Inflammatory bowel diseases in anti-neutrophil cytoplasmic antibody–associated vasculitides: 11 retrospective cases from the French Vasculitis Study Group

Humbert, S.; Guilpain, Philippe; Puéchal, Xavier; Terrier, Benjamin; Rivière, Sophie; Mahr, Alfred; Pagnoux, Christian; Bagnères, D.; Cordier, Jean-François; Quellec, A. Le; Altwegg, Romain; Guillevin, Loı̈c

doi:10.1093/rheumatology/kev199

Cited by 36 publications

(19 citation statements)

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“…A recent genetics study showed that patients with TAK complicated with UC displayed higher positivity for HLA-B * 52:01 than patients without UC [20]. Granulomatous inflammation is a hallmark of both TAK and GPA, as is also a key feature of CD [21,22]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients with IBD and TAK were also more likely to have constitutional symptoms, gastrointestinal symptoms, and headache/dizziness but were less likely to experience claudication of the extremities. A recent case series of 11 patients with ANCA-associated vasculitides (7 patients with GPA and CD and 4 with EGPA and UC) suggested that the coexistence of GPA and UC or EGPA and CD was infrequent [22]. We did not observe this exclusive associative pattern in our patients (1 GPA with CD, 3 GPA with UC, 1 EGPA with CD, and 1 EGPA with UC), but our study replicates another important finding—that the diagnosis of IBD most often antedates the diagnosis of ANCA-associated vasculitis.…”

Section: Discussionmentioning

confidence: 99%

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Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature

Khalidi

Dehghan

et al. 2016

Seminars in Arthritis and Rheumatism

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120

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Background Published small case series suggest that inflammatory bowel disease [IBD; Crohn’s disease (CD) or ulcerative colitis (UC)] and vasculitis co-occur more frequently than would be expected by chance. Objectives To describe this association by an analysis of a large cohort of carefully studied patients and through a systematic literature review. Methods Patients with both IBD and vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Studies, followed in Canadian Vasculitis research network (CanVasc) centers and/or in the University of Toronto’s IBD clinic were included in this case series. A systematic literature review of patients with IBD and vasculitis involved a PubMed search through February 2014. The main characteristics of patients with Takayasu arteritis (TAK) and IBD were compared to those in patients with TAK without IBD followed in the VCRC. Results The study identified 32 patients with IBD and vasculitis: 13 with large-vessel vasculitis [LVV; 12 with TAK, 1 with giant cell arteritis (GCA); 8 with CD, 5 with UC]; 8 with ANCA-associated vasculitis [AAV; 6 granulomatosis with polyangiitis (GPA), 2 with eosinophilic granulomatosis with polyangiitis (EGPA)]; 5 with isolated cutaneous vasculitis; and 6 with other vasculitides. Patients with LVV and AAV were mostly female (18/21). The diagnosis of IBD preceded that of vasculitis in 12/13 patients with LVV and 8/8 patients with AAV. The review of the literature identified 306 patients with IBD and vasculitis: 144 with LVV (133 TAK; 87 with IBD preceding LVV), 19 with AAV [14 GPA, 1 EGPA, 4 microscopic polyangiitis (MPA)], 66 with isolated cutaneous vasculitis, and 77 with other vasculitides. Patients with IBD and TAK were younger and had more frequent headaches, constitutional symptoms, or gastrointestinal symptoms compared to those patients in the VCRC who had TAK without IBD. Conclusions These findings highlight the risk of vasculitis, especially TAK, in patients with IBD (both CD and UC).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature

Khalidi

Dehghan

et al. 2016

Seminars in Arthritis and Rheumatism

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120

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“…3). The coexistence of AAV with IBD has been described in some patients, but is rare 95,96 . In this context, IBD usually precedes AAV by several years 96 .…”

