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- Mohammad, Aladdin J., et al.
(författare)
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Pulmonary involvement in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis : The influence of ANCA subtype
- 2017
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 44:10, s. 1458-1467
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Tidskriftsartikel (refereegranskat)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 (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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| 3. |
- Nakagomi, Daiki, et al.
(författare)
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Development of a score for assessment of radiologic damage in large-vessel vasculitis (Combined Arteritis Damage Score, CARDS)
- 2017
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Ingår i: Clinical and Experimental Rheumatology. - 0392-856X. ; 35:1, s. 139-145
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Outcome assessment in large-vessel vasculitis (LVV) remains challenging and this impairs patient management and the conduct of clinical studies. Previous proposals for outcome tools have not included imaging. This study aimed to develop an imaging score to quantify damage in LVV and to assess the difference between Takayasu (TAK) and giant cell arteritis (GCA).METHODS: Ninety-six patients (41 TAK, 55 GCA) were identified from local registries at two University Hospitals in the UK. Radiologic lesions including stenosis, occlusion and aneurysm were evaluated in 25 arterial regions by enhanced computed tomography or magnetic resonance angiography. Lesion correlation with combined damage assessment scores was employed in a multiple regression analysis to define the weight of individual lesions and develop a damage index.RESULTS: A numerical damage index was developed: the "Combined Arteritis Damage Score (CARDS)". The index was derived from a formula: number of regions with mild stenosis × 0.6 + number of regions with moderate to severe stenosis × 1.2 + number with occlusions × 1.6 + number with aneurysms × 0.8 in 25 arterial regions. The median CARDS was higher in TAK than GCA (4.1 and 0.6, interquartile range 1.3-5.7 and 0-3, p<0.001).CONCLUSIONS: We have developed a damage assessment tool, CARDS, based on imaging in LVV of potential value to clinical studies and patient management. TAK and GCA differ in the radiologic severity of disease.
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