THU0338 Clinical presentation and outcomes of eosinophilic granulomatosis with polyangiitis: anca-negative versus anca-positive

Abstract

ObjectivesThe aim of the prospective study was to compare clinical presentation at diagnosis and long-term outcomes of eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) patients according to antineutrophil cytoplasmic antibody (ANCA) status.MethodsEGPA was classified according to the Revised CHCC Nomenclature and ACR1990 criteria. Activity of vasculitis was evaluated using BVAS. A minor relapse was defined as an increase in at least one new or worse minor item and no major BVAS items. A major relapse was an increase in at least one major BVAS item.ResultsWe followed 93 patients with EGPA for a mean±SD of 6.3±6.5 years. Their mean±SD age was 46.6±13.8 years, and 96.8% patients had a history of asthma. The most common EGPA manifestations at diagnosis included ENT manifestations (88.2%), fever (78.5%), peripheral neuropathy (73.1%), lung involvement (59.1%) and skin lesions (49.5%). Thirty seven of 93 patients (39.8%) were ANCA-positive. These patients had significantly more frequent myalgia and mononeuritis multiplex, than the ANCA-negative patients. The difference in occurrence of kidney disease between the two groups did not reach statistical significance. However, all three patients with rapidly progressive kidney failure were ANCA-positive. BVAS at diagnosis and VDI at the end of the follow-up were significantly higher for ANCA-positive patients. The follow up duration was 587.7 patient-years. The incidence of all vasculitis relapses was 14 per 100 patient-years, including major and minor vasculitis relapses (5.3 and 8.7 per 100 patient-years, respectively). The 3- and 5-year relapse-free survival rate was 65.4% (95% CI 54.6–76.2) and 43.1% (95% CI 30.4–55.7), respectively. The frequency of vasculitis relapses was 21.0 per 100 patient-years in the ANCA-positive group versus 19.6 per 100 patient-years in the ANCA-negative group (P=0.4).Table 1.Main clinical characteristics at diagnosis of the 71 patients with EGPA, according to ANCA statusManifestationsANCA+ (n=37)ANCA- (n=34)P Fever30 (81.1)25 (73.5)0.57Myalgia22 (59.5)10 (29.4) 0.02 ENT33 (89.2)30 (88.2)1.00Lung24 (64.9)19 (55.9)0.47Cutaneous24 (64.9)15 (44.1)0.10Peripheral neuropathy30 (81.1)21 (61.8)0.11Mononeuritis multiplex17 (45.9)6 (17.6) 0.01 Cardiovascular13 (35.1)10 (29.4)0.62Gastrointestinal4 (10.8)4 (11.8)1.00Renal11 (29.7)5 (14.7)0.16BVAS at diagnosis, mean ± SD16.86±6.4412.62±5.52 <0.01 VDI at the end of the follow-up2.43±1.571.76±1.16 <0.01 ConclusionsThe characteristics of EGPA patients differ according to their ANCA status, although long-term outcomes were similar in both groups. EGPA is characterized by relapsing course of disease. The minor vasculitis relapses predominated in the structure of relapses.Disclosure of InterestNone declared