Section: Recommandationmentioning

confidence: 99%

Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis

et al. 2017

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| Anti-neutrophil cytoplasmic antibodies (ANCAs) are valuable laboratory markers used for the diagnosis of well-defined types of small-vessel vasculitis, including granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). According to the 1999 international consensus on ANCA testing, indirect immunofluorescence (IIF) should be used to screen for ANCAs, and samples containing ANCAs should then be tested by immunoassays for proteinase 3 (PR3)-ANCAs and myeloperoxidase (MPO)-ANCAs. The distinction between PR3-ANCAs and MPO-ANCAs has important clinical and pathogenic implications. As dependable immunoassays for PR3-ANCAs and MPO-ANCAs have become broadly available, there is increasing international agreement that high-quality immunoassays are the preferred screening method for the diagnosis of ANCA-associated vasculitis. The present Consensus Statement proposes that high-quality immunoassays can be used as the primary screening method for patients suspected of having the ANCA-associated vaculitides GPA and MPA without the categorical need for IIF, and presents and discusses evidence to support this recommendation.NATURE REVIEWS | RHEUMATOLOGY VOLUME 13 | NOVEMBER 2017 | 683 CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .Given the improvements in antigen-specific immuno assays, the international consensus on the testing of ANCAs in small-vessel vasculitis seems in need of updating [7][8][9][10] . In this manuscript, a revised 2017 international consensus is proposed by a group of international experts (from North and Central America, Australia, Europe and Asia) in the ANCA field. This Consensus Statement highlights the value of ANCA testing as a tool for diagnosis (but not follow-up) of GPA and MPA and gives a historical perspective of ANCAs in small-vessel vasculitis. This Consensus Statement does not, however, present evidence-based guidelines or a meta-analysis. MethodsThis Consensus Statement was prepared by a group of experts from four European laboratories (X.B., J.D., N.R., J.W.C.T. and E.C.) in person and by correspondence. The draft was circulated to each contributor and modified, and the resulting document was distributed by e-mail to 16 experts from four continents, selected based on their expertise and knowledge in clinical and/or laboratory aspects of AAV. This revised document resulted in a second round of discussions and revisions. The final document was returned to all contributors for ratification.The Consensus Statement is based on the results of a multicentre European Vasculitis Study Group (EUVAS) evaluation of the value of IIF versus antigen-specific immunoassays for ANCA detection 6,11,12 . This study, which showed a large variability between different IIF methods and a good diagnostic performance of PR3-ANCA and MPO-ANCA immunoassays 6 , indicated that the 1999 international consensus on ANCA testing for AAV needed revision. When the consensus was put toget...

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“…Similarly, there was a strong female predominance (especially in large vessel and AAV), and IBD-preceded vasculitis also in about ∼70%. Data from France confirmed these findings [10,11]. In a more general setting such as systemic lupus erythematosus, most of the GI comorbidities were found to be of the IBD type.…”

Section: Clinical Presentationmentioning

confidence: 64%

Gut and Liver in Vasculitic Disorders

Müller‐Ladner

2016

Dig Dis

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Background: Although the gastrointestinal (GI) tract including its related organs is not generally regarded as one of the primary organ systems of primary and secondary vasculitic disorders, there are numerous mechanisms of these diseases operative in or around the different structures and compartments of the GI tract. Key Messages: A majority of the respective clinical symptoms and problems are linked to an alteration of (peri)vascular homeostasis. Alteration of perivascular matrix metabolism can also affect the functional integrity and motility of the GI tract. Apart from the specific GI phenomena of the individual diseases as outlined in detail in this review, the epidemiology of GI involvement follows in general the characteristics of the respective underlying systemic disease. In addition, gender and age do neither influence the occurrence nor the severity of the GI manifestations significantly. With respect to clinical symptoms, vasculitides may result in abdominal pain, bleeding, ileus, intestinal necrosis and hematochezia because of reduced blood flow and hyper-acute occlusion in the antiphospholipid syndrome. Small-bowel involvement in vasculitic entities can cause pseudoobstruction, obstruction, malabsorption and bacterial overgrowth. Laboratory parameters can point to specific diseases but are frequently nonspecific. Thus, if biopsy fails or in unclear endoscopic situations, a variety of imaging techniques including Doppler ultrasound, abdominal CT, MRI and angiography are used and required for identification and localization of the underlying disease. Therapeutic strategies in vasculitides usually include corticosteroids and immunosuppressants, for example, cyclophosphamide in granulomatosis with polyangiitis and in panarteriitis nodosa but also biologics such as rituximab in ANCA-associated vasculitides. Virostatic drugs including interferon-α and ribavirin can be used in hepatitis B- and C-triggered vasculitides such as panarteriitis nodosa and hepatitis C-associated cryoglobulinemia. Conclusions: Immediate diagnostic and therapeutic steps of action need to be performed if vasculitis of the GI tract is suspected in order to avoid irreversible damage to organs and to improve the well-being and life of the affected patient.

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Inflammatory bowel diseases in anti-neutrophil cytoplasmic antibody–associated vasculitides: 11 retrospective cases from the French Vasculitis Study Group

Cited by 36 publications

References 18 publications

Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature

Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature

Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis

Gut and Liver in Vasculitic Disorders

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