The association between ear involvement and clinical features and prognosis in ANCA-associated vasculitis

Hosokawa, Yuki; Okada, Masahiro; Suemori, Koichiro; Hamaguchi, Naohiko; Miyoshi, Katsuhiko; Takagi, Toshiharu; Teraoka, Masato; Yamada, Hiroyuki; Ishizaki, Jun; Matsumoto, Takuya; Hato, Naohito

doi:10.1016/j.anl.2021.01.023

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…Refractory otitis media observed in AAV was recently defined as otitis media with AAV (OMAAV) by the study group of the Japan Otological Society (7). Approximately 13% to 37% of patients with OMAAV have HP (7–9), which is consistent with previous studies reporting a high prevalence of HP in patients with AAV (3,4).…”

Section: Introductionsupporting

confidence: 91%

Locations and Predictive Factors of Hypertrophic Pachymeningitis in Otitis Media With Antineutrophil Cytoplasmic Antigen-Associated Vasculitis

Morita¹,

Kitazawa²,

Yagi³

et al. 2022

Otol Neurotol

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Objective: To determine the locations and predictive factors of hypertrophic pachymeningitis (HP), a serious central complication of otitis media with antineutrophil cytoplasmic antigen-associated vasculitis (OMAAV). Study Design: Retrospective study. Setting: University hospital. Patients: Thirty-six patients with OMAAVunderwent contrast-enhanced magnetic resonance imaging (CE-MRI) of the brain, of whom 18 and 18 had or did not have HP, respectively. Main Outcome Measures: The location of HP lesions, which were detected as dural thickening on CE-MRI, was reviewed. Clinical characteristics, laboratory data, and audiometric data before treatment were correlated with the occurrence of HP. Results: HP lesions were most frequently observed in the middle cranial fossa, followed by the internal auditory meatus, tentorium cerebelli, and posterior cranial fossa, which were adjacent to the middle ear primary lesion. Headache was more frequently observed in patients with HP than without HP. The neutrophil-to-lymphocyte ratio (NLR) of the HP (+) group (median, 3.91; interquartile range, 2.50-6.06) was higher than that of the HP (−) group (median, 2.40; interquartile range, 2.01-3.03). The area under the receiver operating characteristic curve for the NLR was 0.741. An NLR of 3.46 had the highest sensitivity (61.1%) and specificity (94.4%) for predicting HP. Other markers of systemic inflammation and comorbidities of systemic diseases were not different between the groups. Conclusions: HP may not be a systemic manifestation of OMAAV but may be related to local lesions in the adjacent brain. A high NLR may be a predictive factor for comorbid HP. Therefore, CE-MRI should be considered for patients with a high NLR.

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Section: Introductionsupporting

confidence: 91%

Locations and Predictive Factors of Hypertrophic Pachymeningitis in Otitis Media With Antineutrophil Cytoplasmic Antigen-Associated Vasculitis

Morita¹,

Kitazawa²,

Yagi³

et al. 2022

Otol Neurotol

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“…In a study that Hosokawa et al done on 36 patients in Japan from 2013 to 2018, ear involvement was a factor to predict relapse, but we could not show this factor to be a predictor [35]. Despujol et al conducted a randomized trial on 174 patients in 2010, one of the findings they concluded was about kidney involvement and that it is not a factor for relapse [41], like we showed.…”

Section: Discussioncontrasting

confidence: 71%

“…We recorded following data for the study: demographic features (gender, age, age at diagnosis of GPA), positive or negative MPO-ANCA and PR3-ANCA results, BVAS at diagnosis of patients, involved organs at initial referral and during the course of the disease and GPA relapses. A state of relapse was defined as (1) occurrence of new involvement, (2) recurrence or worsening of clinical manifestations of vasculitis [35].…”

