Clinical impact of proteinase 3-antineutrophil cytoplasmic antibody positivity in eosinophilic granulomatosis with polyangiitis
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Background/Aims: This study investigated the clinical implication of proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA) in Korean patients with eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Among the 242 patients with ANCA-associated vasculitis identified from the hospital database, 49 patients with EGPA were selected and analysed in this study. Demographic, clinical, and laboratory data at diagnosis were reviewed to compare the features of patients with PR3-ANCA and without, as well as the clinical outcomes of relapse and end-stage renal disease (ESRD) during the follow-up period. The outcomes of patients with PR3-ANCA and without were compared by using the Kaplan-Meier survival analysis. Results: The median age of the patients was 54 years, 17 (34.7%) were male, and six (12.2%) patients had PR3-ANCA at baseline. The most common items of the 1990 American College of Rheumatology criteria for EGPA were sinusitis (95.9%) and asthma (or asthmatic history) (93.9%). During the follow-up, none died, eight experienced relapse and two progressed to ESRD. EGPA patients with PR3-ANCA exhibited peripheral eosinophilia less frequently than those without (50.0% vs. 88.4%, p = 0.047). On the other hand, EGPA patients with PR3-ANCA experienced relapse more often compared to those without (50.0% vs. 11.6%, p = 0.047), and the cumulative relapse-free survival rate was lower compared to those without PR3-ANCA (p = 0.012). Conclusions: EGPA patients possessing PR3-ANCA at disease diagnosis had distinct clinical feature and outcome compared to those without PR3-ANCA. These results should be taken into account in the management of patients with EGPA.
Abstract
Background/Aims: This study investigated the clinical implication of proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA) in Korean patients with eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Among the 242 patients with ANCA-associated vasculitis identified from the hospital database, 49 patients with EGPA were selected and analysed in this study. Demographic, clinical, and laboratory data at diagnosis were reviewed to compare the features of patients with PR3-ANCA and without, as well as the clinical outcomes of relapse and end-stage renal disease (ESRD) during the follow-up period. The outcomes of patients with PR3-ANCA and without were compared by using the Kaplan-Meier survival analysis. Results: The median age of the patients was 54 years, 17 (34.7%) were male, and six (12.2%) patients had PR3-ANCA at baseline. The most common items of the 1990 American College of Rheumatology criteria for EGPA were sinusitis (95.9%) and asthma (or asthmatic history) (93.9%). During the follow-up, none died, eight experienced relapse and two progressed to ESRD. EGPA patients with PR3-ANCA exhibited peripheral eosinophilia less frequently than those without (50.0% vs. 88.4%, p = 0.047). On the other hand, EGPA patients with PR3-ANCA experienced relapse more often compared to those without (50.0% vs. 11.6%, p = 0.047), and the cumulative relapse-free survival rate was lower compared to those without PR3-ANCA (p = 0.012). Conclusions: EGPA patients possessing PR3-ANCA at disease diagnosis had distinct clinical feature and outcome compared to those without PR3-ANCA. These results should be taken into account in the management of patients with EGPA.
참고문헌 (19)
- Jennette JC, "2012 Revised International Chapel Hill consensus conference nomenclature of vasculitides", Arthritis Rheum, 65, pp.1~11 (2013)
- Greco A, "Churg-Strauss syndrome", Autoimmun Rev, 14, pp.341~348 (2015)
- Radice A, "Anti-neutrophil cytoplasmic autoantibodies : methodological aspects and clinical significance in systemic vasculitis", Autoimmun Rev, 12, pp.487~495 (2013)
- Masi AT, "The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome(allergic granulomatosis and angiitis)", Arthritis Rheum, 33, pp.1094~1100 (1990)
- Watts R, "Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies", Ann Rheum Dis, 66, pp.222~227 (2007)
- Millet A, "Antineutrophil cytoplasmic antibody-associated vasculitides : is it time to split up the group?", Ann Rheum Dis, 72, pp.1273~1279 (2013)
- 최찬범, "Eosinophilic Granulomatosis with Polyangiitis: Experiences in Korean Patients", Yonsei Medical Journal, 60(8), pp.705~712 (2019), 연세대학교의과대학[DOI]
- Cornec D, "ANCA-associated vasculitis : clinical utility of using ANCA specificity to classify patients", Nat Rev Rheumatol, 12, pp.570~579 (2016)
- Yoo J, "Clinical and prognostic features of Korean patients with MPO-ANCA, PR3-ANCA and ANCA-negative vasculitis", Clin Exp Rheumatol, 35(Suppl 103), pp.111~118 (2017)
- Papo M, "Significance of PR3-ANCA positivity in eosinophilic granulomatosis with polyangiitis(Churg-Strauss)", Rheumatology(Oxford), 60, pp.4355~4360 (2021)
- Leavitt RY, "The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis", Arthritis Rheum, 33, pp.1101~1107 (1990)
- Mukhtyar C, "Modification and validation of the Birmingham Vasculitis Activity Score(version 3)", Ann Rheum Dis, 68, pp.1827~1832 (2009)
- Guillevin L, "The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG)cohort", Medicine(Baltimore), 90, pp.19~27 (2011)
- Webster AC, "Chronic kidney disease", Lancet, 389, pp.1238~1252 (2017)
- Mukhtyar C, "Outcomes from studies of antineutrophil cytoplasm antibody associated vasculitis : a systematic review by the European League Against Rheumatism systemic vasculitis task force", Ann Rheum Dis, 67, pp.1004~1010 (2008)
- Yates M, "EULAR", ERA-EDTA recommendations for the management of ANCA-associated vasculitis, 2016, pp.75, 1583~1594
- Kitching AR, "ANCA-associated vasculitis", Nat Rev Dis Primers, 6, pp.71~ (2020)
- Fussner LA, "Factors determining the clinical utility of serial measurements of antineutrophil cytoplasmic antibodies targeting proteinase 3", Arthritis Rheumatol, 68, pp.1700~1710 (2016)
- Yoo J, "The utility of the ACR", EULAR 2017 provisional classification criteria for granulomatosis with polyangiitis in Korean patients with antineutrophil cytoplasmic antibody-associated vasculitis, 2017, pp.36(Suppl 111), 85~87