Association of Cigarette Smoking With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

McDermott, Gregory; Fu, Xiaoqing; Stone, John H.; Wallwork, Rachel; Zhang, Yuqing; Choi, Hyon K.; Wallace, Zachary S

doi:10.1001/jamainternmed.2020.0675

Cited by 34 publications

(24 citation statements)

References 37 publications

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“…By contrast, pollution, specifically carbon monoxide levels, has been associated with increased AAV risk in population-dense regions of China 30 . Other postulated risk factors include ultraviolet light 31 , smoking 32 , solvents 24 and occupational solvent exposure 24 , but no single environmental factor seems to confer a major population-attributable risk. Similarly, specific drugs are responsible for some cases of vasculitis with syndromes similar to AAV (box 3).…”

Section: Risk Factors and Disease Determinantsmentioning

confidence: 99%

ANCA-associated vasculitis

Kitching

Anders

Basu

et al. 2020

Nat Rev Dis Primers

575

507

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The anti-neutrophil cytoplasmic antibody (ANCA)associated vasculitides (AAVs) are diseases characterized by inflammation of blood vessels, endothelial injury and tissue damage. The three types of small-vessel vasculitis, namely granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic GPA (EGPA; previously known as Churg-Strauss syndrome), feature a loss of tolerance to neutrophil primary granule proteins, most often leukocyte proteinase 3 (PR3; also known as myeloblastin) or myeloperoxidase (MPO) (Table 1). The vessels involved in AAV are typically capillaries, arterioles and venules but small arteries and veins may also be affected. Autoimmunity is documented clinically by serum ANCAs to PR3 (PR3-ANCA) or MPO (MPO-ANCA), which are generally associated with the main syndromic AAV presentations (box 1). AAVs collectively represent one of several types of autoimmune vasculitis (Fig. 1). GPA and MPA can involve small blood vessels in any organ or tissue but commonly affect the upper and lower respiratory tract and the kidneys (box 2). Patients with AAV typically present with severe organ-threatening or life-threatening disease, although less severe presentations also occur. GPA is predominantly associated with PR3-ANCA and its clinical features typically include sinonasal disease, lower respiratory tract involvement with pulmonary haemorrhage and granulomatous inflammation, and glomerulonephritis. MPA is usually associated with MPO-ANCA and clinical features include more severe renal disease and some of the manifestations of GPA but without granulomatous inflammation. EGPA is characterized by asthma, eosinophilia and, in many (but not all) cases, vasculitis. EGPA is less common than GPA or MPA and, in some cases, is associated with ANCAs, mainly MPO-ANCA (Table 1). Although categorized as a form of AAV, EGPA has less overlap with the other AAVs than that between GPA and MPA with regard to its genetic, pathogenetic, and clinical features and its management and is typically considered a separate entity. Improvements in treatment and prognosis for patients with AAV have resulted from the translation of both preclinical and clinical research findings. Here, we provide an updated overview of the clinical and

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Section: Risk Factors and Disease Determinantsmentioning

confidence: 99%

ANCA-associated vasculitis

Kitching

Anders

Basu

et al. 2020

Nat Rev Dis Primers

575

507

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“…The relationship between smoking and the other AAVs is controversial. While a recent study performed in the US identified smoking as a risk factor for AAV (23), findings from previous European studies identified a protective effect (24), or no effect at all (6,25). Interestingly, the prevalence of smoking is extremely low among patients with chronic eosinophilic lung disorders such as chronic eosinophilic pneumonia (prevalence in ever‐smokers is 10–30%) (26), which may be considered a forme fruste of EGPA.…”

Section: Discussionmentioning

confidence: 89%

Occupational Exposures and Smoking in Eosinophilic Granulomatosis With Polyangiitis: A Case–Control Study

Maritati

Peyronel

Fenaroli

et al. 2021

Arthritis & Rheumatology

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Objective Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis. Environmental agents and occupational exposures may confer susceptibility to EGPA, but data are scarce. This study was undertaken to investigate the association between occupational exposures (e.g., silica, farming, asbestos, and organic solvents) and other environmental agents (e.g., smoking) and the risk of EGPA. Methods Patients with newly diagnosed EGPA (n = 111) and general population controls (n = 333) who were matched for age, sex, and geographic area of origin were recruited at a national referral center for EGPA. Exposures were assessed using a dedicated questionnaire administered by a specialist in occupational medicine, under blinded conditions. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results Exposures to silica (OR 2.79 [95% CI 1.55–5.01], P = 0.001), organic solvents (OR 3.19 [95% CI 1.91–5.34], P < 0.001), and farming (OR 2.71 [95% CI 1.71–4.29], P < 0.001) were associated with an increased risk of EGPA. Co‐exposure to silica and farming yielded an OR of 9.12 (95% CI 3.06–27.19, P < 0.001), suggesting a multiplicative effect between these 2 exposures. Smoking (current and former smokers combined) was significantly less frequent among patients with EGPA compared to controls (OR 0.49 [95% CI 0.29–0.70], P < 0.001). The pack‐year index was also lower among patients with EGPA (OR 0.96 [95% CI 0.94–0.98], P < 0.001). The association of silica and farming was primarily aligned with ANCA‐positive EGPA, while the association of smoking status and organic solvents was primarily aligned with ANCA‐negative EGPA. Conclusion The environment can influence susceptibility to EGPA. Exposure to silica, farming, or organic solvents is associated with an increased risk of EGPA, while smoking is associated with a lower risk. These exposures seem to have distinct effects on different EGPA subsets.

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“…Staphylococcus aureus is a common bacterium that has been implicated in the genesis of ANCAs[ 11 ]. Cigarette smoking and drugs that we mentioned above are also involved in inducing ANCA production[ 12 , 13 ]. There was no evidence that this patient had been infected with bacteria according to the physical examination upon admission.…”

Section: Discussionmentioning

confidence: 99%

Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in a 77-year-old man: A case report

Xu¹,

Li²,

Wang³

et al. 2021

WJCC

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BACKGROUND Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are classically thought to cause renal impairment and small vessel vasculitis with different pathophysiologies. Their overlap constitutes a rare rheumatologic disease. To date, only dozens of such cases with biopsy-proven glomerulonephritis have been reported worldwide typically in women of childbearing age. Here, we present a unique clinical case due to its rarity and individualized treatment of a Chinese man in his eighth decade of life. CASE SUMMARY A 77-year-old man was admitted to several hospitals for shortness of breath and received nonspecific treatments over the past 3 years. As his symptoms were not completely relieved, he visited our hospital for further treatment. Laboratory examinations revealed kidney dysfunction, severe anaemia, hypocom-plementemia, glomerular proteinuria, and microscopic haematuria. Antinuclear antibodies, as well as anti-dsDNA antibodies, were positive. Computed tomography of the chest showed right pleural effusion. Renal biopsy was performed, and histology suggested crescentic glomerulonephritis, pauci-immune type. After treatment with plasmapheresis, glucocorticoid, and cyclo-phosphamide, the disease was in remission, and the patient remained in a stable condition for over 3 years post-hospital discharge. CONCLUSION Due to its complexity and rarity, SLE and AAV overlap syndrome is easily misdiagnosed. An accurate diagnosis and treatment at the earliest stage may significantly improve the condition and reduce irreversible organ injury.

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Association of Cigarette Smoking With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Cited by 34 publications

References 37 publications

ANCA-associated vasculitis

ANCA-associated vasculitis

Occupational Exposures and Smoking in Eosinophilic Granulomatosis With Polyangiitis: A Case–Control Study

Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in a 77-year-old man: A case report

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