Significance of clinical-immunological patterns and diagnostic yield of biopsies in microscopic polyangiitis and granulomatosis with polyangiitis.
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Fernandes-Serodio João, Prieto-González Sergio, Espígol-Frigolé Georgina, Ríos-Garcés Roberto, Gómez-Caverzaschi Verónica, Araújo Olga, Espinosa Gerard, Jordà-Sánchez Raül, Alba Marco A, Quintana Luis, Blasco Miquel, Guillen Elena, Viñas Odette, Ruiz-Ortiz Estíbaliz, Pelegrín Laura, Sainz de la Maza Maite, Sánchez-Dalmau Bernardo, García-Herrera Adriana, Solé Manel, Castillo Paola, Aldecoa Iban, Cano María D, Sellarés Jacobo, Hernández-González Fernanda, Agustí Carlos, Lucena Carmen M, López-Rueda Antonio, Sánchez Marcelo, Benegas Mariana, Capurro Sebastián, Sanmartí Raimon, Grau Josep M, Vilaseca Isabel, Alobid Isam, Cid Maria C, Hernández-Rodríguez José
Аннотация
OBJECTIVES: To characterize a homogenous AAV cohort and to assess the impact of clinicopathological profiles and ANCA serotypes on clinical presentation and prognosis. Clinical differences in GPA patients according to ANCA serotype and the diagnostic yield for vasculitis of biopsies in different territories were also investigated.
RESULTS: This retrospective study (2000-2021) included 152 patients with AAV (77 MPA/75 GPA). MPA patients (96.1% myeloperoxidase [MPO]-ANCA and 2.6% proteinase 3 [PR3]-ANCA) presented more often with weight loss, myalgia, renal involvement, interstitial lung disease (ILD), cutaneous purpura, and peripheral nerve involvement. Patients with GPA (44% PR3-ANCA, 33.3% MPO, and 22.7% negative/atypical ANCA) presented more commonly with ear, nose, and throat and eye/orbital manifestations, more relapses, and higher survival than patients with MPA. GPA was the only independent risk factor for relapse. Poor survival predictors were older age at diagnosis and peripheral nerve involvement. ANCA serotypes differentiated clinical features in a lesser degree than clinical phenotypes. A mean of 1.5 biopsies were performed in 93.4% of patients in different territories. Overall, vasculitis was identified in 80.3% (97.3% in MPA and 61.8% in GPA) of patients.
CONCLUSIONS: The identification of GPA presentations associated with MPO-ANCA and awareness of risk factors for relapse and mortality are important to guide proper therapeutic strategies in AAV patients. Biopsies of different affected territories should be pursued in difficult-to-diagnose patients based on their significant diagnostic yield.