Bateman James, Nadeem Mir, Barraclough James, Adizie Tochukwu, Pucci Mark, Sheeran Tom
Institute of Clinical Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK.
Department of Rheumatology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Rheumatol Adv Pract. 2025 Feb 11;9(2):rkaf018. doi: 10.1093/rap/rkaf018. eCollection 2025.
Study aims were to assess the impact of urine cocaine screening in distinguishing cocaine-induced midline destruction lesions (CIMDLs) from idiopathic ANCA-associated systemic vasculitis (AASV), to evaluate the adoption and effectiveness of screening and to explore its clinical implications.
We conducted a retrospective single-centre case series, reviewing rheumatology patients with suspected new or relapsing AASV, ages 18-55 years, from April 2021 to July 2024. Patients were in two groups: an active screening group offering urinary cocaine testing for all patients and a standard care group, with ad hoc testing based on clinical suspicion. Demographics, clinical presentations and diagnostic pathways were analysed.
Of 11 cases in the active screening group, all denied cocaine use, 7 were diagnosed with CIMDL from urine screening and 4 patients were treated for vasculitis. In the standard care group of 15 patients, 2 patients had CIMDLs (admitted cocaine use), no patients had urine screening and 13 were treated for AASV. In total, there were nine CIMDL cases [mean age 38.2 years (interquartile range 11; six females), most [7/9 (78%)] were from active screening. CIMDL presentations were heterogeneous, including vocal cord palsy, lymphadenopathy and cutaneous vasculitis. CIMDL cases were positive for perinuclear ANCA (6/9) and PR3 (7/9), with no MPO positivity, and 5/9 (71%) failed to provide an adequate initial urine sample. There were no formal complaints or concerns from screening.
These data support the effectiveness and acceptability of systematic screening for cocaine to improve the identification of CIMDLs, reducing misdiagnosis and unnecessary treatment. A protocol for systematic screening is proposed to improve the care for these patients.
研究目的是评估尿液可卡因筛查在区分可卡因诱导的中线破坏病变（CIMDLs）与特发性抗中性粒细胞胞浆抗体相关性系统性血管炎（AASV）方面的影响，评估筛查的采用情况和有效性，并探讨其临床意义。
我们进行了一项回顾性单中心病例系列研究，回顾了2021年4月至2024年7月期间年龄在18 - 55岁、疑似新发或复发AASV的风湿病患者。患者分为两组：一个主动筛查组，为所有患者提供尿液可卡因检测；一个标准治疗组，根据临床怀疑进行临时检测。分析了人口统计学、临床表现和诊断途径。
在主动筛查组的11例患者中，所有患者均否认使用过可卡因，7例通过尿液筛查被诊断为CIMDL，4例患者接受了血管炎治疗。在标准治疗组的15例患者中，2例患有CIMDL（承认使用过可卡因），没有患者进行尿液筛查，13例接受了AASV治疗。总共9例CIMDL病例[平均年龄38.2岁（四分位间距11；6名女性），大多数[7/9（78%）]来自主动筛查。CIMDL的表现具有异质性，包括声带麻痹、淋巴结病和皮肤血管炎。CIMDL病例核周抗中性粒细胞胞浆抗体（6/9）和蛋白酶3（7/9）呈阳性，髓过氧化物酶无阳性，5/9（71%）未能提供足够的初始尿液样本。筛查过程中没有正式的投诉或担忧。
这些数据支持对可卡因进行系统筛查以改善CIMDL识别、减少误诊和不必要治疗的有效性和可接受性。提出了一项系统筛查方案以改善对这些患者的护理。
