Prevalence and Clinical Significance of Antineutrophil Cytoplasmic Antibodies in North American Patients With Idiopathic Pulmonary Fibrosis

Liu, Gabrielle Y; Ventura, Iazsmin Bauer; Achtar-Zadeh, Natalia; Elicker, Brett M.; Jones, Kirk D.; Wolters, Paul J.; Collard, Harold R.; Adegunsoye, Ayodeji; Strek, Mary E.; Ley, Brett

doi:10.1016/j.chest.2019.05.014

Cited by 49 publications

(59 citation statements)

References 20 publications

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“…Patients with cardiac involvement had distinct characteristics from those without cardiac involvement in this cohort. According to previous studies [11,12,17,29], EGPA was more common in male than female, which was also observed in our cohort (male vs. female, 68.7% vs. 31.3%).…”

Section: Discussionsupporting

confidence: 89%

Cardiac involvement in eosinophilic granulomatosis with polyangitis: a retrospective study in Chinese population

Chen

Zhou

et al. 2020

Preprint

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Background: Cardiac involvement in EGPA indicates poor prognosis and high mortality, while few data about cardiac involvement of EGPA in Chinese population are available. We conducted this study to figure out the clinical characteristics and overall outcome of EGPA patients with cardiac involvement in Chinese population.Methods: We retrospectively collected the clinical data of 83 patients diagnosed with EGPA and analyzed the differences between patients with and without cardiac involvement.Results: The prevalence of cardiac involvement of EGPA in this cohort was 27.7%. Compared with those who without cardiac involvement, EGPA patients with cardiac involvement tended to have younger onset age (mean ± SD, 38.4 ± 10.5 vs. 42.1 ± 15.9 years, p=0.039), higher eosinophil count [median (IQR), 5810 (4020-11090) vs. 2880 (1530-6570) n/μL , p=0.004)], higher disease activity [median (IQR), 20 (16-28) vs. 15 (12-18), p=0.001)] and poorer prognosis (FFS≥1, 100% vs. 38.3%, p=0.001). The most common cardiac manifestation was chest pain (56.5%), and 43.5% of patients were asymptomatic but cardiac abnormalities could be detected by cardiac examinations. With appropriate treatment, the overall outcome of EGPA patients with cardiac involvement in our cohort turned out to be good, with 3 ( 13% ) patients died at acute phase and no patient died during follow-up.Conclusions: Cardiac involvement was common in EGPA and was associated with younger onset age, higher eosinophil count, higher disease activity and poorer prognosis. Comprehensive cardiac examinations and appropriate treatment are essential to improve the prognosis of cardiac involvement.

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Section: Discussionsupporting

confidence: 89%

Cardiac involvement in eosinophilic granulomatosis with polyangitis: a retrospective study in Chinese population

Chen

Zhou

et al. 2020

Preprint

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“…For this reason, ANCAs are not currently included in any classification criteria, neither for AAV nor for IPAF [89]. However, in recent studies, patients with Idiopathic Pulmonary Fibrosis (IPF) and ANCA positivity developed vasculitis (MPA and GPA) [86,90]. This is in line with the current knowledge that recognizes the Usual Interstitial Pneumonia (UIP) pattern as the most common ILD in AAV [91].…”

Section: First-line Autoimmunity Examsmentioning

confidence: 87%

Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

Sambataro

Pignataro³

et al. 2020

Diagnostics

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The diagnostic assessment of patients with Interstitial Lung Disease (ILD) can be challenging due to the large number of possible causes. Moreover, the diagnostic approach can be limited by the severity of the disease, which may not allow invasive exams. To overcome this issue, the referral centers for ILD organized Multidisciplinary Teams (MDTs), including physicians and experts in complementary discipline, to discuss the management of doubtful cases of ILD. MDT is currently considered the gold standard for ILD diagnosis, but it is not often simple to organize and, furthermore, rheumatologists are still not always included. In fact, even if rheumatologic conditions represent a common cause of ILD, they are sometimes difficult to recognize, considering the variegated clinical features and their association with all possible radiographic patterns of ILD. The first objective of this review is to describe the clinical, laboratory, and instrumental tests that can drive a diagnosis toward a possible rheumatic disease. The secondary objective is to propose a set of first-line tests to perform in all patients in order to recognize any possible rheumatic conditions underlying ILD.

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“…Whereas treatment of ILD in patients with other AAV manifestations follows the typical approaches described earlier, the management of ILD and a positive ANCA test without other AAV manifestations is uncertain. In a small case series that included 36 patients, approximately 20-30% of patients with ANCA positivity and ILD went on to develop AAV, especially those who were MPO-ANCA positive 142. A case series of 12 patients with usual interstitial pneumonia associated with ANCA positivity reported improvement in ILD with immunosuppression,143 but other series (n<20) did not report a benefit 144145.…”

Section: Treatment Challenges Associated With Specific Manifestationsmentioning

confidence: 99%

Management of ANCA associated vasculitis

Wallace

Miloslavsky

2020

BMJ

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Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a small to medium vessel vasculitis associated with excess morbidity and mortality. This review explores how management of AAV has evolved over the past two decades with pivotal randomized controlled trials shaping the management of induction and maintenance of remission. Contemporary AAV care is characterized by approaches that minimize the cumulative exposure to cyclophosphamide and glucocorticoids, increasingly use rituximab for remission induction and maintenance, and consider therapies with less toxicity (for example, methotrexate, mycophenolate mofetil) for manifestations of AAV that do not threaten organ function or survival. Simultaneously, improvements in outcomes, such as renal and overall survival, have been observed. Additional trials and observational studies evaluating the comparative effectiveness of agents for AAV in various patient subgroups are needed. Prospective studies are necessary to assess the effect of psychosocial interventions on patient reported outcomes in AAV. Despite the expanding array of treatments for AAV, little guidance on how to personalize AAV care is available to physicians.

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Prevalence and Clinical Significance of Antineutrophil Cytoplasmic Antibodies in North American Patients With Idiopathic Pulmonary Fibrosis

Cited by 49 publications

References 20 publications

Cardiac involvement in eosinophilic granulomatosis with polyangitis: a retrospective study in Chinese population

Cardiac involvement in eosinophilic granulomatosis with polyangitis: a retrospective study in Chinese population

Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

Management of ANCA associated vasculitis

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