Long-term damage assessment in patients with microscopic polyangiitis and renal-limited vasculitis using the Vasculitis Damage Index

Itabashi, Mitsuyo; Takei, Takashi; Moriyama, Takahito; Shiohira, Syunji; Shimizu, Ari; Tsuruta, Yuki; Uchida, Keiko; Nitta, Kosaku

doi:10.3109/14397595.2013.852836

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…An important factor that strongly plays in favour of RTX is the low risk of serious side effects, especially in the short term. In all patients we performed the VDI score at the end of the follow up for the clinical assessment of organ damage related to the disease and our data showed a very low value particularly in patients treated with RTX in de novo vasculitis with high BVAS at the onset (Table 2), in contrast with previous reports of higher VDI in the same setting as well as in relapsing vasculitis [23]. In all the cases rituximab was well tolerated, without reactions or clinical symptoms during the infusion.…”

Section: Discussioncontrasting

confidence: 79%

Rituximab in relapsing and de novo MPO ANCA-associated vasculitis with severe renal involvement: a case series

et al. 2019

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Background Antineutrophil cytoplasmic antibody associated vasculitis (AAV) is a group of diseases associated in most cases with the presence of anti-neutrophil cytoplasmic antibodies (ANCAs). Rituximab- based remission induction has been proven effective in ANCA associated vasculitis but scarce data exist in forms with severe renal involvement. In this case series, we report the outcomes in patients with de novo or recurrent MPO-AAV and severe renal involvement treated with rituximab without cyclophosphamide (CYC). Methods In this single centre retrospective study, we analysed patients with a clinical diagnosis of de novo or recurrent AAV who met the following criteria: detection of P-ANCA, creatinine clearance lower than 30 ml/min, induction of remission therapy with rituximab without concomitant CYC and a follow up period of at least 6 months. The primary outcomes were complete remission after induction therapy, renal function recovery and mortality after the induction treatment. Results Eight patients met the inclusion criteria. The M:F ratio was 1:7, the average age was 54 years old and the median follow up was 10 months (7–72); in 2 patients there was a MPA renal limited vasculitis. A renal biopsy was performed in 7 patients. The median BVAS score at rituximab induction was 14(range 6–21). Two patients required haemodialysis before the induction treatment. Four patients developed end stage renal disease (ESRD) that required haemodialysis. These data show a remission of the disease, associated with a stabilization of the kidney function in 50% of patients. In 3 patients who did not show a response, there was also no response to CYC. Conclusions This study shows a partial efficacy of rituximab in renal function recovery and a low risk of infectious complications in patients with MPO vasculitis with severe renal involvement, in particular in the short term. The optimal treatment in this subgroup of patients still has to be established because data are lacking.

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Section: Discussioncontrasting

confidence: 79%

Rituximab in relapsing and de novo MPO ANCA-associated vasculitis with severe renal involvement: a case series

et al. 2019

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“…Data on damage in EGPA are scarce, at least when compared with data on GPA and MPA (26–29). Early identification of patients more at risk of damage and better management of the latter remain important unmet needs.…”

Section: Discussionmentioning

confidence: 99%

Clinical Manifestations and Long‐Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America

Doubelt

Cuthbertson

Carette

et al. 2021

ACR Open Rheumatology

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Objective To describe clinical manifestations and outcomes in patients with eosinophilic granulomatosis with polyangiitis (EGPA) in North America. Methods Analysis of patients aged 18 years or older who fulfilled the 1990 American College of Rheumatology Classification Criteria for EGPA enrolled in the Vasculitis Clinical Research Consortium from 2003 to 2019. Main clinical characteristics, treatments, outcomes, and accumulated damage were studied. Results The cohort included 354 patients; 59% female; age at diagnosis of 50.0 (±14) years; 39% were antineutrophil cytoplasm antibody (ANCA) positive. Time from diagnosis to last follow‐up was 7.0 (±6.2) years; 49.4% had one or more relapse. Patients positive for ANCA more commonly had neurological and kidney involvement when compared with patients negative for ANCA, who had more cardiac and lung manifestations. At last study visit, only 35 (12.6%) patients had been off all therapy for more than 2 years during their follow‐up. The overall mortality rate was 4.0% and did not differ by ANCA status or cyclophosphamide use. Scores on the Vasculitis Damage Index (VDI) for 134 patients with two or more visits and more than 1 year of follow‐up increased from 1.7 (±1.8) at enrollment (3.7 [±5.1] years after diagnosis) to 3.35 (±2.1) at last follow‐up (7.5 [±5.8] years after diagnosis), mainly represented by chronic asthma (67.5%), peripheral neuropathy (49.6%), and chronic sinusitis (31.3%). Longer duration of glucocorticoid use and relapse were associated with higher VDI scores. Conclusion This analysis describes the many clinical manifestations and varied outcomes of EGPA and highlights the ongoing need to attain more sustained, long‐term remission to limit the accrual of disease‐related damage.

