ANCA-Associated Vasculitis: A Comparison of Cases Presenting to Nephrology and Rheumatology Services.

ANCA-Associated Vasculitis: A Comparison of Cases Presenting to Nephrology and Rheumatology Services.

QJM. 2016 Jun 17;

Authors: McNicholas BA, Griffin TP, Donnellan S, Ryan L, Garrahy A, Coughlan R, Giblin L, Lappin D, Reddan D, Carey JJ, Griffin MD

Abstract
BACKGROUND: Anti-neutrophil cytoplasmic antibody(ANCA) associated vasculitis(AAV) is a disease characterised by inflammation of small vessels and detectable ANCA in the circulation. Patients may develop a broad spectrum of clinical features ranging from indolent sino-nasal disease and rashes to fulminant renal failure or acute life-threatening pulmonary haemorrhage. Consequently, patients with AAV present to a variety of specialties including nephrology and rheumatology, whose training and approaches to management of such patients may differ. There is little literature comparing patients presenting to different specialties, and their outcomes.
METHODS: We compared 2 cohorts of patients with ANCA-positive AAV presenting to either the rheumatology or nephrology department at Galway University Hospitals from June 2002-July 2011. A standardised data collection form was used to collect information regarding baseline demographics, manifestations of AAV, initial management, relapses and complications.
RESULTS: 45 patients were included in this study(15 rheumatology/30 nephrology). The nephrology cohort were older, had a higher C-reactive protein, Birmingham Vascular Activity Score and ANCA titre at presentation compared to the rheumatology group. Induction treatment varied between the cohorts with rheumatology patients most commonly receiving a combination of oral corticosteroids(73%) and methotrexate(60%) and nephrology patients receiving a combination of intravenous corticosteroids(93%) and cyclophosphamide(90%). 53% of the rheumatology patients who completed induction therapy relapsed compared to 30% of the nephrology patients.
CONCLUSION: This study presents two different cohorts of patients with the same disease that were managed by two different disciplines. It highlights the heterogeneity of AAV and the importance of interdisciplinary communication and cooperation when managing these patients.

PMID: 27318367 [PubMed - as supplied by publisher]

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