Berti Alvise, Caporali Roberto, Montecucco Carlomaurizio, Paolazzi Giuseppe, Monti Sara
Rheumatology Department, Santa Chiara Hospital, Largo Medaglie D'oro, 9, 38122, Trento, TN, Italy.
Centre for Integrative Biology, University of Trento, Trento, Italy.
Drugs Aging. 2019 Jan;36(1):53-63. doi: 10.1007/s40266-018-0617-4.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) usually affect adults and older populations. The well recognized clinical (i.e., granulomatosis with polyangiitis [GPA], microscopic polyangiitis, and eosinophilic GPA) and serological phenotypes (i.e., anti-MPO-ANCA, anti-PR3-ANCA and ANCA negative) within AAV differ substantially for clinical, demographic, and epidemiological features, including age at presentation. Whether and how aging could contribute to the clinical expression of these disease phenotypes is intriguing and still overlooked. In addition, despite being predominantly a disease of the elderly, most of the studies analyzing drug interventions and the clinical trials on AAV explicitly excluded older patients, limiting the understanding of the disease in this subset of patients. In elderly patients induced with cyclophosphamide, a lower dose of treatment for patients aged 60 years or older and with reduced renal function has been recommended. Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) are two primary systemic vasculitides involving large vessels that differ in age at presentation, with GCA patients being at least 10 years older than TAK patients. Different treatment approaches are effective in these conditions. However, a few authors have suggested that they might be considered expressions of the same clinical syndrome, rather than two different diseases. Novel insights into the role of senescence-related immunological and vascular processes might help to interpret the link between these two conditions. Overall, the impact of aging on all these vasculitides is complex and not easy to analyze. So far, few studies focusing on this topic have been published. We reviewed data on the clinical presentation, epidemiology, therapy, and disease- and treatment-related complications in patients affected by these vasculitides, highlighting the differences in young versus elderly subjects.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）通常影响成年人及老年人群。AAV中公认的临床类型（即肉芽肿性多血管炎[GPA]、显微镜下多血管炎和嗜酸性GPA）以及血清学表型（即抗MPO-ANCA、抗PR3-ANCA和ANCA阴性）在临床、人口统计学和流行病学特征方面存在显著差异，包括发病年龄。衰老是否以及如何影响这些疾病表型的临床表现令人关注且仍被忽视。此外，尽管AAV主要是一种老年疾病，但大多数分析药物干预和AAV临床试验的研究明确排除了老年患者，这限制了对该患者亚组疾病的了解。对于使用环磷酰胺诱导治疗的老年患者，建议对60岁及以上且肾功能减退的患者采用较低剂量的治疗。巨细胞动脉炎（GCA）和大动脉炎（TAK）是两种累及大血管的原发性系统性血管炎，其发病年龄不同，GCA患者比TAK患者至少大10岁。不同的治疗方法在这些疾病中有效。然而，一些作者认为它们可能是同一临床综合征的表现，而非两种不同的疾病。对衰老相关免疫和血管过程作用的新见解可能有助于解释这两种疾病之间的联系。总体而言，衰老对所有这些血管炎的影响是复杂的，不易分析。到目前为止，很少有专注于该主题的研究发表。我们回顾了受这些血管炎影响患者的临床表现、流行病学、治疗以及与疾病和治疗相关并发症的数据，突出了年轻与老年受试者之间的差异。
