Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
Occupational and non-occupational exposures may play a role in the occurrence of ANCA-associated vasculitides (AAV) and affect their initial clinical-biological phenotype. Among these potential exposures, tobacco use could represent a factor that could influence AAV characteristics at diagnosis. However, these effects could differ according to the type of AAV, since granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) involve different pathophysiological mechanisms.
AAV patients entered in the FVSG database with available information on previous and current smoking habits were analyzed. The clinical-biological phenotype at diagnosis was compared according to current tobacco use (current smokers) or not (including previous and never smokers).
This analysis concerned 1165 patients (545 men and 620 women; mean age of 52.8±16.1 years). AAV diagnoses were: GPA for 583 (50%), MPA for 256 (22%) and EGPA for 326 (28%). Among them, 973 patients (84%) were never smokers, 116 (10%) were previous smokers and 76 (6%) were current smokers. Among GPA patients, current smokers (n=55), compared to non-current smokers (n=528) respectively, were younger (44.5±13.5 vs. 52.0±16.3, P=0.0001), more frequently men (64 vs. 48%, P=0.016) and had more frequent cutaneous involvement (50 vs. 32%, P=0.025), and tended to have more frequent arthralgias (67 vs. 54%, P=0.11) and less frequent constitutional symptoms (33 vs. 47%, P=0.08) and ear, nose & throat (ENT) involvement (73 vs. 83%, P=0.13). BVAS, PR3-ANCA–positivity and inflammatory parameters were similar for the 2 groups. Among EGPA patients, current smokers (n=15), compared to non-current smokers (n=311) respectively, were also younger (41.1±15.8 vs. 50.3±15.2, P=0.028) and had less frequent constitutional symptoms (29 vs. 62%, P=0.02), arthralgias (7 vs. 35%, P=0.04), renal involvement (0 vs. 26%, P=0.025) and MPO-ANCA–positivity (0 vs 30%, P=0.02). BVAS and inflammatory parameters were comparable for the 2 groups. Finally, analysis of MPA patients was impossible because only 6 (2%) were current smokers.
These results suggest that tobacco use could differentially affect GPA and EGPA clinical-biological phenotypes, while no conclusion can be drawn for MPA. Moreover, they support the role of environmental exposures in AAV development and its phenotype.
C. Le Jeunne,
L. Guillevin for the French Vasculitis Study Group,
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