Alice Delapierre1, Benjamin Terrier2,3,4, Evangéline Pillebout5, Pauline Baudart1, Noémie Jourde-Chiche6, Bertrand Lioger7, Nihal Martis8, Guillaume Moulis9, Etienne Rivière10, Noémie Le Gouellec11, Loïc Raffray12, Geoffrey Urbanski13, Sébastien Sanges14,15, Francois Maurier16, Alban Deroux17, Arsène Mekinian18, Renato Monteiro19, Christian Marcelli1, Loïc Guillevin2,3,4, Francois Maillot20,21, Bruno Lucas22, Achille Aouba23, Alexandra Audemard-Verger24,25. 1. Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France. 2. Université Paris Descartes, Paris, France. 3. Department of Internal Medicine, Hôpital Cochin, Paris, France. 4. National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France. 5. Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 6. Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie Et Transplantation Rénale, CHU de La Conception, AP-HM, Marseille, France. 7. Department of Internal Medicine, Hôpital Saint Louis, APHP, Paris, France. 8. Department of Internal Medicine, CHU, Nice, France. 9. Department of Internal Medicine, CHU, Toulouse, France. 10. Department of Internal Medicine, CHU, Bordeaux, France. 11. Department of Internal Medicine and Nephrology, Valenciennes, CH, France. 12. Department of Internal Medicine, CHU, La Réunion, France. 13. Department of Internal Medicine, CHU, Angers, France. 14. Département de Médecine Interne Et Immunologie Clinique, CHU Lille, 59000, Lille, France. 15. Univ. Lille, INSERM, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France. 16. Department of Internal Medicine, Hôpitaux privés, Metz, France. 17. Department of Internal Medicine, CHU de Grenoble, Grenoble, France. 18. Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 19. Center of Research On Inflammation INSERM U1149, CNRS ERL8252, Paris Diderot University, Paris, France. 20. Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France. 21. University of Tours, Tours, France. 22. Paris Descartes University, Cochin Institute, CNRS UMR8104, INSERM U1016, Paris, France. 23. Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France. 24. Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France. alexandra.audemardverger@univ-tours.fr. 25. University of Tours, Tours, France. alexandra.audemardverger@univ-tours.fr.
Abstract
OBJECTIVE: Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile. METHODS: We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays. RESULTS: Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80-0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18-3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1 pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5 pg/ml; p = 0.076). CONCLUSION: Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement. Key Points • Joint involvement in adult IgAV is a frequent manifestation. • Joint involvement is associated with more frequent gastrointestinal manifestations. • Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV. • IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.
OBJECTIVE: Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile. METHODS: We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays. RESULTS: Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80-0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18-3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1 pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5 pg/ml; p = 0.076). CONCLUSION: Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement. Key Points • Joint involvement in adult IgAV is a frequent manifestation. • Joint involvement is associated with more frequent gastrointestinal manifestations. • Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV. • IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.
Authors: R C Monteiro; L Halbwachs-Mecarelli; M C Roque-Barreira; L H Noel; J Berger; P Lesavre Journal: Kidney Int Date: 1985-10 Impact factor: 10.612
Authors: J C Jennette; R J Falk; P A Bacon; N Basu; M C Cid; F Ferrario; L F Flores-Suarez; W L Gross; L Guillevin; E C Hagen; G S Hoffman; D R Jayne; C G M Kallenberg; P Lamprecht; C A Langford; R A Luqmani; A D Mahr; E L Matteson; P A Merkel; S Ozen; C D Pusey; N Rasmussen; A J Rees; D G I Scott; U Specks; J H Stone; K Takahashi; R A Watts Journal: Arthritis Rheum Date: 2013-01