@article{3219551,
    title = "A past medical history of autoimmune disease predicts a future with fewer relapses in patients with ANCA-associated vasculitis",
    author = "Lionaki, S. and Marinaki, S. and Fragkioudaki, S. and Bellos, I. and Kalaitzakis, E. and Kalogeropoulos, P. and Liapis, G. and Tzioufas, A.G. and Boletis, J.N.",
    journal = "Clinical and Experimental Rheumatology",
    year = "2022",
    volume = "40",
    number = "4",
    pages = "741-750",
    publisher = "Clinical and Experimental Rheumatology S.A.S.",
    issn = "0392-856X, 1593-098X",
    doi = "10.55563/clinexprheumatol/acphbb",
    keywords = "myeloblastin;  neutrophil cytoplasmic antibody;  peroxidase, adolescent;  ANCA associated vasculitis;  female;  human;  kidney disease;  male;  middle aged;  recurrent disease;  retrospective study;  Wegener granulomatosis, Adolescent;  Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis;  Antibodies, Antineutrophil Cytoplasmic;  Female;  Granulomatosis with Polyangiitis;  Humans;  Kidney Diseases;  Male;  Middle Aged;  Myeloblastin;  Peroxidase;  Recurrence;  Retrospective Studies",
    abstract = "Objective To explore the frequency and impact of an autoimmune disease past-medical history (PMH) in the clinical picture and outcomes of patients with antineutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis (AAV). Methods This was a retrospective study of patients with biopsy-proven AAV, >16 years old, with detailed information about their PMH. Outcomes of interest included remission, treatment resistance, relapse, end-stage kidney disease (ESKD), and death. Results 206 patients with biopsy-proven AAV and available information regarding their PMH were studied. 63(30.6%) of them had a history of autoimmune disease prior to AAV diagnosis. The mean age overall was 54.1 years. One hundred and five patients (51%) were positive for PR3-ANCA, 101 (49%) for MPO-ANCA. Granulomatosis with polyangiitis was diagnosed in 79 (38.3%), microscopic polyangiitis in 97 (47.1%) and renal-limited vasculitis in 30 (14.6%) individuals. Remission rate was similar among patients with and without a PMH of autoimmune disease. Time-to-event analysis indicated that the relapse-free survival was significantly longer in patients with PMH of autoimmune disease (148.2 vs. 61.9 months, p-value <0.001). After adjusting for covariates, autoimmune disease history was associated with significantly lower risk of relapse (HR: 0.33, 95% CI: 0.15-0.72), which remained significant in males, patients ≥60 years old and those with C/PR3-ANCA, kidney and lung involvement. Conclusion Patients with a PMH of autoimmune disease, prior to AAV diagnosis, experienced significantly fewer relapses after achievement of remission, compared to patients without such a history, underlining the importance of individualisation of maintenance immunosuppressive therapy, given the different aetiopathogenetic settings the disease was developed. © Copyright Clinical and Experimental Rheumatology 2022."
}