Joint Damage in ANCA-Associated Systemic Vasculitis. Report II: Wegener’s and Churg-Strauss Granulomatous Polyangiitis
Wegener’s (granulomatosis with polyangiitis, GPA) and Churg-Strauss (eosinophilic polyangiitis, EPA) vasculitis are treated as a single variant of systemic necrotizing granulomatosis vasculitis, associated with anti-neutrophil cytoplasmic antibodies (ANCA). There is an urgent need for further study of articular syndrome in patients with ANCA-SV. Objective: to evaluate the incidence and nature of the lesion of the joints at GPA and EPA, connection with extra-articular signs of the disease. Material and methods. The study involved 58 patients with ANCA-SV, among which there were 28 patients with GPA (16 men and 12 women aged from 17 to 70 years old) and 30 with EPA (14 men and 16 women aged 19–70 years old).The average duration of the disease in the first and second groups was 4 years and 11 years, respectively. I, II and III degree activity of the GPA were in the ratio 1 : 6 : 7 and in the cases of EPA — 1 : 3 : 4. The lung pathology was diagnosed in all cases with EPA, in patients with GPA — in 68 % of cases. In addition, 2.3 times less frequently cutaneous syndrome was detected. Results. The lesion of the joints in the form of arthritis or arthralgia occurs in 1/2 of the number of patients with granulomatous ANCA-SV in the ratio of HPA to EPA as 1 : 2, which is associated with the severity of extra-articular manifestations of disease, and in cases of EPA — with the level of antibodies to proteinase-3. Patients with EPA significantly more frequently had lesions of the maxillary joints, digital joints of foot, ankle, metatarsophalangeal, hip, sacroiliac and vertebral, and the last 4 were not diagnosed in patients with HPA. Epiphyseal osteoporosis, subchondral sclerosis, osteocytes, artrocalcinosis and changes of the menisci horns of the knee-joints were observed only at EPA. Conclusions. The severity of arthropathy prevails in EPA, compared to GPA, that is associated with great inflammatory degenerative changes of the articular, but intra-articular Goff bodies were typical only for patients with GPA. Unfavorable prognosis criteria in relation to joint pathology in GPA are high blood levels of immunoglobulin M and circulating immune complexes, and at EPA — fibrinogen.
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