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. 2024 May;295(5):651-667.
doi: 10.1111/joim.13777. Epub 2024 Mar 11.

Significance of clinical-immunological patterns and diagnostic yield of biopsies in microscopic polyangiitis and granulomatosis with polyangiitis

João Fernandes-Serodio  1   2 , Sergio Prieto-González  1 , Georgina Espígol-Frigolé  1 , Roberto Ríos-Garcés  1 , Verónica Gómez-Caverzaschi  1 , Olga Araújo  1 , Gerard Espinosa  1 , Raül Jordà-Sánchez  1 , Marco A Alba  1 , Luis Quintana  3 , Miquel Blasco  3 , Elena Guillen  3 , Odette Viñas  4 , Estíbaliz Ruiz-Ortiz  4 , Laura Pelegrín  5 , Maite Sainz de la Maza  5 , Bernardo Sánchez-Dalmau  5 , Adriana García-Herrera  6 , Manel Solé  6 , Paola Castillo  6 , Iban Aldecoa  6 , María D Cano  6 , Jacobo Sellarés  7 , Fernanda Hernández-González  7 , Carlos Agustí  7 , Carmen M Lucena  7 , Antonio López-Rueda  8 , Marcelo Sánchez  9 , Mariana Benegas  9 , Sebastián Capurro  9 , Raimon Sanmartí  10 , Josep M Grau  11 , Isabel Vilaseca  12 , Isam Alobid  12 , Maria C Cid  1 , José Hernández-Rodríguez  1
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Free article

Significance of clinical-immunological patterns and diagnostic yield of biopsies in microscopic polyangiitis and granulomatosis with polyangiitis

João Fernandes-Serodio et al. J Intern Med. 2024 May.
Free article

Abstract

Background: Microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) are the two major antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Objectives: To characterize a homogenous AAV cohort and to assess the impact of clinicopathological profiles and ANCA serotypes on clinical presentation and prognosis. Clinical differences in GPA patients according to ANCA serotype and the diagnostic yield for vasculitis of biopsies in different territories were also investigated.

Results: This retrospective study (2000-2021) included 152 patients with AAV (77 MPA/75 GPA). MPA patients (96.1% myeloperoxidase [MPO]-ANCA and 2.6% proteinase 3 [PR3]-ANCA) presented more often with weight loss, myalgia, renal involvement, interstitial lung disease (ILD), cutaneous purpura, and peripheral nerve involvement. Patients with GPA (44% PR3-ANCA, 33.3% MPO, and 22.7% negative/atypical ANCA) presented more commonly with ear, nose, and throat and eye/orbital manifestations, more relapses, and higher survival than patients with MPA. GPA was the only independent risk factor for relapse. Poor survival predictors were older age at diagnosis and peripheral nerve involvement. ANCA serotypes differentiated clinical features in a lesser degree than clinical phenotypes. A mean of 1.5 biopsies were performed in 93.4% of patients in different territories. Overall, vasculitis was identified in 80.3% (97.3% in MPA and 61.8% in GPA) of patients.

Conclusions: The identification of GPA presentations associated with MPO-ANCA and awareness of risk factors for relapse and mortality are important to guide proper therapeutic strategies in AAV patients. Biopsies of different affected territories should be pursued in difficult-to-diagnose patients based on their significant diagnostic yield.

Keywords: ANCA‐associated vasculitis; biopsy diagnostic yield; granulomatosis with polyangiitis; microscopic polyangiitis; mortality; relapse.

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