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Pulmonary involvement in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis : The influence of ANCA subtype

Mohammad, Aladdin J. LU ; Mortensen, Kristian H.; Babar, Judith; Smith, Rona; Jones, Rachel B; Nakagomi, Daiki; Sivasothy, Pasupathy and Jayne, David R. W. (2017) In Journal of Rheumatology 44(10). p.1458-1467
Abstract

Objective. To describe pulmonary involvement at time of diagnos is in a ntineutrophil cytoplasm ic antibodies (ANCA)-associated vasculitis (AAV), as defined by computed tomography (CT). Methods. Pati ents w ith thoracic CT perfor med on or after the onset of AAV (n = 140; 7 5 women; granulomatosis with polyangiitis, n = 79; microscopic polyangiitis MPA, n = 61) followed at a tertiary referral center vasculitis clinic were studied. Radiological patterns of pulmonary involvement were evaluated from the CT studies using a predefined protocol, and compared to proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA specificity. Results. Of the patients, 77% had an abnormal thoracic CT study. The most common abnormality was nodular disease... (More)

Objective. To describe pulmonary involvement at time of diagnos is in a ntineutrophil cytoplasm ic antibodies (ANCA)-associated vasculitis (AAV), as defined by computed tomography (CT). Methods. Pati ents w ith thoracic CT perfor med on or after the onset of AAV (n = 140; 7 5 women; granulomatosis with polyangiitis, n = 79; microscopic polyangiitis MPA, n = 61) followed at a tertiary referral center vasculitis clinic were studied. Radiological patterns of pulmonary involvement were evaluated from the CT studies using a predefined protocol, and compared to proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA specificity. Results. Of the patients, 77% had an abnormal thoracic CT study. The most common abnormality was nodular disease (24%), of which the majority were peribronchial nodules, followed by bronchiectasis and pleural effusion (19%, each), pulmonary hemorrhage and lymph node enlargement (14%, each), emphysema (13%), and cavitating lesions (11%). Central airways disease and a n odular pattern of pulmonary involvement were more common in PR3-ANCA-positive patients (p < 0.05). Usual interstitial pneumonitis (UIP) and bronchiectasis were more prevalent in MPO-ANCA-positive patients (p < 0.05). Alveolar hemorrhage, pleural effusion, lymph node enlargement, and pulmonary venous congestion were more frequent in MPO-ANCA-positive patients. Conclusion. Pulmonary involvement is frequent and among 140 patients with AAV who underwent a thoracic CT study, almost 80% have pulmonary abnormalities on thoracic CT. Central airway disease oc curs exclusively among patients with PR3-ANCA while UIP were mainl y seen in those wit h MPO-ANCA. These findings may have important implications for the investigation, ma nagement, and pathogenesis of AAV.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ANCA-Associated vasculitis, Computed tomography scan, Myeloperoxidase pulmonary, Outcome, Proteinase 3
in
Journal of Rheumatology
volume
44
issue
10
pages
10 pages
publisher
J Rheumatol Publ Co
external identifiers
  • scopus:85030319384
  • wos:000412085100007
ISSN
0315-162X
DOI
10.3899/jrheum.161224
language
English
LU publication?
yes
id
d788a721-2ba0-4ab6-b44b-0c0fdd6dc5ad
date added to LUP
2017-10-24 15:53:18
date last changed
2018-11-21 21:35:32
@article{d788a721-2ba0-4ab6-b44b-0c0fdd6dc5ad,
  abstract     = {<p>Objective. To describe pulmonary involvement at time of diagnos is in a ntineutrophil cytoplasm ic antibodies (ANCA)-associated vasculitis (AAV), as defined by computed tomography (CT). Methods. Pati ents w ith thoracic CT perfor med on or after the onset of AAV (n = 140; 7 5 women; granulomatosis with polyangiitis, n = 79; microscopic polyangiitis MPA, n = 61) followed at a tertiary referral center vasculitis clinic were studied. Radiological patterns of pulmonary involvement were evaluated from the CT studies using a predefined protocol, and compared to proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA specificity. Results. Of the patients, 77% had an abnormal thoracic CT study. The most common abnormality was nodular disease (24%), of which the majority were peribronchial nodules, followed by bronchiectasis and pleural effusion (19%, each), pulmonary hemorrhage and lymph node enlargement (14%, each), emphysema (13%), and cavitating lesions (11%). Central airways disease and a n odular pattern of pulmonary involvement were more common in PR3-ANCA-positive patients (p &lt; 0.05). Usual interstitial pneumonitis (UIP) and bronchiectasis were more prevalent in MPO-ANCA-positive patients (p &lt; 0.05). Alveolar hemorrhage, pleural effusion, lymph node enlargement, and pulmonary venous congestion were more frequent in MPO-ANCA-positive patients. Conclusion. Pulmonary involvement is frequent and among 140 patients with AAV who underwent a thoracic CT study, almost 80% have pulmonary abnormalities on thoracic CT. Central airway disease oc curs exclusively among patients with PR3-ANCA while UIP were mainl y seen in those wit h MPO-ANCA. These findings may have important implications for the investigation, ma nagement, and pathogenesis of AAV.</p>},
  author       = {Mohammad, Aladdin J. and Mortensen, Kristian H. and Babar, Judith and Smith, Rona and Jones, Rachel B and Nakagomi, Daiki and Sivasothy, Pasupathy and Jayne, David R. W.},
  issn         = {0315-162X},
  keyword      = {ANCA-Associated vasculitis,Computed tomography scan,Myeloperoxidase pulmonary,Outcome,Proteinase 3},
  language     = {eng},
  month        = {10},
  number       = {10},
  pages        = {1458--1467},
  publisher    = {J Rheumatol Publ Co},
  series       = {Journal of Rheumatology},
  title        = {Pulmonary involvement in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis : The influence of ANCA subtype},
  url          = {http://dx.doi.org/10.3899/jrheum.161224},
  volume       = {44},
  year         = {2017},
}