Vasculitis in the Very Elderly

Abstract

Background: Whatever may be their clinical presentation, vasculitis syndromes (VS) have a bad prognosis in the very elderly. Objective: The aim of this work was to study VS particularities in very old people. Most published studies on VS in elderly people concern patients older than 60 years; studies concerning very old patients are unusual. Methods: We studied retrospectively subjects older than 75 years with a diagnosis of VS from the Departments of Geriatrics and Internal Medicine at Dijon University Hospital. These subjects were hospitalized between January 1995 and December 1999. Data were obtained from the medical files of these patients. Several aspects were considered: type of VS, associated diseases, treatment, complications, and outcome. Results: Twelve patients, 5 men and 7 women aged 79–91 (mean age 82.3) years, were included. Primary VS was observed in half of the patients and secondary VS in the others. The initial clinical presentation was often polymorphous and unspecific; 8 of the patients died, 2 developed progressive severe functional impairment, 1 was stabilized under therapy, and 1 patient with VS secondary to infection recovered. Most patients either died quickly or progressively deteriorated from infections, malnutrition, or functional impairment. Conclusion: The health of the majority of patients (83%) deteriorated dramatically, leading to death or severe functional impairment.

Treatment of Systemic Necrotizing Vasculitides in Patients Aged Sixty‐Five Years or Older: Results of a Multicenter, Open‐Label, Randomized Controlled Trial of Corticosteroid and Cyclophosphamide–Based Induction Therapy

“…Older SNV patients are more fragile and their outcomes were reported to be worse than those of younger populations in previous series (2)(3)(4)(5)(6). A recent retrospective study from Spain (Registro Español de Vasculitis Sistémicas [REVAS]) and our own findings showed that SNV in this older population is severe at diagnosis, often with advanced renal involvement, and high treatment-related morbidity and mortality (24).…”

“…A previous retrospective study by our group showed that patients aged 65 years or older who were diagnosed as having systemic necrotizing vasculitis (SNV; polyarteritis nodosa [PAN], granulomatosis with polyangiitis [Wegener's] [GPA], microscopic polyangiitis [MPA], or eosinophilic GPA [Churg‐Strauss] [EGPA]) had poorer outcomes than their younger counterparts, mainly because they developed more frequent and/or serious adverse events (SAEs; 68% versus 13%) while receiving conventional therapy . Several other groups have reported similar findings . Therefore, it is a common recommendation or practice to diminish, by up to one‐third, the dose of the most potent induction immunosuppressant, e.g., cyclophosphamide (CYC), for patients aged 65 years or older .…”

Etiological and clinicopathological study of secondary small vessel vasculitis in elderly: A case series of 12 patients

“…Literature on secondary causes, management, and outcome for systemic vasculitis in elderly is scanty with one study reporting only six patients and high mortality. [ 13 ] The various etiological factors are categorized into drugs, infections, connective tissue diseases, malignancies, and paraneoplastic small vessel vasculitis. [ 2 4 13 14 15 16 ] While certain type of vasculitis can have a concurrent association of malignancies, certain malignancies can also present as vasculitis.…”

“…[ 13 ] The various etiological factors are categorized into drugs, infections, connective tissue diseases, malignancies, and paraneoplastic small vessel vasculitis. [ 2 4 13 14 15 16 ] While certain type of vasculitis can have a concurrent association of malignancies, certain malignancies can also present as vasculitis. [ 17 ] In a previous case series of 12 patients who were diagnosed to have vasculitis and cancer within a duration span of 12 months out of 15 million patients presenting to Cleveland Clinic, 6 had solid organ tumors, 4 had lymphoma, and the other 2 had leukemia and multiple myeloma.…”

“…[ 19 ] In a study including patients above 75 years of age with both primary and secondary vasculitis, rapid deterioration, severe functional impairment, and death were seen in more than 80% of patients. [ 13 ] Other adverse indicators that have been identified in elderly patients with AAV were advanced renal dysfunction and noninitiation of immunosuppressive agent. [ 6 20 ] Role of immunosuppressive agent in secondary vasculitis is unclear; however, the role of glucocorticoids, cyclophosphamide, and mycophenolate mofetil in elderly patients with AAV and renal involvement is clear.…”