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“…Сейчас широко обсуждаются изменения опорно-двигательного аппарата при мелкососудистых СВ, ассоциированных с антинейтрофильными цитоплазматическими антителами, -микроскопическом полиангиите [13], гранулематозе с полиангиитом Вегенера [10,11], эозинофильном гранулематозном полиангиите Черджа -Стросса [3,9]. Такие исследования при среднесосудистом узелковом полиартериите (УПА) отсутствуют [4,6].…”

Section: Introductionunclassified

Поражение Опорно-Двигательного Аппарата При Узелковом Полиартериите

Syniachenko

Pomazan

Yermolaieva

et al. 2021

TRAUMA

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Актуальность. Поражение суставов и периартикулярных тканей является одним из основных признаков всех системных васкулитов (СВ). Сейчас широко обсуждаются изменения опорно-двигательного аппарата при мелкососудистых СВ, ассоциированных с антинейтрофильными цитоплазматическими антителами (микроскопический полиангиит, гранулематоз с полиангиитом Вегенера, эозинофильный гранулематозный полиангиит Черджа — Стросса). Такие исследования при среднесосудистом узелковом полиартериите (УПА) отсутствуют. Цель: оценить характер течения и факторы риска патологии суставов и периартикулярных тканей при УПА, выделить прогностические критерии. Материалы и методы. Под наблюдением находились 39 больных УПА (62 % мужчин и 38 % женщин) в возрасте от 17 до 75 лет (в среднем — 44 года). Длительность заболевания составила в среднем 9 лет, соотношение острого и хронического течения патологического процесса было 1 : 7, минимальной, умеренной и высокой степени активности болезни — 1 : 2 : 2. Результаты. Изменения опорно-двигательного аппарата установлены в 97 % случаев УПА. Периферическая нейропатия диагностирована у 82 % от числа больных, периферический артрит — у 63 %, миозит конечностей — у 56 %, тендовагиниты — у 28 %, энтезопатии — у 23 %, сакроилеит и спондилопатия — соответственно у 21 %, альгодистрофия — у 8 %, что было связано с системными проявлениями болезни (в первую очередь с поражением кожи и сердца), функцией почек (с артритом голеностопных сочленений и формированием лигаментоза), степенью активности патологического процесса (с параметрами активности и тяжести суставного синдрома). Тяжесть артропатии прямо коррелирует с уровнем среднего артериального давления, наличием диастолической дисфункции левого желудочка сердца, тендовагинитов и энтезопатий, при этом уровень периферического сосудистого сопротивления обладает прогностической значимостью в отношении миозита конечностей. Выводы. Поражение опорно-двигательного аппарата наблюдается практически во всех случаях УПА, что требует дальнейшего изучения патогенеза такой патологии и разработки индивидуальной медикаментозной технологии лечения больных.

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Long-term damage assessment in patients with microscopic polyangiitis and renal-limited vasculitis using the Vasculitis Damage Index

Abstract: The VDI was found to be a useful tool for determining the severity of damage caused by disease and the effects of treatment. The individual contributions of the VDI items may also be applied to treatment decisions.

Cited by 8 publications

References 12 publications

Rituximab in relapsing and de novo MPO ANCA-associated vasculitis with severe renal involvement: a case series

Rituximab in relapsing and de novo MPO ANCA-associated vasculitis with severe renal involvement: a case series

Clinical Manifestations and Long‐Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America

Поражение Опорно-Двигательного Аппарата При Узелковом Полиартериите

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