Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
BMC Nephrol. 2022 Apr 22;23(1):155. doi: 10.1186/s12882-022-02788-6.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) may coexist with rheumatoid arthritis (RA). However, it is unclear whether the manifestations of AAV with and without coexisting RA are similar. This observational study aimed to investigate the clinicopathological manifestations of AAV with coexisting RA and to explore potential predictors for identifying AAV superimposed on RA.
Patients with both AAV and RA were identified by searching our hospital database and the literature. Data including age, sex, clinical manifestation, laboratory tests, renal pathology, and therapeutic regimens were retrieved. To assess the difference in clinical features and renal pathology between AAV patients with and without RA, we conducted 1:4 matched case-control studies.
A total of 47 patients were identified, 15 from our hospital and 32 from the literature, and 33 (70.2%) were women. AAV was diagnosed later than RA in 83.0% of the patients and manifested as microscopic polyangiitis (MPA) in 78.7% of the patients. The kidney was the most frequently involved extra-articular organ (74.5%), followed by the lung (51.1%), and skin (8.5%). Patients with both AAV and RA were more likely to be asymptomatic (26.7% vs 3.3%, p = 0.013) than those with isolated AAV. However, they did not differ in other clinicopathological features. In RA patients, those with ANCA associated glomerulonephritis, were more likely to have decreased renal function at renal biopsy as opposed to those with primary glomerulonephritis.
AAV can coexist with RA. In this coexistence, AAV usually develops after RA, is more likely to be asymptomatic, and manifests predominately as MPA with renal involvement. Thus, we should remain vigilant to superimposed AAV on RA.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）可能与类风湿关节炎（RA）并存。然而，目前尚不清楚同时存在 RA 的 AAV 与不并存 RA 的 AAV 的临床表现是否相似。本观察性研究旨在探讨同时存在 RA 的 AAV 的临床病理表现，并探讨潜在的预测指标以识别重叠于 RA 的 AAV。
通过检索我院数据库和文献，确定同时存在 AAV 和 RA 的患者。收集患者的年龄、性别、临床表现、实验室检查、肾脏病理和治疗方案等数据。为了评估 AAV 患者有无 RA 时的临床特征和肾脏病理差异，我们进行了 1:4 的病例对照研究。
共纳入 47 例患者，其中 15 例来自我院，32 例来自文献，33 例（70.2%）为女性。在患者中，83.0%的 AAV 诊断晚于 RA，78.7%的患者表现为显微镜下多血管炎（MPA）。肾脏是最常受累的关节外器官（74.5%），其次是肺（51.1%）和皮肤（8.5%）。与单纯 AAV 患者相比，同时存在 AAV 和 RA 的患者无症状的可能性更高（26.7% vs. 3.3%，p=0.013）。然而，两组患者在其他临床病理特征方面无差异。在 RA 患者中，与原发性肾小球肾炎患者相比，伴有抗中性粒细胞胞质抗体相关性肾小球肾炎的患者在肾活检时更可能出现肾功能下降。
AAV 可与 RA 并存。在此共存中，AAV 通常在 RA 之后发生，更可能无症状，且以肾脏受累为主的 MPA 为主要表现。因此，我们应该警惕 RA 重叠 AAV。
