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Anca İlişkili Vaskülitlerde Tek Merkez Deneyimi

Yıl 2021, Cilt 31, Sayı 2, 159 - 162, 30.06.2021
https://doi.org/10.15321/GenelTipDer.2021.305

Öz

Giriş-Amaç: Anti-nötrofil sitoplazmik antikor (ANCA) ilişkili küçük damar vaskülitleri granülomatöz polianjjiitis(GPA), eozinofilik granülomatöz polianjiiitis(EGPA) ve mikroskopik polianjiitistir(MPA). Bu çalışma ile kliniğimizde takip edilen ANCA ilişkili vaskülit sıklığı ve tedavi cevapları değerlendirilmiştir. Gereç-Yöntem: Bu çalışma retrospektif olarak Ocak 2015-Aralık 2018 arasında yapıldı. Çalışmaya 18 yaş üstü 2012 Chapel Hill sınıflamasına göre ANCA ilişkili vaskülit tanısı alan hastalar alındı. Bulgular: Kliniğimizde 18 tane ANCA ilişkili vaskülit hastası retrospektif olarak değerlendirildi. Hastaların 12’si kadın, 6’sı erkekti. Hastaların yaş ortalaması 57.8 olarak bulundu. Hastaların 2 tanesi EGPA, 3 tanesi MPA, 13 tanesi GPA tanısı ile izlendiği görüldü. GPA tanısı ile izlenen hastaların 11 tanesi sistemik tutulumla, 2 tanesinin sınırlı tutulumla seyrettiği gözlendi. GPA tanısı ile izlenen hastalarda en sık tutulumun %76 ile akciğer tutulumu, 2. sıklıkta %53 oranında böbrek tutulumu olduğu tespit edildi. MPA ile izlenen hastaların 2 hastada böbrek tutulumu, 2 hastada akciğer tutulumu olduğu saptandı. EGPA tanısı ile izlenen hastaların 2 tanesinde akciğer tutulumu olduğu gözlendi. RF ve ANA pozitifliği GPA’da en yüksek tespit edildi. ANCA ilişkili vaskülitlerde indüksiyon tedavisinde pulse steroid ve siklofosfamid ile kombine olarak verildiği gözlendi. 3 GPA hastasının nüks olduğu ve nüks olan hastaların rituksimab ile izlendiği görüldü. Tartışma-Sonuç: ANCA ilişkili vaskülitlerin klinik ve tedavisi benzerdir. ANCA ilişkili vaskülitlerin tedavisinde kısa sürede remisyon sağlanmalıdır. ANCA ilişkili vaskülitlerin takibinde nüks önemli bir problemdir. Nüks eden olgularda rituksimab tercih edilebilir.

Kaynakça

  • Jennette JC, Falk R, Bacon P, et al. 2012 revised international chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum 2013; 65: 1-11
  • Bosch X, Guilabert A, Font J. Antineutrophil cytoplasmic antibodies The Lancet 2006; 368: 404-18
  • Girard T, Mahr A, Noel LH, et al. Are antineutrophil cytoplasmic antibodies a marker predictive of relapse in Wegener's granulomatosis? A prospective study. Rheumatology 2001; 40: 147-51
  • Stegeman CA. Anti‐neutrophil cytoplasmic antibody (ANCA) levels directed against proteinase‐3 and myeloperoxidase are helpful in predicting disease relapse in ANCA‐associated small‐vessel vasculitis. Nephrology Dialysis Transplantation 2002; 17: 2077-80
  • Jayne D. Treatment of ANCA‐associated systemic small‐vessel vasculitis. Apmis 2009; 117: 3-9
  • Puéchal X, Pagnoux C, Perrodeau É, et al. Long‐term outcomes among participants in the WEGENT trial of remission‐maintenance therapy for granulomatosis with polyangiitis (Wegener's) or microscopic polyangiitis. Arthritis Rheumatology 2016; 68: 690-701
  • Yilmaz N, Emmungil H, Gucenmez S ve ark. Incidence of cyclophosphamide-induced urotoxicity and protective effect of mesna in rheumatic diseases. The Journal of rheumatology 2015; 42: 1661-6
  • Carruthers D, Sherlock J. Evidence-based management of ANCA vasculitis. Best Practice Research Clinical Rheumatology 2009; 23: 367-78
  • Jayne D. Progress of treatment in ANCA‐associated vasculitis. Nephrology 2009; 14: 42-8
  • Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. New England Journal of Medicine 2010; 363: 221-32
  • Puéchal X. Targeted immunotherapy strategies in ANCA-associated vasculitis. Joint Bone Spine 2018
  • Smith RM, Merkel PA, Jayne DR. An international, open-label, randomised controlled trial comparing rituximab with azathioprine as maintenance therapy in relapsing ANCA-associated vasculitis (RITAZAREM) Rheumatology 2017
  • Tomasson G, Lavalley M, Tanriverdi K, et al. Wegener’s Granulomatosis Etanercept Trial (WGET) Research Group: Relationship between markers of platelet activation and inflammation with disease activity in Wegener’s granulomatosis. J Rheumatol 2011; 38: 1048
  • Keser G. Antinötrofil sitoplazmik antikor (ANCA) pozitif vaskülitler. RAED Dergisi 2009; 1: 1-14

