Alvise Berti1, Mara Felicetti2, Sara Monti3, Augusta Ortolan2, Roberto Padoan2, Giuliano Brunori4, Roberto Bortolotti5, Roberto Caporali6, Carlomaurizio Montecucco7, Franco Schiavon2, Giuseppe Paolazzi5. 1. Department of Rheumatology, Santa Chiara Hospital, Trento, Italy; Department of Cellular, Computational and Integrative Biology-CIBIO, University of Trento, Trento, Italy. Electronic address: alvise.berti@apss.tn.it. 2. Operative Unit of Rheumatology, Department of Medicine DI-MED, University of Padova, Italy. 3. Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy; Ph.D. in Experimental Medicine, University of Pavia, Pavia, Italy. 4. Nephrology Department, Santa Chiara Hospital, Trento, Italy. 5. Department of Rheumatology, Santa Chiara Hospital, Trento, Italy. 6. Department of Clinical Sciences and community health, University of Milan, Italy. 7. Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy.
Abstract
OBJECTIVE: Aging may be a risk factor for morbidity in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We compared the rate and better characterized the type of disease- and treatment-related complications affecting young and elderly patients with AAV. METHODS: All new cases of granulomatosis with polyangiitis or microscopic polyangiitis diagnosed in three referral centers between 2000-2016 were included. Patients were stratified by age into young or elderly (< or ≥65 years old, respectively). Data were collected from diagnosis until end of follow-up, with scheduled annual visits or additional visits in case of relapse or complication requiring hospitalization. RESULTS: Of 141 patients included, 42 were elderly and 99 were young at the time of AAV diagnosis. Median follow-up was 58.0 [25-75% IQR, 31.0-60.0] months in young and 48.0 [23.25-60.0] months in elderly patients (p>0.05). Overall, the elderly group was associated to higher damage accrual assessed by Vasculitis Damage Index during follow-up (β=0.28, p<0.05). Sixty-three (44.7%) patients had acute kidney injury due to AAV-glomerulonephritis at diagnosis. In contrast to elderly, young patients showed significant improvement in renal function over time, particularly in the first 6 months while on induction treatment (ΔeGFR, median [25-75%IQR], 5.3 [0.4-14] versus 22.8 [5.9-52.1] ml/min/1.73m2, p=0.008), without significant changes after ANCA type stratification. Despite similar immunosuppressive therapy approaches and relapse rates, elderly patients had a higher rate of severe infections compared to younger patients (HR 2.1, 95% CIs: 1.1-4.4, p=0.043). CONCLUSIONS: Elderly patients with AAV had higher susceptibility to disease- and treatment-related morbidity than younger patients, particularly to renal and infective morbidity.
OBJECTIVE: Aging may be a risk factor for morbidity in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We compared the rate and better characterized the type of disease- and treatment-related complications affecting young and elderly patients with AAV. METHODS: All new cases of granulomatosis with polyangiitis or microscopic polyangiitis diagnosed in three referral centers between 2000-2016 were included. Patients were stratified by age into young or elderly (< or ≥65 years old, respectively). Data were collected from diagnosis until end of follow-up, with scheduled annual visits or additional visits in case of relapse or complication requiring hospitalization. RESULTS: Of 141 patients included, 42 were elderly and 99 were young at the time of AAV diagnosis. Median follow-up was 58.0 [25-75% IQR, 31.0-60.0] months in young and 48.0 [23.25-60.0] months in elderly patients (p>0.05). Overall, the elderly group was associated to higher damage accrual assessed by Vasculitis Damage Index during follow-up (β=0.28, p<0.05). Sixty-three (44.7%) patients had acute kidney injury due to AAV-glomerulonephritis at diagnosis. In contrast to elderly, young patients showed significant improvement in renal function over time, particularly in the first 6 months while on induction treatment (ΔeGFR, median [25-75%IQR], 5.3 [0.4-14] versus 22.8 [5.9-52.1] ml/min/1.73m2, p=0.008), without significant changes after ANCA type stratification. Despite similar immunosuppressive therapy approaches and relapse rates, elderly patients had a higher rate of severe infections compared to younger patients (HR 2.1, 95% CIs: 1.1-4.4, p=0.043). CONCLUSIONS: Elderly patients with AAV had higher susceptibility to disease- and treatment-related morbidity than younger patients, particularly to renal and infective morbidity.