Farm Exposure as a Differential Risk Factor in ANCA-Associated Vasculitis

Abstract

Objective: To investigate the association of farm exposure and the development of ANCA-associated vasculitis (AAV).

Methods: One hundred eighty-nine well defined patients with AAV (n = 119 with granulomatosis with polyangiitis [GPA], n = 48 with microscopic polyangiitis [MPA], n = 22 patients with eosinophilic granulomatosis with polyangiitis [EGPA]) and 190 controls (n = 119 patients with rheumatoid arthritis, n = 71 with large vessel vasculitis) were interrogated using a structured questionnaire. Factors investigated were occupation, farm exposure, contact to different livestock, participation in harvesting, residence next to a farm, MRSA status, and contact to domestic pets at disease onset or ever before. The odds ratio (OR) and 95% confidence interval [95%CI] were calculated for each item.

Results: Univariate analysis revealed a strong association of AAV with regular farm exposure; OR 3.44 [95%CI 1.43-8.27]. AAV was also associated with regular contact to cattle 4.30 (1.43-8.27), pigs 2.75 (1.12-6.75) and MRSA carriage 3.38 (1.11-10.3). This association was stronger in the subgroup of GPA patients. OR in this group for farm exposure was 4.97; [2.02-12.2], for cattle 6.71 [95% CI 2.19-20.7], for pigs 4.34 [1.75-10.9], and MRSA carriage 5.06 [1.62-15.8]). There was no significant association of MPA or EGPA with these parameters.

Conclusion: A significant association between farm exposure or farm animal exposure and AAV especially in the subgroup of patients with GPA has been identified. This suggests that these entities are distinct and have different triggers for the immune process.

Fig 1. Schematic diagram showing the number of study participants in each group.

AAV = ANCA associated vasculitis; GPA = granulomatosis with polyangiitis (Wegener’s); MPA = microscopic polyangiitis; EGPA = eosinophilic granulomatosis with polyangiitis.

Fig 2. Forest Plot.

The bars represent the odds ratio (circle) and 95% confidence interval for the association of GPA with different parameters (upper part) and for non-GPA patients with ANCA-associated vasculitis (lower grey part). AAV = ANCA-associated vasculitis; GPA = granulomatosis with polyangiitis (Wegener’s).