Single Center Experience in Anca-Related Vasculitides

Yıl 2021, Cilt 31, Sayı 2, 159 - 162, 30.06.2021
https://doi.org/10.15321/GenelTipDer.2021.305

Öz

İntroduction: Granulomatosis polyangitiis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA and microscopic polyangiitis(MPA) are small vessel vasculitides associated with anti-neutrophil cytoplasmic antibody (ANCA). İn this study, the frequency of ANCA associated vasculitis and treatment responses in our clinic are evaluated. Methods: This retrospective study was performed between January 2015- December 2018. 18 patients who older than 18 and diagnosed ANCA associated vasculitis according to the 2012 Chapel Hill Classification were included. Results: İn totals, 18 patients who diagnosed ANCA associated vasculitis were included, 12 of whom females, 6 of whom males. The mean age of the patients was 57.8. Two of the patients were diagnosed with EGPA, 3 with MPA and 13 with GPA. 11 of the patients followed up with GPA with systemic involvement and 2 with limited involvement. The most common involvement in patients with GPA was pulmonary involvement with 76% and renal involvement in 53% of the patients. Pulmonary involvement was detected in 2 patients and lung involvement in 2 patients in MPA. Pulmonary involvement was observed in 2 patients with EGPA. RF and ANA positivity was highest in GPA. İt was observed in combination with pulse steroid and cyclophosphamide in the induction treatment of ANCA-associated vasculitis. It was seen that 3 GPA patients had recurrence and followed up with rituximab. Discussion-conclusion: ANCA related vasculitides treatment and clinic are similar. İn the treatment of ANCA-associated vasculitis, remission should be achieved in a short time. In recurrent cases, rituximab may be preferred.

Kaynakça

  • Jennette JC, Falk R, Bacon P, et al. 2012 revised international chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum 2013; 65: 1-11
  • Bosch X, Guilabert A, Font J. Antineutrophil cytoplasmic antibodies The Lancet 2006; 368: 404-18
  • Girard T, Mahr A, Noel LH, et al. Are antineutrophil cytoplasmic antibodies a marker predictive of relapse in Wegener's granulomatosis? A prospective study. Rheumatology 2001; 40: 147-51
  • Stegeman CA. Anti‐neutrophil cytoplasmic antibody (ANCA) levels directed against proteinase‐3 and myeloperoxidase are helpful in predicting disease relapse in ANCA‐associated small‐vessel vasculitis. Nephrology Dialysis Transplantation 2002; 17: 2077-80
  • Jayne D. Treatment of ANCA‐associated systemic small‐vessel vasculitis. Apmis 2009; 117: 3-9
  • Puéchal X, Pagnoux C, Perrodeau É, et al. Long‐term outcomes among participants in the WEGENT trial of remission‐maintenance therapy for granulomatosis with polyangiitis (Wegener's) or microscopic polyangiitis. Arthritis Rheumatology 2016; 68: 690-701
  • Yilmaz N, Emmungil H, Gucenmez S ve ark. Incidence of cyclophosphamide-induced urotoxicity and protective effect of mesna in rheumatic diseases. The Journal of rheumatology 2015; 42: 1661-6
  • Carruthers D, Sherlock J. Evidence-based management of ANCA vasculitis. Best Practice Research Clinical Rheumatology 2009; 23: 367-78
  • Jayne D. Progress of treatment in ANCA‐associated vasculitis. Nephrology 2009; 14: 42-8
  • Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. New England Journal of Medicine 2010; 363: 221-32
  • Puéchal X. Targeted immunotherapy strategies in ANCA-associated vasculitis. Joint Bone Spine 2018
  • Smith RM, Merkel PA, Jayne DR. An international, open-label, randomised controlled trial comparing rituximab with azathioprine as maintenance therapy in relapsing ANCA-associated vasculitis (RITAZAREM) Rheumatology 2017
  • Tomasson G, Lavalley M, Tanriverdi K, et al. Wegener’s Granulomatosis Etanercept Trial (WGET) Research Group: Relationship between markers of platelet activation and inflammation with disease activity in Wegener’s granulomatosis. J Rheumatol 2011; 38: 1048
  • Keser G. Antinötrofil sitoplazmik antikor (ANCA) pozitif vaskülitler. RAED Dergisi 2009; 1: 1-14

Ayrıntılar

Birincil Dil Türkçe
Konular Tıp
Bölüm Original Article
Yazarlar

Muhammet LİMON Bu kişi benim
Selçuk Üniversitesi Tıp Fakültesi, Romatoloji
Türkiye


Dilek TEZCAN>
Selçuk Üniversitesi Tıp Fakültesi, Romatoloji
0000-0002-8295-9770
Türkiye


Semral GÜLCEMAL>
Selçuk Üniversitesi Tıp Fakültesi, Romatoloji
Türkiye


Sema YİLMAZ>
Selçuk Üniversitesi Tıp Fakültesi, Romatoloji
Türkiye

Yayımlanma Tarihi 30 Haziran 2021
Gönderilme Tarihi 6 Ocak 2020
Kabul Tarihi 14 Eylül 2020
Yayınlandığı Sayı Yıl 2021, Cilt 31, Sayı 2

Kaynak Göster

Vancouver Limon M. , Tezcan D. , Gülcemal S. , Yilmaz S. Anca İlişkili Vaskülitlerde Tek Merkez Deneyimi. Genel Tıp Dergisi. 2021; 31(2): 159-162.

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