nach oben

Current Rheumatology Reports

Erschienen in:

01.09.2017 | Vasculitis (L Espinoza, Section Editor)

Pulmonary Involvement in Systemic Vasculitis

verfasst von: Luis Felipe Flores-Suárez, Marco A. Alba, Heidegger Mateos-Toledo, Natllely Ruiz

Erschienen in: Current Rheumatology Reports | Ausgabe 9/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The purpose of this study is to describe the most relevant advances concerning lung involvement in the ANCA-associated vasculitides (excluding eosinophilic granulomatosis with polyangiitis which may have different disease mechanisms). Focus is on pathophysiology, recent important imagenological procedures, treatment, and outcome.

Recent Findings

Emerging information exists on potential newly investigated diagnostic procedures (v.g. transbronchial cryobiopsies), detailed tomographic abnormalities, the potential favorable role of rituximab and the still uncertain one of plasma exchange in the treatment, and the increasing description of interstitial lung disease. Survival is reduced in case of both, diffuse alveolar hemorrhage and diffuse parenchymal disease.

Summary

There is the need to expand the knowledge concerning better long-term treatment options with specific regimes, and to incorporate other measures regarding integral treatment in patients afflicted with lung involvement these maladies, as the outcome seems adverse in this scenario.

Jennette JC, Falk RJ, Bacon PA, et al. 2012 Revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2013;65:1–11.CrossRefPubMed

Watts RA, Mahr A, Mohammad AJ, et al. Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant. 2015;30(Suppl 1):i14–22.CrossRefPubMed

Fujimoto S, Watts RA, Kobayashi S, et al. Comparison of the epidemiology of anti-neutrophil cytoplasmic antibody-associated vasculitis between Japan and the U.K. Rheumatology. 2011;50:1916–20.CrossRefPubMed

Roth AJ, Ooi JD, Hess JJ, et al. Epitope specificity determines pathogenicity and detectability in ANCA-associated vasculitis. J Clin Invest. 2013;123:1773–83.CrossRefPubMedPubMedCentral

Kim YC, Choi YS, Alam J, et al. Induction of proteinase 3-anti-neutrophil cytoplasmic autoantibodies by proteinase 3-homologous bacterial protease in mice. Immunol Res. 2016;64:438–44.CrossRefPubMed

Kain R, Exner M, Brandes R, et al. Molecular mimicry in pauci-immune focal necrotizing glomerulonephritis. Nat Med. 2008;14:1088–96.CrossRefPubMedPubMedCentral

Lyons PA, Rayner TF, Trivedi S, et al. Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med. 2012;367:214–23.CrossRefPubMedPubMedCentral

• Merkel PA, Xie G, Monach PA, et al. Identification of functional and expression polymorphisms associated with risk for anti-neutrophil cytoplasmic autoantibody-associated vasculitis. Arthritis Rheumatol. 2017;69:1054–66. A study which ratified the findings of the large European GWAS study (previous reference). CrossRefPubMedPubMedCentral

Ciavatta DJ, Yang J, Preston GA, et al. Epigenetic basis for aberrant upregulation of autoantigen genes in humans with ANCA vasculitis. J Clin Invest. 2010;120:3209–19.CrossRefPubMedPubMedCentral

10.

Abdgawad M, Gunnarsson L, Bengtsson AA, et al. Elevated neutrophil membrane expression of proteinase 3 is dependent upon CD177 expression. Clin Exp Immunol. 2010;161:89–97.PubMedPubMedCentral

11.

Komocsi A, Lamprecht P, Csernok E, et al. Peripheral blood and granuloma CD4(+)CD28(−) T cells are a major source of interferon-gamma and tumor necrosis factor-alpha in Wegener’s granulomatosis. Am J Pathol. 2002;160:1717–24.CrossRefPubMedPubMedCentral

12.

Rimbert M, Hamidou M, Braudeau C, et al. Decreased numbers of blood dendritic cells and defective function of regulatory T cells in antineutrophil cytoplasmic antibody-associated vasculitis. PLoS One. 2011;6:e18734.CrossRefPubMedPubMedCentral

13.

Free ME, Bunch DO, McGregor JA, et al. Patients with antineutrophil cytoplasmic antibody-associated vasculitis have defective Treg cell function exacerbated by the presence of a suppression-resistant effector cell population. Arthritis Rheum. 2013;65:1922–33.CrossRefPubMed

14.

Ooi JD, Chang J, Hickey MJ, et al. The immunodominant myeloperoxidase T-cell epitope induces local cell-mediated injury in antimyeloperoxidase glomerulonephritis. Proc Natl Acad Sci U S A. 2012;109:E2615–24.CrossRefPubMedPubMedCentral

15.

Bunch DO, McGregor JG, Khandoobhai NB, et al. Decreased CD5(+) B cells in active ANCA vasculitis and relapse after rituximab. Clin J Am Soc Nephrol. 2013;8:382–91.CrossRefPubMedPubMedCentral

16.

