No abstract

Background This study investigated whether the inflammation prognostic index (IPI) and the mortality predicting index (MPI) at diagnosis could predict all‐cause mortality in patients with antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis (AAV). Methods We included 223 AAV patients and reviewed their medical records. Clinical and laboratory data and AAV‐specific indices at diagnosis were assessed. The IPI was calculated as neutrophil‐to‐lymphocyte ratio (NLR) × C‐reactive protein to albumin ratio (CAR). Here, we newly developed an MPI (NLR × CAR × monocyte counts). Results The mean age of 223 patients (122 MPA, 57 GPA and 44 EGPA patients) was 59 years. The rate of mortality was 11.2%. Using the receiver operator characteristic curve for all‐cause mortality, the cut‐offs were calculated as NLR: 3.22, CAR: 3.25, IPI: 18.53 and MPI: 8367.82. In the univariable Cox hazard analysis, age, gender, smoking history, BVAS, FFS and over the cut‐off of each index showed statistical significance. As the indices share at least two mutual variables, the multivariable analysis was conducted four times based on each index. An IPI ≥18.53 (HR 3.162) and MPI ≥8367.82 (HR 3.356) were significantly associated with all‐cause mortality. Conclusions This study developed a novel indicator, MPI, that uses the existing NLR and CAR indices and proved that it could predict all‐cause mortality in AAV patients.

Background: The Gout Impact Scale (GIS), a part of the Gout Assessment Questionnaire 2.0, is used to measure gout-specific health-related quality of life (HRQOL). Recently, GIS was translated into Korean and validated for Korean patients. Several studies on factors affecting HRQOL of patients with gout have been conducted, but few have focused on lifestyle factors. This study aimed to investigate the correlation between lifestyle habits and HRQOL in Korean patients with gout. Methods: For this study, we used data from the aftermath of Urate Lowering TheRApy in gout (ULTRA) registry, a prospective cohort of Korean patients with gout treated in multiple centers nationwide since September 2021. Participants had to be 18 years or older and meet the 2015 gout classification criteria. They were asked to fill out the GIS questionnaire in terms of their lifestyle from November 2021 to March 2023. Results: This study included 232 patients. The mean (± standard deviation) age was 55.1 ± 17.7 years, and 90.5% of patients were men. The ‘gout concern overall’ score in the GIS was significantly lower in patients who exercised less frequently and consumed soft drinks and meat, and the ‘well-being during attack’ score was significantly lower in patients who more frequently consumed vegetables and exercised. The frequency of vegetable consumption had a negative linear relationship with the ‘well-being during attack’ and ‘gout concern during attack’ scores. The frequency of exercise had a negative linear relationship with the ‘gout concern overall’ and ‘gout concern during attack’ scores. Conclusion: Certain GIS subscale scores were related to specific lifestyle habits in Korean patients with gout. Patients are encouraged to more frequently consume vegetables and exercise to improve HRQOL.

Background/Aim: This study investigated a correlation between ex vivo interferon-gamma (IFN)-gamma production using IFN-gamma releasing assay (IGRA) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) activity assessed by Birmingham vasculitis activity score (BVAS) in AAV patients. Patients and Methods: A total of 113 patients with AAV were consecutively selected from the AAV cohort and their medical records were reviewed. IGRA was performed at AAV diagnosis and before the initiation of glucocorticoids or immunosuppressive drugs for AAV treatment. Results: The median age was 61.8 years and 41.6% of the patients were men. Eighteen, 28, and 67 patients had EGPA, GPA, and MPA, respectively. Eighteen, 84, and 11 patients had positive, negative, and indeterminate results, and the median Nil, tuberculosis antigen, mitogen, and ex vivo IFN-gamma production were 0.1, 0.1, 10.0, and 9.8 IU/ml, respectively. There was no significant correlation between ex vivo IFN-gamma production and BVAS in AAV patients. When AAV patients were divided into two groups according to BVAS of 18, the higher tertile of BVAS, there was no significant difference in ex vivo IFN-gamma production between AAV patients with BVAS ≥18 and those without. In addition, there were no statistically significant correlations between ex vivo IFN-gamma production and BVAS in AAV patients with either indeterminate and negative IGRA results or only negative IGRA results. Conclusion: There is no correlation between ex vivo IFN-gamma production and BVAS. This study provided information on the reliability of the IGRA results for latent tuberculosis screening in AAV patients regardless of the activity of AAV.

This study investigated the clinical implications of serious infections in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) who received the first cycle of rituximab (RTX) during the first 6 months of follow-up. Methods: The medical records of 36 AAV patients treated with RTX were reviewed. A weekly dose of 375 mg/m 2 RTX was administered for 4 weeks to all patients along with glucocorticoids. Serious infections were defined as those requiring hospitalization. All-cause mortality during the first 6 months of follow-up was counted. The follow-up duration was defined as the period from the first RTX infusion to 6 months after the first RTX infusion. Results: The median age was 60.5 years, and 16 patients were male. Seven of 36 patients (19.4%) died and three AAV patients had five cases of serious infection such as enterocolitis, pulmonary aspergillosis, atypical pneumonia, cytomegalovirus pneumonia, and cellulitis. AAV patients with serious infections during the first 6 months of follow-up exhibited a significantly lower cumulative survival rate than those without serious infections (p<0.001). However, we found no independent predictor of serious infections using the Cox hazard model analysis. Conclusion:Serious infection is an important predictor of all-cause mortality in Korean patients with AAV who received their first cycle of RTX but there were no significant variables to predict the occurrence of serious infections at the first RTX. Thus, in cases refractory to other induction therapies, RTX should be strongly considered, despite an increase in mortality rate.