肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）与纤维肌痛：PR3 与 MPO 抗中性粒细胞胞浆抗体相关性血管炎，一项探索性横断面研究。
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia: PR3-versus MPO-ANCA-associated vasculitis, an exploratory cross-sectional study.
作者信息
van Eeden Charmaine, Mohazab Naima, Redmond Desiree, Yacyshyn Elaine, Clifford Alison, Russell Anthony S, Osman Mohammed S, Cohen Tervaert Jan Willem
机构信息
Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
University of Alberta, Rm5-68, Heritage Medical Research Center, Edmonton, T6G 2S2, Canada.
出版信息
Lancet Reg Health Am. 2023 Feb 27;20:100460. doi: 10.1016/j.lana.2023.100460. eCollection 2023 Apr.
BACKGROUND
Persistent fatigue is a common complaint in ANCA-vasculitis (AAV) patients and has a profound impact on patient's quality of life. The symptoms associated with this fatigue mirror those found in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia. Etiologic and pathophysiologic differences exist between PR3- and MPO-ANCA disease, yet differences in their fatigue manifestations have not been well researched. We compared fatigue and its associations in healthy controls, AAV patients and fibromyalgia controls.
METHODS
The Canadian consensus criteria were used for ME/CFS diagnosis, and American College of Rheumatology criteria for fibromyalgia diagnosis. Factors such as cognitive failure, depression, anxiety, and sleep disturbances were assessed by patient reported questionnaires. Clinical factors such as BVAS, vasculitis damage index, CRP and BMI were also collected.
FINDINGS
Our AAV cohort comprised 52 patients, with a mean age of 44.7 (20-79), 57% (30/52) of the patients were female. We found 51.9% (27/52) of patients fulfilled the diagnostic criteria for ME/CFS, with 37% (10/27) of those having comorbid fibromyalgia. Rates of fatigue were higher in MPO-ANCA patients, than in PR3-ANCA patients, and their symptoms were more similar to the fibromyalgia controls. Fatigue in PR3-ANCA patients was related to inflammatory markers. These differences may be due to the varied pathophysiology of the PR3- and MPO-ANCA serotypes.
INTERPRETATION
A large proportion of AAV patients suffer from debilitating fatigue consequential enough to meet the diagnostic criteria for ME/CFS. Fatigue associations were not the same between PR3- and MPO-ANCA patients, suggesting that the underlying mechanisms may be different. Future studies should consider ANCA serotype, as further research may inform different clinical treatment strategies for AAV patients suffering from ME/CFS.
FUNDING
This manuscript was funded by the Dutch Kidney Foundation (17PhD01).
背景
持续性疲劳是抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者的常见主诉，对患者的生活质量有深远影响。与这种疲劳相关的症状与肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）和纤维肌痛患者的症状相似。PR3-ANCA病和MPO-ANCA病在病因和病理生理方面存在差异，但其疲劳表现的差异尚未得到充分研究。我们比较了健康对照者、AAV患者和纤维肌痛对照者的疲劳情况及其相关性。
方法
采用加拿大共识标准诊断ME/CFS，采用美国风湿病学会标准诊断纤维肌痛。通过患者报告的问卷评估认知功能障碍、抑郁、焦虑和睡眠障碍等因素。还收集了如BVAS、血管炎损伤指数、CRP和BMI等临床因素。
研究结果
我们的AAV队列包括52例患者，平均年龄44.7岁（20 - 79岁），57%（30/52）的患者为女性。我们发现51.9%（27/52）的患者符合ME/CFS的诊断标准，其中37%（10/27）合并纤维肌痛。MPO-ANCA患者的疲劳发生率高于PR3-ANCA患者，且其症状与纤维肌痛对照者更相似。PR3-ANCA患者的疲劳与炎症标志物有关。这些差异可能归因于PR3-ANCA和MPO-ANCA血清型不同的病理生理机制。
解读
很大一部分AAV患者患有使人衰弱的疲劳，严重程度足以符合ME/CFS的诊断标准。PR3-ANCA患者和MPO-ANCA患者的疲劳相关性不同，这表明潜在机制可能不同。未来的研究应考虑ANCA血清型，因为进一步的研究可能为患有ME/CFS的AAV患者提供不同的临床治疗策略。
资助
本手稿由荷兰肾脏基金会（17PhD01）资助。
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