Xiao H, Hu P, Falk RJ, Jennette JC. Overview of the pathogenesis of ANCA-associated vasculitis. Kidney Dis (Basel). 2016;1:205–15.CrossRef

17.

Holden NJ, Williams JM, Morgan MD, et al. ANCA-stimulated neutrophils release BLyS and promote B cell survival: a clinically relevant cellular process. Ann Rheum Dis. 2011;70:2229–33.CrossRefPubMed

18.

Porges AJ, Redecha PB, Kimberly WT, et al. Anti-neutrophil cytoplasmic antibodies engage and activate human neutrophils via Fc gamma RIIa. J Immunol. 1994;153:1271–80.PubMed

19.

Schönermarck U, Csernok E, Gross WL. Pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis: challenges and solutions 2014. Nephrol Dial Transplant. 2015;30(Suppl 1):i46–52.PubMed

20.

Ewert BH, Jennette JC, Falk RJ. Anti-myeloperoxidase antibodies stimulate neutrophils to damage human endothelial cells. Kidney Int. 1992;41:375–83.CrossRefPubMed

21.

Little MA, Smyth L, Salama AD, et al. Experimental autoimmune vasculitis: an animal model of anti-neutrophil cytoplasmic autoantibody-associated systemic vasculitis. Am J Pathol. 2009;174:1212–20.CrossRefPubMedPubMedCentral

22.

Xiao H, Heeringa P, Hu P, et al. Antineutrophil cytoplasmic autoantibodies specific for myeloperoxidase cause glomerulonephritis and vasculitis in mice. J Clin Invest. 2002;110:955–63.CrossRefPubMedPubMedCentral

23.

Mueller A, Holl-Ulrich K, Lamprecht P, Gross WL. Germinal centre-like structures in Wegener’s granuloma: the morphological basis for autoimmunity? Rheumatology. 2008;47:1111–3.CrossRefPubMed

24.

Hu P, Xiao H, Alba MA, Falk RJ, Jennette JC. Anti-MPO antibodies cause granulomatosis in mice: an animal model of GPA. Rheumatology 2017;56 (suppl. 3):iii29. Abstract WS6_1. The 18th International Vasculitis & ANCA Workshop 2017.

25.

Thickett DR, Richter AG, Nathani N, et al. Pulmonary manifestations of anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis. Rheumatology. 2006;45:261–8.CrossRefPubMed

26.

Ravindran V, Watts RA. Pulmonary haemorrhage in ANCA associated vasculitis. Rheumatology. 2010;49:1410–2.CrossRefPubMed

27.

Lichtenberger JP, Digumarthy SR, Abbott GF, et al. Diffuse pulmonary hemorrhage: clues to the diagnosis. Curr Probl Diagn Radiol. 2014;43:128–39.CrossRefPubMed

28.

•• Yamagata M, Ikeda K, Tsushima K, et al. Prevalence and responsiveness to treatment of lung abnormalities on chest computed tomography in patients with microscopic polyangiitis: a multicenter, longitudinal, retrospective study of one hundred fifty consecutive hospital-based Japanese patients. Arthritis Rheumatol. 2016;68:713–23. A very informative study concerning the detailed imagenological findings in MPA and their changes according to treatment. CrossRefPubMed

29.

Rolla G, Heffler E, Guida G, et al. Exhaled NO in diffuse alveolar haemorrhage. Thorax. 2005;60:614–5.CrossRefPubMedPubMedCentral

30.

Lally L, Spiera F. Pulmonary vasculitis. Rheum Dis Clin N Am. 2015;41:315–31.CrossRef

31.

• Ussavarungsi K, Kern R, Anja C, et al. Transbronchial cryobiopsy in diffuse parenchymal lung disease: retrospective analysis of 74 cases. Chest. 2017;151:400–8. An article describing a recent technique to obtain adequate samples in diffuse lung parenchymal disease from different etiologies. CrossRefPubMed

32.

Mahmoud S, Ghosh S, Farver C, et al. Pulmonary vasculitis: spectrum of imaging appearances. Radiol Clin N Am. 2016;54:1097–118.CrossRefPubMed

33.

Castañer E, Alguersuari A, Andreu M, et al. Imaging findings in pulmonary vasculitis. Semin Ultrasound CT MR. 2012;33:567–79.CrossRefPubMed

34.

• Ikeda S, Arita M, Misaki K, et al. Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study. BMC Pulm Med. 2015;15:78. Important study from Japan in where many GPA patients are MPO-ANCA positive, and poses the question regarding clinical classification versus serotyping as a more accurate discrimination tool. CrossRefPubMedPubMedCentral

35.

Alba MA, Flores-Suárez LF, Henderson AG, et al. Interstitial lung disease in ANCA vasculitis. Autoimmun Rev. 2017; doi:10.1016/j.autrev.2017.05.008.

36.

