AB0682 Risk factors associated with relapse of anti-neutrophil cytoplasmic antibody-associated vasculitis. (12th June 2018)

• Record Type: Journal Article
• Authors: Nakahara, M.; Yamashita, H.; Takahashi, Y.; Araki, K.; Mino, N.; Suga, K.; Yashima, A.; Kaneko, H.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1484
• Page End: 1484
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.5468
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Several factors increasing the risk of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis have been reported. These include pulmonary and cardiovascular lesions, PR3-ANCA-positivity in patients with granulomatosis with polyangiitis, and persistent ANCA-positivity or an increase in the titer of such antibodies. Objectives: We aimed to identify potentially novel factors predicting relapse in patients with ANCA-associated vasculitis. Methods: We reviewed data on 73 patients (61 with microscopic polyangiitis [MPA], 12 with granulomatosis with polyangiitis [GPA]; 46 females) treated in our centre from 1998 to 2017 for whom medical histories were available. All achieved at least one remission after induction therapy. Relapse was defined as novel organ involvement or a need for therapy intensification. Follow-up continued to the first relapse or for as long as possible if no relapse was noted. Results: The median age at disease onset (interquartile range) was 74 years (range: 67–80 years). The relapse rate was 42.5% (MPA 41%, GPA 50%), thus not significantly different between the two groups (p=0.75). The median follow-up duration was 23 months (range: 11–65 months) and the median time to relapse was 18 months (range: 10.5–54 months). Although pulmonary and cardiac lesions reportedly increase the relapse rate, neither contributed significantly to the rate in this study. Furthermore, ANCA-positivity after remission and increases in ANCA levels prior to relapse did not significantly increase the relapse risk. In terms of medical histories recorded at the time of first onset of disease, the frequency of diabetes, dyslipidemia, coronary artery disease, and cerebral infarction did not differ significantly between patients who did and did not relapse. However, in MPA patients, a history of hypertension was significantly less in those who relapsed (p=0.01). In a multiple logistic regression analysis adjusted for sex and age, history of hypertension was a significant predictor of fewer relapse (odds ratio: 0.23; 95% confidence interval 0.07–0.69, p=0.009). Conclusions: In addition to known factors, a history of hypertension recorded at the time of disease onset may predict fewer MPA relapse. References: [1] Kyndt X, et al. Am J Med. 1999May;106(5):527–33. [2] Hogan SL, et al. Ann Intern Med. 2005Nov 1;143(9):621–31. Disclosure of Interest: None declared