From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
QJM. 2016 Dec;109(12):803-809. doi: 10.1093/qjmed/hcw100. Epub 2016 Jun 17.
Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV) is a disease characterized 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.
We compared two cohorts of patients with ANCA-positive AAV presenting to either the rheumatology or nephrology department at Galway University Hospitals from June 2002 to July 2011. A standardized data collection form was used to collect information regarding baseline demographics, manifestations of AAV, initial management, relapses and complications.
Forty-five patients were included in this study (15 rheumatology/30 nephrology). The nephrology cohort was older, had a higher C-reactive protein, Birmingham Vascular Activity Score and ANCA titer 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%). Fifty-three percent of the rheumatology patients who completed induction therapy relapsed compared to 30% of the nephrology patients.
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.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）是一种以小血管炎症和循环中可检测到 ANCA 为特征的疾病。患者可能会出现广泛的临床特征，从惰性鼻窦疾病和皮疹到暴发性肾衰竭或急性危及生命的肺出血。因此，AAV 患者可能会就诊于包括肾脏科和风湿科在内的多个科室，这些科室的医生在培训和处理此类患者的方法上可能存在差异。比较就诊于不同科室的患者及其结局的文献很少。
我们比较了 2002 年 6 月至 2011 年 7 月在戈尔韦大学医院就诊的风湿科或肾脏科的两组 ANCA 阳性 AAV 患者。使用标准化的数据收集表收集基线人口统计学特征、AAV 表现、初始治疗、复发和并发症的信息。
本研究纳入了 45 例患者（风湿科 15 例，肾脏科 30 例）。与风湿科患者相比，肾脏科患者年龄更大，就诊时 C 反应蛋白、伯明翰血管活动评分和 ANCA 滴度更高。两组诱导治疗不同，风湿科患者最常接受口服皮质类固醇（73%）和甲氨蝶呤（60%）联合治疗，肾脏科患者接受静脉皮质类固醇（93%）和环磷酰胺（90%）联合治疗。完成诱导治疗的风湿科患者中有 53%复发，而肾脏科患者中有 30%复发。
本研究介绍了两组患有相同疾病的患者，他们分别由两个不同的科室进行管理。这突出了 AAV 的异质性以及在管理这些患者时跨学科沟通和合作的重要性。