Section: Methodsmentioning

confidence: 99%

Predictors of relapse in granulomatosis with polyangiitis: a multi-center study

Safari

Alesaeidi²,

Pakzad³

et al. 2022

Egypt Rheumatol Rehabil

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Background Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis. Its severity ranges from indolent disease to fulminant that may cause death. With treatment, remission is seen in more than 80% of cases, although relapse is still common. There have been studies showing that there may be factors to predict relapse in GPA. Based on relapses, the decision to start treatment and/or to monitor the patients more closely is made. Therefore, predicting the relapse of GPA can be effective in controlling the disease. Our aim was to investigate possible factors for relapse in GPA. We recruited 254 patients diagnosed with GPA who were under treatment at Alzahra hospital affiliated to Isfahan University of Medical Sciences (from 2013 to 2020) and Amir Alam Hospital affiliated to Tehran University of Medical Sciences (from 2020 to 2022) to plan a retrospective study. Chi-squared or Fisher’s exact tests were performed to compare categorical variables, while the Mann–Whitney U test was used to compare continuous variables. Results Analysis of our patients (aged 20–80,122 females) showed that 147 patients (57.9%) experienced relapse. Mean age in relapse group was 43.8 ± 16.6 and in no-relapse group was 45.6 ± 15.1 (P > 0.05). Among many potential predictors, we observed in multivariate analysis that positive PR3-ANCA (proteinase 3-antineutrophilic cytoplasmic antibodies) (P = 0.007, OR:2.62,CI:1.29–5.31),nose manifestations (P = 0.004, OR 3.00, CI 1.43–6.26), mucosal membranes involvement (P = 0.009, OR 4.21, CI 1.43–12.38), and gastrointestinal tract (GI) complications (P = 0.03, OR 5.64, CI 1.14–27.90) were significant predictors of GPA relapse. Conclusion Among clinical and laboratory features we studied, positive PR3-ANCA, nose manifestations, mucosal membranes involvement, and GI complications were independent predictors of relapse in patients with GPA.

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“…As it has been reported that facial palsy occurs in 5 to 8% patients with GPA (3,11), facial palsy is thought to occur more frequently in patients with OMAAV. In the report investigating the association between ear involvement and clinical features in AAV, the proportion of patients with facial palsy was significantly higher in the OMAAV group than in the non-OMAAV group (13). Although the mechanism of facial palsy in patients with OMAAV is still unknown, granulation spreading to the fallopian canal (14), vasculitis of the vasa nervorum of the facial nerve (15) or intracranial route due to hypertrophic pachymeningitis (14), is speculated as the cause of facial palsy.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of and Prognosis for Facial Palsy in Patients With Otitis Media With ANCA-Associated Vasculitis (OMAAV)

Fujiwara

Morita

Fukuda

et al. 2021

Otology &Amp; Neurotology

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Objectives:The aim of the present study was to investigate the characteristics and prognosis of facial palsy in patients with otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV). Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Thirty-seven patients with OMAAV. Main Outcome Measures: The patients were divided into the facial palsy group and non-palsy group. The severity of and prognosis for facial palsy were evaluated using the House-Brackmann facial grading system (HB). Characteristics were compared between the facial palsy group and nonpalsy group. Results: Facial palsy was observed in eight patients. The last HB grade for all patients was either grade I or II after treatment with a combination of corticosteroids and immunosuppressant therapy. There were no cases in which palsy relapsed. Facial palsy in OMAAV was significantly more common in female patients, and patients with facial palsy demonstrated significantly higher rates of hypertrophic pachymeningitis than did those without facial palsy. Conclusions: Facial palsy in patients with OMAAV was detected in 21.6% and a good prognosis was obtained by use of the appropriate treatment. Facial palsy is one of the most important symptoms by which to diagnose OMAAV. When encountering the patients with intractable otitis media complicated with facial palsy, appropriate examination including ANCA titer should be performed.

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The association between ear involvement and clinical features and prognosis in ANCA-associated vasculitis

Cited by 8 publications

References 24 publications

Locations and Predictive Factors of Hypertrophic Pachymeningitis in Otitis Media With Antineutrophil Cytoplasmic Antigen-Associated Vasculitis

Locations and Predictive Factors of Hypertrophic Pachymeningitis in Otitis Media With Antineutrophil Cytoplasmic Antigen-Associated Vasculitis

Predictors of relapse in granulomatosis with polyangiitis: a multi-center study

Characteristics of and Prognosis for Facial Palsy in Patients With Otitis Media With ANCA-Associated Vasculitis (OMAAV)

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