Limited Wegener's granulomatosis presenting as lung nodules in a patient with rheumatoid arthritis: a case report

Pai, Sushma; Panda, Mukta

doi:10.1186/1757-1626-1-417

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…RA is largely an inflammatory disease limited to joints, whereas AAV is a systemic autoimmune disease usually with multi-organ destructive processes and devastating outcomes. It has been reported that AAV can coexist with RA [3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. This coexistence may not be entirely coincidental, as evidenced by facts such as ANCA positivity in 20% of RA patients [25], a positive association between ANCA titer and rapid joint destruction in early RA [26], the presence of myeloperoxidase-ANCA in synovial fluid of RA patients [27], and AAV sharing susceptibility loci with RA [28,29].…”

Section: Discussionmentioning

confidence: 99%

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Anti-neutrophil cytoplasmic antibody associated vasculitis in patients with rheumatoid arthritis

et al. 2022

BMC Nephrol

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Background Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) may coexist with rheumatoid arthritis (RA). However, it is unclear whether the manifestations of AAV with and without coexisting RA are similar. This observational study aimed to investigate the clinicopathological manifestations of AAV with coexisting RA and to explore potential predictors for identifying AAV superimposed on RA. Methods Patients with both AAV and RA were identified by searching our hospital database and the literature. Data including age, sex, clinical manifestation, laboratory tests, renal pathology, and therapeutic regimens were retrieved. To assess the difference in clinical features and renal pathology between AAV patients with and without RA, we conducted 1:4 matched case-control studies. Results A total of 47 patients were identified, 15 from our hospital and 32 from the literature, and 33 (70.2%) were women. AAV was diagnosed later than RA in 83.0% of the patients and manifested as microscopic polyangiitis (MPA) in 78.7% of the patients. The kidney was the most frequently involved extra-articular organ (74.5%), followed by the lung (51.1%), and skin (8.5%). Patients with both AAV and RA were more likely to be asymptomatic (26.7% vs 3.3%, p = 0.013) than those with isolated AAV. However, they did not differ in other clinicopathological features. In RA patients, those with ANCA associated glomerulonephritis, were more likely to have decreased renal function at renal biopsy as opposed to those with primary glomerulonephritis. Conclusions AAV can coexist with RA. In this coexistence, AAV usually develops after RA, is more likely to be asymptomatic, and manifests predominately as MPA with renal involvement. Thus, we should remain vigilant to superimposed AAV on RA.

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Section: Discussionmentioning

confidence: 99%

“…Patients with suspected drug-induced AAV were excluded. We pooled these cases with those from our center [3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]…”

Section: Patients With Both Aav and Ra From Our Center And The Litera...mentioning

confidence: 99%

Anti-neutrophil cytoplasmic antibody associated vasculitis in patients with rheumatoid arthritis

et al. 2022

BMC Nephrol

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“… Steroids, Cyc, & rituximab. Pai 2008 [ 1 ] F 57 60 RA 3 y Arthritis, +RF, & + CCP + PR3 ANCA & lung bx: fibrosis, inflammation, & necrotizing vasculitis. MTX & steroids.…”

Section: Tablementioning

confidence: 99%

“…GPA and RA have shared features including vasculitis, ocular inflammation, interstitial lung disease, and arthritis but existing evidence indicates they are distinct conditions. Interestingly, the co-existence of GPA and RA has been described in the literature [ 1 - 11 ]. Herein, we report two cases of GPA developing in patients with underlying RA and examine the relationship between the two conditions.…”

Section: Introductionmentioning

confidence: 99%

The Co-existence of Rheumatoid Arthritis and Granulomatosis With Polyangiitis: Two Cases and Review of the Literature

