Interstitial lung disease and ANCA-associated vasculitis: a retrospective observational cohort study

Arulkumaran, Nishkantha; Periselneris, Naomi; Gaskin, G.; Strickland, Nicola H.; Ind, Philip W.; Pusey, Charles D.; Salama, Alan D.

doi:10.1093/rheumatology/ker236

Cited by 115 publications

(156 citation statements)

References 26 publications

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“…Although this has been previously reported in the literature (4,5,7,8,(27)(28)(29)(30)(31), we analyzed CT images in sequential hospital-based patients before they received treatment and determined the prevalence of each imaging component of ILD (Table 2). Ground-glass opacity was the most prevalent component, which indicates that a large proportion of MPA patients have an active inflammatory process in the lungs before they receive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Diffuse alveolar hemorrhage (DAH) is a well-described pulmonary manifestation of small vessel vasculitis (3,6). However, interstitial lung disease (ILD) was recently recognized as a major pulmonary manifestation in patients with MPA (7,8), although its pathogenesis remains largely unknown. Even more intriguingly, a previous histopathologic analysis showed that a wide variety of extravascular pulmonary injuries, including airway lesions, can be observed in patients with AAVs (9).…”

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confidence: 99%

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Prevalence and Responsiveness to Treatment of Lung Abnormalities on Chest Computed Tomography in Patients With Microscopic Polyangiitis: A Multicenter, Longitudinal, Retrospective Study of One Hundred Fifty Consecutive Hospital‐Based Japanese Patients

Yamagata

Ikeda

Tsushima

et al. 2016

Arthritis & Rheumatology

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Objective. To determine the prevalence of lung abnormalities on chest computed tomography (CT) in patients with microscopic polyangiitis (MPA), to assess the responsiveness of such abnormalities to initial treatment, and to assess associations between these abnormalities and patient and disease characteristics and mortality.Methods. We retrospectively identified 167 consecutive hospital-based patients with MPA in 3 hospitals in Japan. We longitudinally collected clinical information for 150 of these patients, for whom CT images obtained before treatment were available. We then determined the presence of 22 imaging components of lung abnormalities in these patients.Results. The vast majority of patients (97%) had at least 1 lung abnormality on chest CT images, including interstitial lung lesions (66%), airway lesions (66%), pleural lesions (53%), and emphysematous lesions (37%). In multivariate analyses, ground-glass opacity was associated with the Birmingham Vasculitis Activity Score, whereas 3 of 4 airway lesions were associated with myeloperoxidase-antineutrophil cytoplasmic antibodies. Latent class analysis identified a distinct group of patients with airwaypredominant lung lesions. Airway lesions such as bronchiolitis and bronchovascular bundle thickening were among the components that showed improvement within 3 months of the initial treatment. An idiopathic pulmonary fibrosis pattern was the only chest CT variable that was independently associated with shorter survival.Conclusion. Abnormalities in a wide range of anatomic areas, including the whole airway, can be identified in the lungs of patients with MPA before treatment. The prevalence, clustering patterns, and responsiveness to treatment of individual lung abnormalities provide groundwork for informing future studies to understand the pathophysiology of MPA.Microscopic polyangiitis (MPA) is a necrotizing systemic vasculitis that affects small to medium-sized vessels. In MPA, immune deposits on the vessel wall are usually absent, and serum antineutrophil cytoplasmic antibodies (ANCAs) are frequently present. MPA shares these

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prevalence and Responsiveness to Treatment of Lung Abnormalities on Chest Computed Tomography in Patients With Microscopic Polyangiitis: A Multicenter, Longitudinal, Retrospective Study of One Hundred Fifty Consecutive Hospital‐Based Japanese Patients

Yamagata

Ikeda

Tsushima

et al. 2016

Arthritis & Rheumatology

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“…As expected, the prognosis of PF in overlap syndromes is worse than individual entities (Cambridge et al 1994;Derrett-Smith et al 2013;Szücs et al 2007). Also, ANCA positivity in PF can predispose to development of ANCA associated vasculitis (AAV) (Arulkumaran et al 2011). Here, we present a case of PF with RA, scleroderma sine scleroderma (SSS) and AAV which has never been reported before and has a grave prognosis.…”

Section: Introductionmentioning

confidence: 65%

A case of pulmonary fibrosis associated with rheumatoid arthritis, scleroderma sine scleroderma and ANCA associated vasculitis.

Anand

Joseph

Vera-Vazquez

2014

Indian Journal of Rheumatology

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“…The characteristic lung manifestation of MPA is diffuse alveolar hemorrhage caused by pulmonary capillaritis, which has been reported in 12-55% of patients [1]. Pulmonary fibrosis is a less frequently described pulmonary manifestation and may precede, manifest at time of or follow the diagnosis of MPA [1,4]. However, Tzelepis et al reported recently a relatively high prevalence of pulmonary fibrosis in patients with MPA [5].…”

Section: Discussionmentioning

confidence: 99%

“…Diffuse alveolar hemorrhage caused by pulmonary capillaritis is the most common manifestation of respiratory involvement presenting clinically with dyspnea, hemoptysis, cough, pleuritic chest pain and anemia [2,3]. Pulmonary fibrosis is a rarely reported clinical feature and can be seen months to years prior to, at the time of, or years after the diagnosis of MPA [1,4].…”

Section: Pulmonary Fibrosis Presentingmentioning

confidence: 99%

Pulmonary fibrosis presenting as an early manifestation of microscopic polyangiitis

Eleftheriou

Katsenos

Zorbas

et al. 2015

Monaldi Arch Chest Dis

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Microscopic polyangiitis (MPA) is a systemic small vessel vasculitis that is included in the pulmonary-renal syndromes. Although glomerulonephritis represents the major clinical feature of MPA indicative of renal involvement, diffuse alveolar haemorrhage is the classic manifestation of pulmonary involvement. However, pulmonary fibrosis is a less frequently reported pulmonary manifestation. Herein we describe a patient who was diagnosed with MPA presenting with radiographic evidence of pulmonary interstitial fibrosis as an early clinical manifestation accompanied by constitutional symptoms such as fever and weight loss. We also include a short literature review focusing on the association between pulmonary fibrosis and MPA.

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Interstitial lung disease and ANCA-associated vasculitis: a retrospective observational cohort study

Cited by 115 publications

References 26 publications

Prevalence and Responsiveness to Treatment of Lung Abnormalities on Chest Computed Tomography in Patients With Microscopic Polyangiitis: A Multicenter, Longitudinal, Retrospective Study of One Hundred Fifty Consecutive Hospital‐Based Japanese Patients

Prevalence and Responsiveness to Treatment of Lung Abnormalities on Chest Computed Tomography in Patients With Microscopic Polyangiitis: A Multicenter, Longitudinal, Retrospective Study of One Hundred Fifty Consecutive Hospital‐Based Japanese Patients

A case of pulmonary fibrosis associated with rheumatoid arthritis, scleroderma sine scleroderma and ANCA associated vasculitis.

Pulmonary fibrosis presenting as an early manifestation of microscopic polyangiitis

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