Article Dans Une Revue Journal of Rheumatology Année : 2020

Spectrum and prognosis of antineutrophil cytoplasmic antibody–associated vasculitis-related bronchiectasis: Data from 61 patients

Zahir Amoura
Thomas Barba
Vincent Cottin
Stéphane Dominique
  • Fonction : Auteur
Pierre Duhaut
Olivier Fain
Alexis Mathian
Pierre Yves Brillet

Résumé

Objective.To report on a large series of patients with antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis (AAV) and bronchiectasis, with a specific focus on the timeline of occurrence of both features. Methods. Retrospective nationwide multicenter study of patients diagnosed with both AAV and bronchiectasis. Results. Sixty-one patients were included, among whom 27 (44.25%) had microscopic polyangiitis (MPA), 27 (44.25%) had granulomatosis with polyangiitis (GPA), and 7 (11.5%) had eosinophilic GPA. Thirty-nine (64%) had myeloperoxidase (MPO)-ANCA and 13 (21%) had proteinase 3–ANCA. The diagnosis of bronchiectasis either preceded (n = 25; median time between both diagnoses: 16 yrs, IQR 4–54 yrs), was concomitant to (n = 12), or followed (n = 24; median time between both diagnoses: 1, IQR 0–6 yrs) that of AAV. Patients in whom bronchiectasis precedes the onset of AAV (B-AAV group) have more frequent mononeuritis multiplex, MPA, MPO-ANCA, and a 5-fold increase of death. The occurrence of an AAV relapse tended to be protective against bronchiectasis worsening (HR 0.6, 95% CI 0.4–0.99, P = 0.049), while a diagnosis of bronchiectasis before AAV (HR 5.8, 95% CI 1.2–28.7, P = 0.03) or MPA (HR 18.1, 95% CI 2.2–146.3, P = 0.01) were associated with shorter survival during AAV follow-up. Conclusion. The association of bronchiectasis with AAV is likely not accidental and is mostly associated with MPO-ANCA. Patients in whom bronchiectasis precedes the onset of AAV tend to have distinct clinical and biological features and could carry a worse prognosis.

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Dates et versions

hal-02984277 , version 1 (30-10-2020)

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Citer

Raphael Lhote, Marie Chilles, Matthieu Groh, Xavier Puéchal, Philippe Guilpain, et al.. Spectrum and prognosis of antineutrophil cytoplasmic antibody–associated vasculitis-related bronchiectasis: Data from 61 patients. Journal of Rheumatology, 2020, 47 (10), pp.1522-1531. ⟨10.3899/jrheum.190313⟩. ⟨hal-02984277⟩
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