Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France.
Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
Rheumatology (Oxford). 2024 Apr 2;63(4):999-1006. doi: 10.1093/rheumatology/kead319.
Data on ANCA-associated vasculitis (AAV) induced by anti-thyroid drugs (ATD) are scarce. We aimed to describe the characteristics and outcome of these patients in comparison to primary AAV.
We performed a retrospective multicentre study including patients with ATD-induced AAV. We focused on ATD-induced microscopic polyangiitis (MPA) and compared them with primary MPA by matching each case with four controls by gender and year of diagnosis.
Forty-five patients with ATD-induced AAV of whom 24 MPA were included. ANCA were positive in 44 patients (98%), including myeloperoxidase (MPO)-ANCA in 21 (47%), proteinase 3 (PR3)-ANCA in six (13%), and double positive MPO- and PR3-ANCA in 15 (33%). Main clinical manifestations were skin involvement (64%), arthralgia (51%) and glomerulonephritis (20%). ATD was discontinued in 98% of cases, allowing vasculitis remission in seven (16%). All the remaining patients achieved remission after glucocorticoids, in combination with rituximab in 11 (30%) or cyclophosphamide in four (11%). ATD were reintroduced in seven cases (16%) without any subsequent relapse. Compared with 96 matched primary MPA, ATD-induced MPA were younger at diagnosis (48 vs 65 years, P < 0.001), had more frequent cutaneous involvement (54 vs 25%, P = 0.007), but less frequent kidney (38 vs 73%, P = 0.02), and a lower risk of relapse (adjusted HR 0.07; 95% CI 0.01, 0.65, P = 0.019).
ATD-induced AAV were mainly MPA with MPO-ANCA, but double MPO- and PR3-ANCA positivity was frequent. The most common manifestations were skin and musculoskeletal manifestations. ATD-induced MPA were less severe and showed a lower risk of relapse than primary MPA.
抗甲状腺药物（ATD）引起的抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）的数据很少。我们旨在描述这些患者的特征和结局，并与原发性 AAV 进行比较。
我们进行了一项回顾性多中心研究，纳入了 ATD 诱导的 AAV 患者。我们专注于 ATD 诱导的显微镜下多血管炎（MPA），并通过性别和诊断年份将每个病例与 4 个对照进行匹配，比较它们与原发性 MPA。
共纳入 45 例 ATD 诱导的 AAV，其中 24 例 MPA。44 例患者的 ANCA 阳性（98%），包括髓过氧化物酶（MPO）-ANCA 阳性 21 例（47%），蛋白酶 3（PR3）-ANCA 阳性 6 例（13%），双阳性 MPO 和 PR3-ANCA 阳性 15 例（33%）。主要临床表现为皮肤受累（64%）、关节炎（51%）和肾小球肾炎（20%）。98%的病例停用了 ATD，7 例（16%）患者的血管炎缓解。其余所有患者在接受糖皮质激素治疗后，联合利妥昔单抗 11 例（30%）或环磷酰胺 4 例（11%）后均缓解。7 例（16%）患者重新开始使用 ATD，没有出现后续复发。与 96 例匹配的原发性 MPA 相比，ATD 诱导的 MPA 在诊断时更年轻（48 岁 vs. 65 岁，P < 0.001），皮肤受累更常见（54% vs. 25%，P = 0.007），但肾脏受累较少（38% vs. 73%，P = 0.02），复发风险较低（调整后的 HR 0.07；95%CI 0.01，0.65，P = 0.019）。
ATD 诱导的 AAV 主要为 MPA 伴 MPO-ANCA，但双 MPO 和 PR3-ANCA 阳性较为常见。最常见的表现为皮肤和肌肉骨骼表现。与原发性 MPA 相比，ATD 诱导的 MPA 病情较轻，复发风险较低。
