Article
作者: Lebas, Celine ; Culerrier, Julien ; Aouba, Achille ; Servettaz, Amélie ; Poindron, Vincent ; Jayne, David ; Gauckler, Philipp ; Milesi, Anne-Marie ; Luca, Luminita ; Teixeira, Vitor ; Yazici, Ayten ; Nguyen, Yann ; Yazisiz, Veli ; Ögüt, Tahir Saygin ; Sadioglu Cagdas, Oznur ; Jego, Patrick ; Vandergheynst, Frédéric ; Terrier, Benjamin ; Dernoncourt, Amandine ; Delvino, Paolo ; Droumaguet, Celine ; Flossmann, Oliver ; Regent, Alexis ; Kronbichler, Andreas ; Duffau, Pierre ; Karadag, Omer ; Housz-Oro, Saskia Ingen- ; Lamprecht, Peter ; Marchand-Adam, Sylvain ; Yasar Bilge, Sule ; Lechtman, Sarah ; Puéchal, Xavier ; Andre, Baptiste ; Pagnoux, Christian ; Padoan, Roberto ; Celfe, Ayse ; Ruivard, Marc ; Yildrim, Tuba Demirci ; Yacyshyn, Elaine ; Bes, Cemal
AbstractObjectiveData 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.MethodsWe 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.ResultsForty-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).ConclusionATD-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.