•• Kagiyama N, Takayanagi N, Kanauchi T, et al. Antineutrophil cytoplasmic antibody-positive conversion and microscopic polyangiitis development in patients with idiopathic pulmonary fibrosis. BMJ Open Resp Res. 2015;2:e000058. A relevant article which describes that some patients with IPF can evolve to MPA, and the influence of GC treatment (or not) in possibly evolving to that endpoint. CrossRefPubMedPubMedCentral

37.

Ando M, Miyazaki E, Ishii T, et al. Incidence of myeloperoxidase anti-neutrophil cytoplasmic antibody positivity and microscopic polyangitis in the course of idiopathic pulmonary fibrosis. Respir Med. 2013;107:608–15.CrossRefPubMed

38.

Homma S, Suzuki A, Sato K. Pulmonary involvement in ANCA-associated vasculitis from the view of the pulmonologist. Clin Exp Nephrol. 2013;17:667–71.CrossRefPubMed

39.

•• Comarmond C, Crestani B, Tazi A, et al. Pulmonary fibrosis in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. A series of 49 patients and review of the literature. Medicine. 2014;93:340–9. The largest up to date single center study regarding this complication in patients with AAV. CrossRefPubMedPubMedCentral

40.

• Iftikhar IH, Alghothani L, Sardi A, et al. Transbronchial lung cryobiopsy and video-assisted lung thorachoscopic lung biopsy in the diagnosis of diffuse parenchymal disease: e meta-analysis of diagnostic test accuracy. Ann Am Thorac Soc. 2017; doi:10.1513/AnnalsATS.201701-086SR. This metaanalysis secures the safety of transbronchial lung biopsies versus video-assisted thoracoscopic tissue obtainment, with similar diagnostic accuracy in diffuse lung diseases.

41.

Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010;363:221–32.CrossRefPubMedPubMedCentral

42.

Specks U, Merkel PA, Seo P, et al. Efficacy of remission-induction regimens for ANCA-associated vasculitis. New Engl J Med. 2013;369:417–27.CrossRefPubMed

43.

• Miloslavsky EM, Specks U, Merkel PA, et al. Rituximab for the treatment of relapses in antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatol. 2014;66:3151–9. Retreatment with RTX in relapsing patients is safe and probably a better option than other treatments, in patients previously treated with CYC or RTX. CrossRefPubMedPubMedCentral

44.

•• Cartin-Ceba R, Diaz-Caballero L, Al-Qadi MO, et al. Diffuse alveolar hemorrhage secondary to antineutrophil cytoplasmic antibody-associated vasculitis. Predictors of respiratory failure and clinical outcomes. Arthritis Rheumatol. 2016;68:1467–76. The most comprehensive up to date study of alveolar hemorrhage in the context of AAV. It details important points to be considered regarding outcome and therapy. CrossRefPubMed

45.

Holle JU, Dubrau C, Herlyn K, et al. Rituximab for refractury granulomatosis with polyangiitis (Wegener’s granulomatosis): comparison of efficacy in granulomatous versus vasculitic manifestations. Ann Rheum Dis. 2012;71:327–33.CrossRefPubMed

46.

de Groot K, Rasmussen N, Bacon PA, et al. Randomized trial of cyclophosphamide versus methotrexate for induction of remission in early systemic antineutrophil cytoplasmic antibody associated-vasculitis. Arthritis Rheum. 2005;52:2461–9.CrossRefPubMed

47.

•• Guillevin L, Pagnoux C, Karras A, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med. 2014;371:1771–80. A seminal study regarding RTX treatment for remission maintenance in AAV as compared to the standard for this indication since 1993. CrossRefPubMed

48.

Hirayama K, Kobayashi M, Usui J, et al. Pulmonary involvements of anti-neutrophil cytoplasmic autoantibody-associated renal vasculitis in Japan. Nephrol Dial Transplant. 2015;30:i83–93.PubMed

49.

Homma S, Matsushita H, Nakata K. Pulmonary fibrosis in myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitides. Respirology. 2004;9:190–6.CrossRefPubMed

50.

Flores-Suárez LF, Ruiz N, Saldarriaga Rivera LM, et al. Reduced survival in microscopic polyangiitis patients with pulmonary fibrosis in a respiratory center. Clin Rheumatol. 2015;34:1653–4.CrossRefPubMed

Titel: Pulmonary Involvement in Systemic Vasculitis
verfasst von: Luis Felipe Flores-Suárez
Marco A. Alba
Heidegger Mateos-Toledo
Natllely Ruiz
Publikationsdatum: 01.09.2017
Verlag: Springer US
Erschienen in: Current Rheumatology Reports / Ausgabe 9/2017
Print ISSN: 1523-3774
Elektronische ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-017-0682-4

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2017

Mechanism of New Bone Formation in Axial Spondyloarthritis

Do Biologic Therapies for Rheumatoid Arthritis Offset Treatment-Related Resource Utilization and Cost? A Review of the Literature and an Instrumental Variable Analysis

Wnt/β-catenin Signaling in Osteoarthritis and in Other Forms of Arthritis

Predictors of Osteoarthritis Pain: the Importance of Resilience

Epigenetics in SLE