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Objectives: ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- A nd older-onset patients are still incompletely understood. Methods: We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: <65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results: A total of 1338 patients with AAV were included: 66% had disease onset at <65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion: Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients.
Association between age at disease onset of anti-neutrophil cytoplasmic antibody-associated vasculitis and clinical presentation and short-term outcomes / Monti, S.; Craven, A.; Klersy, C.; Montecucco, C.; Caporali, R.; Watts, R.; Merkel, P. A.; Luqmani, R.; Achilleos, K.; Adler, M.; Alba, M. A.; Albert, D. A.; Alibaz-Oner, F.; Allcoat, P.; Amano, K.; Amarasuriya, M.; Amudala, N. A.; Andrews, J.; Archer, A. M.; Arimura, Y.; Atukorala, I.; Azevedo, E.; Bajad, S.; Baldwin, C.; Barra, L. J.; Baslund, B.; Basu, N.; Baykal, M.; Berger, C.; Berglin, E.; Besada, E.; Bhardwaj, M.; Bischof, A.; Blockmans, D.; Blood, J.; Draibe, J. B.; Brand, S.; Brandao, M.; Bruce, I. N.; Butler, A.; Calabrese, L. H.; Ferrer, D. C.; Carette, S.; Carmona, D.; Ceunen, H.; Chakravarty, K.; Chapman, P. T.; Chocova, Z.; Chung, S. A.; Ci, W.; Cid, M. C.; Clark, T. M.; Clarkson, M. R.; De Jesus Contreras-Rodriguez, F.; Conway, R.; Cooke, K.; Viros, X. C.; Cordeiro, A.; Costa, A.; Craven, A.; Culfear, K.; Daikeler, T.; Danda, D.; Das, S. K.; Dasgupta, B.; De Castro, A. M.; Dehghan, N.; Devassy, R.; Dhindsa, N.; Diamantopoulos, A. P.; Direskeneli, H.; Dobashi, H.; Juan, D.; Durrani, M.; Edelsten, C.; Eifert, J.; Elhayek, S.; Elsideeg, S.; Endo, T.; Erden, A.; Erer, B.; Eriksson, P.; Erturk, Z.; Espigol-Frigole, G.; Felicetti, M.; Ferraro, A.; Ferro, J. M.; Fifi-Mah, A.; Flores-Suarez, L. F.; Flossmann, O.; Flynn, D.; Fonseca, J. E.; Foot, J.; Foote, M.; Forbess, L.; Fujimoto, S.; Fukuoka, K.; Furtado, C.; Furuta, S.; Gaffo, A. L.; Gallagher, P.; Gao, N.; Gatenby, P.; Gendi, N.; Geraldes, R.; Gerits, A.; Gioffredi, A.; Gomples, L.; Goncalves, M. J.; Gondo, P.; Graham, A.; Grainger, R.; Gray, D. T.; Grayson, P. C.; Griffiths, L.; Guo, Y.; Gupta, R.; Gylling, M.; Hajj-Ali, R. A.; Hammam, N.; Harigai, M.; Hartley, L.; Haslett, J.; Hassan, A.; Hatemi, G.; Hellmich, B.; Henckaerts, L.; Henes, J. C.; Hepburn, J.; Herd, V.; Hess, C.; Hill, C.; Hinojosa-Azaola, A.; Hirahashi, J.; Hirano, F.; Hocevar, A.; Holle, J.; Hollinger, N.; Homma, S.; Howard, T.; Hoyles, R. K.; Hruskova, Z.; Hutcheon, G.; Ignacak, M.; Igney-Oertel, A.; Ikeda, K.; Ikegaya, N.; Jagadeesh, S.; Jaquith, J.; Jayne, D. R. W.; Jewell, T.; Jones, C.; Joshi, A.; Kalyoncu, U.; Kamall, S.; Kamath, S.; Lai, K. S.; Kaname, S.; Kanchinadham, S.; Karadag, O.; Karube