Hassan¹,

Edigin²,

Patel³

et al. 2021

Cureus

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Granulomatosis with polyangiitis (GPA) and rheumatoid arthritis (RA) have shared features including vasculitis, ocular inflammation, interstitial lung disease, and arthritis but existing evidence indicates they are distinct conditions. Interestingly, the co-existence of GPA and RA has been described in the literature. Herein, we report two cases of GPA developing in patients with underlying RA and examine the relationship between the two conditions. Two cases of GPA that developed in patients with preexisting RA are described in detail. Additionally, PubMed was searched for articles in English showing an association of RA and GPA using keywords “rheumatoid arthritis, and vasculitis, and Wegener’s, and ANCA, and granulomatosis polyangiitis.” In addition to our two cases of RA and GPA overlap, 14 reports were identified in PubMed library from 1970 to 2020. Most of the cases were females (14/16, 88%), and had RA as the initial diagnosis (15/16, 94%). The mean age of RA diagnosis was 45.5 years, the mean age of GPA diagnosis was 52 years and the mean interval between both diagnoses was 101 months. Cyclophosphamide and steroid therapy were used in most of the cases. There are numerous reports of GPA and RA overlap in the literature. GPA should be considered in the differential diagnosis when vasculitis develops in patients with RA.

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“…atvejų, kurio metu pasireiškia kosulys, dusulys, skrepliavimas, stridoras, švokštimas, atsikosėjimas krauju. Krūtinės (pleuritinis) skausmas būna rečiau [10,11]. Pacientai skundžiasi virškinimo trakto (toliau VT) sutrikimais -pilvo skausmu, vėmimu krauju.…”

Section: Wegenerio Granulomatozė Klinikinis Atvejisunclassified

Wegenerio Granulomatozė. Klinikinis Atvejis

Kovalevska¹,

Kubiliūtė²

2018

Public Health

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Wegenrio granulomatozė, kitaip vadinama granulomatoze su poliangitu, priklauso su antikūnų prieš neutrofilų citoplazmos antigenus susijusių vaskulitų grupei. Ji, pagal 1994 metais Chapel Hillyje vykusiame konferencijos susitarime priimtą vaskulitų skirstymą, pažeidžia smulkiąsias kraujagysles. Granulomatoze su poliangitu serga įvairaus amžiaus žmonės, bet dažniausiai liga manifestuoja ketvirtą – penktą dešimtmetį. Ilgai laikoma blogos prognozės liga, taikant šiuolaikinį, inovatyvų gydymą ir atsiradus naujiems vaistams, Wegenerio granulomatozė buvo ištraukta iš blogos prognozės ligų sąrašo. Pacientų išgyvenamumo vidurkis, lyginant su mikroskopinio poliangito išgyvenamumo vidurkiu, padidėjo. Kliniškai Wegenerio granulomatozė prasideda į gripą panašiais požymiais: bendru silpnumu, karščiavimu, galvos skausmais, apetito stoka. Vėliau pasireiškia viršutinių kvėpavimo takų, plaučių, inkstų bei virškinimo trakto pažeidimas. Pusei iš sergančių šia liga pacientų pasireiškia odos bėrimas (hemoraginis bėrimas, poodiniai mazgai). Taip pat gali būti stebimas nervų sistemos pakenkimas. Pateikiame Wegenerio granulomatozės atvejį, kuriame matyti, kaip laiku pradėjus specifinį gydymą galima stebėti pažeistos inkstų funkcijos atsistatymą, bendros ligonio būklės pagerėjimą bei klastingos ligos atkryčio atsiradimą.

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Limited Wegener's granulomatosis presenting as lung nodules in a patient with rheumatoid arthritis: a case report

Abstract: Background: Rheumatoid arthritis has varied pleuroparenchymal manifestations. Wegener's granulomatosis can develop in an established case of rheumatoid arthritis and this association although previously reported is very rare.

Cited by 9 publications

References 7 publications

Anti-neutrophil cytoplasmic antibody associated vasculitis in patients with rheumatoid arthritis

Anti-neutrophil cytoplasmic antibody associated vasculitis in patients with rheumatoid arthritis

The Co-existence of Rheumatoid Arthritis and Granulomatosis With Polyangiitis: Two Cases and Review of the Literature

Wegenerio Granulomatozė. Klinikinis Atvejis

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