning their disease in autumn-winter were compared with those beginning in spring-summer. Rate of relapses in the different seasonal periods was also compared.
Results: one hundred patients with AAV were included (females 70%, CI 60.9-79.1; mean age at diagnosis 58.4, SD 18.8, GPA=38, MPA=19 EGPA=15, RLV, =28). Forty seven patients began their vasculitis symptoms in autumn-winter, and another 47 in spring-summer. Dates of initial symptoms could not be established in 6 patients. Patients’ characteristics at disease onset are compared in table 1. Clinical manifestations were similar in patients beginning their disease in different seasons except for sinus involvement that was more frequent in those starting symptoms in autumn-winter. A total of 26 patients (26%, GPA= 11, EGPA=7, MPA=4 and RLV=4) had relapses of AAV during follow-up, with a total of 30 relapses. Relapses were more frequent in autumn-winter (n=21) than in spring-summer (n=9) (p=0.004) for all patients, and in particular in GPA (p=0.03) and EGPA (p=0.03) (table 2).
Conclusion: no disease characteristic pattern at disease onset was observed according to seasonal period of the beginning of AAV. Relapses were more frequent in autumn-winter in GPA and EGPA, suggesting that environmental seasonal exposures may trigger them.
Table 1. ANCA vasculitis patients grouped by season of beginning of symptoms
|
|
Beginning of symptoms in autumn-winter (n=47) |
Beginning of symptoms in spring-summer (n=47) |
P |
|
Females, % (CI95) |
74.5 (61.7-87.2) |
63.8 (49.8-77.9) |
0.264 |
|
Age at diagnosis, media (SD) |
58.9 (SD 19.2) |
59.1 (18.2) |
0.98 |
|
Follow up, years, median (IQR) |
6.9 (2.5-9.7) |
6 (1.7-9.4) |
0.54 |
|
GPA, n (%) |
18 (38.3) |
16 (34) |
0.67 |
|
EGPA, n (%) |
8 (17) |
6 (12.7) |
0.44 |
|
MPA, n (%) |
8 (17) |
11 (23.4) |
0.56 |
|
LRV, n (%) |
13 (27.7) |
14 (29.8) |
0.82 |
|
ANCA C positive, % (CI) |
34.8 (20.7-48.9) |
34.1 (19.7-48.5) |
0.94 |
|
ANCA P positive, % (CI) |
47.9 (35.2-62.8) |
52.1 9 (0.7-70.4) |
0.6 |
|
Initial clinical manifestations, % (CI) – Renal – Pulmonar infiltrates – Alveolar Hemorrhage – Fever – Constitutional – Ocular – Sinus – Hearing loss – Neuropathy – Cutaneous |
66 (52-79.8) 27.7 (14.6-40.8) 10.6 (1.6-19.7) 21.3 (9.3-33.3) 31.9 (18.3-45.6) 4,3 (1.7-10.2) 40.4 (26.1-54.8) 10.6 (1.6-19.7) 12.8 (3-22.5) 8.5 (0.3-16.7) |
68.1 (54.4-81.7) 27.7 (14.6-40.8) 8.5 (0.3-16.7) 23.4 (11-35.8) 36.2 (22.1-50.2) 4,3 (1.7-10.2) 21.3 (9.3-33.3) 14.9 (4.5-25.3) 14.9 (4.5-25.3) 14.9 (4.5-25.3) |
0.83 1 0.73 0.8 0.66 1 0.04 0.54 0.77 0.34 |
|
Relapses during follow up, % (CI) |
31.9 (18.3-45.6) |
21.3 (9.3-33.3) |
0.243 |
Table 2. Relapses of ANCA vasculitis grouped by season
|
|
Relapses in autumm-winter (n=21) |
Relapses in spring-summer (n=9) |
P |
|
Total of ANCA vasculitis relapses, n |
21 |
9 |
0.004 |
|
GPA, n |
11 |
4 |
0.03 |
|
EGPA, n |
6 |
1 |
0.03 |
|
MPA, n |
3 |
1 |
0.5 |
|
LRV, n |
1 |
3 |
0.5 |
To cite this abstract in AMA style:
Pompermayer LE, Scolnik M, Scaglioni V, Gallardo MDLA, Soriano ER. Seasonality in ANCA-Associated Vasculitis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/seasonality-in-anca-associated-vasculitis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/seasonality-in-anca-associated-vasculitis/