, M.; Kaszuba, M.; Kaur, R.; Kawakami, T.; Kawashima, S.; Khalidi, N.; Khan, A.; Kikuchi, M.; Kilic, L.; Kimura, M.; King, M. J.; Klapa, S.; Klocke, R.; Kobayashi, T.; Kobayashi, S.; Komagata, Y.; Kronbichler, A.; Kuczia, P.; Kumar, M. S.; Kurosawa, M.; Lamprecht, P.; Langford, C. A.; Lanyon, P.; Laversuch, C.; Lee, S. J.; Leoni, S.; Li, J.; Liang, K.; Liang, P.; Liao, H.; Lee, L. A.; Luqmani, R. A.; Lyle, A.; Macdonald, M.; Mackie, S. L.; Madden, L.; Magliano, M.; Makino, H.; Makol, A.; Malaiya, R.; Malaviya, A.; Manthri, R.; Maritati, F.; Da Silva, A. M.; Mason, J. C.; Matara, C.; Matsui, K.; Matteson, E. L.; Mcbride, D.; Mccullough, K.; Mcgeoch, L.; Mclaren, J.; Mcmillian, C.; Mendiratta, N.; Menon, A.; Merinopoulos, D.; Merkel, P. A.; Merkel, P.; Messier, S.; Micheletti, R. G.; Mills, K.; Milman, N.; Minoda, M.; Minz, R. W.; Mock, C.; Mohammad, A. J.; Moiseev, S.; Moitinho, M.; Molloy, E.; Monach, P. A.; Montgomery, M.; Moosig, F.; Moradizadeh, M.; Morgan, M.; Morgan, A. W.; Morgan, A. -M.; Muir, A.; Mukhtyar, C.; Muller, A.; Muratore, F.; Muso, E.; Nada, R.; Nakajima, H.; Nakajima, T.; Nakano, H.; Nandagudi, A.; Neumann, T.; Ng, Y. F.; Ng, K. H.; Nogueira, E. L.; Nolkha, N.; Nordstrom, D.; Novikov, P.; Nugaliyadde, A.; O'Donnell, J. L.; O'Donoghue, J.; O'Neill, L.; O'Riordan, E.; Oatley, M.; Okubo, K.; Oliva, E.; Oshikawa, H.; Ota, Y.; Padoan, R.; Pagnoux, C.; Pan, L.; Panaritis, K.; Park, J. K.; Patel, S.; Patil, P.; Pazzola, G.; Peall, A.; Pearce, F.; Pehlevan, S.; Pereira, L.; Pettersson, T.; Pineau, C. A.; Pirila, L.; Poglodek, B.; Ponte, C.; Prieto-Gonzalez, S.; Priya, S. R.; Purewal, B.; Purschke, S.; Putaala, J.; Quickert, S.; Quincey, V.; Raghuvanshi, S.; Rajasekhar, L.; Ranganathan, D.; Rathi, M.; Rees, D.; Rees, F.; Renken, U.; Restuccia, G.; Rhee, R. L.; Rice, B.; Robins, D.; Robson, J.; Rodrigues, M.; Romao, V. C.; Rotar, C.; Ruediger, C.; Rutgers, A.; Sa, A. C.; Saavedra, M. J.; Sada, K. -E.; Sahbudin, I.; Salvarani, C.; Sandhu, N.; Santos, E.; Sato, Y.; Schafer, V. S.; Schiavon, F.; Schmidt, W. A.; Segelmark, M.; Shahin, A.; Sharma, A.; Shotton, J.; Silva, C.; Singer, O. G.; Sivasuthan, G.; Smolen, S.; Solanich-Moreno, X.; Boixader, L. S.; Song, Y. W.; Springer, J.; Sreih, A. G.; Srivastava, R.; Stamp, L. K.; Stevens, R.; Strbian, D.; Sugino, K.; Sunderkotter, C.; Suppiah, R.; Suzuki, K.; Suzuki, K.; Szekanecz, Z.; Sznajd, J.; Taimen, K.; Tak, P. P.; Takeuchi, T.; Takizawa, N.; Tames, L.; Tan, B. E.; Tanaka, M.; Tang, M. W.; Tatlisumak, T.; Tesar, V.; Thomas, A.; Tian, X.; Tokunaga, K.; Tombetti, E.; Tomsic, M.; Toz, B.; Tsukamoto, T.; Uchida, S.; Unal, A. U.; Urban, M. L.; Usui, J.; Vaglio, A.; Venkatachalam, S.; Vermaak, E.; Viswanath, V.; Wada, T.; Wagh, S.; Wallace, D. J.; Walters, G.; Walz, B.; Wan, J.; Wang, T.; Wang, G.; Warrington, K. J.; Watts, R. A.; Wawrzycka-Adamczyk, K.; Weeratunga, P.; Weisman, M. H.; Wickramasinghe, S.; Williams, M.; Williams, M.; Wojcik, K.; Woodruff, L.; Xenitidis, T.; Yamada, H.; Yamagata, K.; Yee, C. -S.; Yoon, M.; Yoshida, K.; Yoshifuji, H.; Ytterberg, S. R.; Yumura, W.; Zayed, H.; Zeng, X.; Zhao, M. -H.; Zugaj, A.; Zuk, J.. - In: RHEUMATOLOGY. - ISSN 1462-0324. - 60:2(2021), pp. 617-628. [10.1093/rheumatology/keaa215]
Association between age at disease onset of anti-neutrophil cytoplasmic antibody-associated vasculitis and clinical presentation and short-term outcomes
Monti S.;Craven A.;Klersy C.;Montecucco C.;Caporali R.;Watts R.;Merkel P. A.;Luqmani R.;Achilleos K.;Adler M.;Alba M. A.;Albert D. A.;Alibaz-Oner F.;Allcoat P.;Amano K.;Amarasuriya M.;Amudala N. A.;Andrews J.;Archer A. M.;Arimura Y.;Atukorala I.;Azevedo E.;Bajad S.;Baldwin C.;Barra L. J.;Baslund B.;Basu N.;Baykal M.;Berger C.;Berglin E.;Besada E.;Bhardwaj M.;Bischof A.;Blockmans D.;Blood J.;Draibe J. B.;Brand S.;Brandao M.;Bruce I. N.;Butler A.;Calabrese L. H.;Ferrer D. C.;Carette S.;Carmona D.;Ceunen H.;Chakravarty K.;Chapman P. T.;Chocova Z.;Chung S. A.;Ci W.;Cid M. C.;Clark T. M.;Clarkson M. R.;De Jesus Contreras-Rodriguez F.;Conway R.;Cooke K.;Viros X. C.;Cordeiro A.;Costa A.;Craven A.;Culfear K.;Daikeler T.;Danda D.;Das S. K.;Dasgupta B.;De Castro A. M.;Dehghan N.;Devassy R.;Dhindsa N.;Diamantopoulos A. P.;Direskeneli H.;Dobashi H.;Juan D.;Durrani M.;Edelsten C.;Eifert J.;Elhayek S.;Elsideeg S.;Endo T.;Erden A.;Erer B.;Eriksson P.;Erturk Z.;Espigol-Frigole G.;Felicetti M.;Ferraro A.;Ferro J. M.;Fifi-Mah A.;Flores-Suarez L. F.;Flossmann O.;Flynn D.;Fonseca J. E.;Foot J.;Foote M.;Forbess L.;Fujimoto S.;Fukuoka K.;Furtado C.;Furuta S.;Gaffo A. L.;Gallagher P.;Gao N.;Gatenby P.;Gendi N.;Geraldes R.;Gerits A.;Gioffredi A.;Gomples L.;Goncalves M. J.;Gondo P.;Graham A.;Grainger R.;Gray D. T.;Grayson P. C.;Griffiths L.;Guo Y.;Gupta R.;Gylling M.;Hajj-Ali R. A.;Hammam N.;Harigai M.;Hartley L.;Haslett J.;Hassan A.;Hatemi G.;Hellmich B.;Henckaerts L.;Henes J. C.;Hepburn J.;Herd V.;Hess C.;Hill C.;Hinojosa-Azaola A.;Hirahashi J.;Hirano F.;Hocevar A.;Holle J.;Hollinger N.;Homma S.;Howard T.;Hoyles R. K.;Hruskova Z.;Hutcheon G.;Ignacak M.;Igney-Oertel A.;Ikeda K.;Ikegaya N.;Jagadeesh S.;Jaquith J.;Jayne D. R. W.;Jewell T.;Jones C.;Joshi A.;Kalyoncu U.;Kamall S.;Kamath S.;Lai K. S.;Kaname S.;Kanchinadham S.;Karadag O.;Karube M.;Kaszuba M.;Kaur R.;Kawakami T.;Kawashima S.;Khalidi N.;Khan A.;Kikuchi M.;Kilic L.;Kimura M.;King M. J.;Klapa S.;Klocke R.;Kobayashi T.;Kobayashi S.;Komagata Y.;Kronbichler A.;Kuczia P.;Kumar M. S.;Kurosawa M.;Lamprecht P.;Langford C. A.;Lanyon P.;Laversuch C.;Lee S. J.;Leoni S.;Li J.;Liang K.;Liang P.;Liao H.;Lee L. A.;Luqmani R. A.;Lyle A.;Macdonald M.;Mackie S. L.;Madden L.;Magliano M.;Makino H.;Makol A.;Malaiya R.;Malaviya A.;Manthri R.;Maritati F.;Da Silva A. M.;Mason J. C.;Matara C.;Matsui K.;Matteson E. L.;Mcbride D.;Mccullough K.;Mcgeoch L.;Mclaren J.;Mcmillian C.;Mendiratta N.;Menon A.;Merinopoulos D.;Merkel P. A.;Merkel P.;Messier S.;Micheletti R. G.;Mills K.;Milman N.;Minoda M.;Minz R. W.;Mock C.;Mohammad A. J.;Moiseev S.;Moitinho M.;Molloy E.;Monach P. A.;Montgomery M.;Moosig F.;Moradizadeh M.;Morgan M.;Morgan A. W.;Morgan A. -M.;Muir A.;Mukhtyar C.;Muller A.;Muratore F.;Muso E.;Nada R.;Nakajima H.;Nakajima T.;Nakano H.;Nandagudi A.;Neumann T.;Ng Y. F.;Ng K. H.;Nogueira E. L.;Nolkha N.;Nordstrom D.;Novikov P.;Nugaliyadde A.;O'donnell J. L.;O'donoghue J.;O'neill L.;O'riordan E.;Oatley M.;Okubo K.;Oliva E.;Oshikawa H.;Ota Y.;Padoan R.;Pagnoux C.;Pan L.;Panaritis K.;Park J. K.;Patel S.;Patil P.;Pazzola G.;Peall A.;Pearce F.;Pehlevan S.;Pereira L.;Pettersson T.;Pineau C. A.;Pirila L.;Poglodek B.;Ponte C.;Prieto-Gonzalez S.;Priya S. R.;Purewal B.;Purschke S.;Putaala J.;Quickert S.;Quincey V.;Raghuvanshi S.;Rajasekhar L.;Ranganathan D.;Rathi M.;Rees D.;Rees F.;Renken U.;Restuccia G.;Rhee R. L.;Rice B.;Robins D.;Robson J.;Rodrigues M.;Romao V. C.;Rotar C.;Ruediger C.;Rutgers A.;Sa A. C.;Saavedra M. J.;Sada K. -E.;Sahbudin I.;Salvarani C.;Sandhu N.;Santos E.;Sato Y.;Schafer V. S.;Schiavon F.;Schmidt W. A.;Segelmark M.;Shahin A.;Sharma A.;Shotton J.;Silva C.;Singer O. G.;Sivasuthan G.;Smolen S.;Solanich-Moreno X.;Boixader L. S.;Song Y. W.;Springer J.;Sreih A. G.;Srivastava R.;Stamp L. K.;Stevens R.;Strbian D.;Sugino K.;Sunderkotter C.;Suppiah R.;Suzuki K.;Suzuki K.;Szekanecz Z.;Sznajd J.;Taimen K.;Tak P. P.;Takeuchi T.;Takizawa N.;Tames L.;Tan B. E.;Tanaka M.;Tang M. W.;Tatlisumak T.;Tesar V.;Thomas A.;Tian X.;Tokunaga K.;Tombetti E.;Tomsic M.;Toz B.;Tsukamoto T.;Uchida S.;Unal A. U.;Urban M. L.;Usui J.;Vaglio A.;Venkatachalam S.;Vermaak E.;Viswanath V.;Wada T.;Wagh S.;Wallace D. J.;Walters G.;Walz B.;Wan J.;Wang T.;Wang G.;Warrington K. J.;Watts R. A.;Wawrzycka-Adamczyk K.;Weeratunga P.;Weisman M. H.;Wickramasinghe S.;Williams M.;Williams M.;Wojcik K.;Woodruff L.;Xenitidis T.;Yamada H.;Yamagata K.;Yee C. -S.;Yoon M.;Yoshida K.;Yoshifuji H.;Ytterberg S. R.;Yumura W.;Zayed H.;Zeng X.;Zhao M. -H.;Zugaj A.;Zuk J.
2021
Abstract
Objectives: ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- A nd older-onset patients are still incompletely understood. Methods: We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: <65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results: A total of 1338 patients with AAV were included: 66% had disease onset at <65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion: Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients.
Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1280544
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