Pulmonary function in patients with ANCA-associated vasculitis

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Johannes Dieterich
Bernhard Hellmich
Juliane Mahrhold
You-Shan Feng
Abdallah El Rai
Felix Nessyt
Ulrich Specks
Jürgen Hetzel
Christian Löffler

Keywords

ANCA-associated vasculitis, pulmonary function test, spirometry, interstitial lung disease

Abstract

Background and aim: Although pulmonary manifestations occur frequently in ANCA-associated vasculitis (AAV), empirical evidence of their impact on pulmonary function is scarce. This study analyzed pulmonary function test (PFT) data from a large cohort of patients with AVV. Results were correlated with findings from diagnostic imaging and disease activity. Methods: Data from AAV patients with PFTs performed between 2008 and 2018 were extracted retrospectively from the database of a tertiary vasculitis center. Demographic and disease characteristics, imaging data and follow-up results were assessed and compared to PFT results. Results: The final analysis encompassed 147 patients. The mean time between first PFT and follow-up was 7.0 ± 11.0 months. In Granulomatosis with Polyangiitis (GPA), forced expiratory vital capacity (FVCex, p<0.001), residual volume (RV, p<0.001) and the diffusion capacity of carbon oxide (TLCO, p=0.003) were significantly reduced compared to the reference value of 100% predicted. There was no significant difference between patients with or without pulmonary manifestations. In Microscopic Polyangiitis (MPA), reductions of FVCex (p<0.001), TLC (p=0.005), and TLCO (p=0.003) were observed. In Eosinophilic Granulomatosis with Polyangiitis (EGPA), total airway resistance (RAWtot, p=0.024) and RV (p=0.009) were significantly elevated and TLCO was reduced (p=0.014). Interstitial lung disease (ILD) is associated with a decline of FVCex (-15.7%, p=0.0028), TLC (-26.5%, p<0.001), RV (-38.9%, p=0.023) and TLCO (-29.1%, p=0.007). Significant differences were neither detected between first PFT and follow-up examination, nor between patients with active versus inactive disease. Conclusions: AAV patients presented with characteristic alterations in PFTs according to their respective pulmonary and/or airway manifestations. These results did not change over time and were independent from vasculitis activity.

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References

1. Hellmich B, Lamprecht P, Spearpoint P, et al. New insights into the epidemiology of ANCA-associated vasculitides in Germany: results from a claims data study. Rheumatology 2021:1–6.
2. Herlyn K, Hellmich B, Gross WL, Reinhold-Keller E. Stable incidence of systemic vasculitides in Schleswig-Holstein, Germany. Dtsch Arztebl Int 2008;105:355–361.
3. Fidler LM, Kandel S, Fisher JH, Mittoo S, Shapera S. Utility of anti-neutrophil cytoplasmic antibody screening in idiopathic interstitial lung disease. Sarcoidosis Vasc Dif;38:e2021015.
4. Kim YK, Lee KS, Chung MP, et al. Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings. Eur Radiol 2007;17:3157–3165.
5. Guillevin L, Durand-Gasselin B, Cevallos R, et al. Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. Arthritis Rheum 1999;42:421–30.
6. Reinhold-Keller E, Beuge N, Latza U, et al. An interdisciplinary approach to the care of patients with Wegener’s granulomatosis: long-term outcome in 155 patients. Arthritis Rheum 2000;43:1021–32.
7. Mohammad AJ, Mortensen KH, Babar J, et al. Pulmonary Involvement in Antineutrophil Cytoplasmic Antibodies (ANCA)-associated Vasculitis: The Influence of ANCA Subtype. J Rheumatol 2017;44:1458–1467.
8. Lai QY, Ma TT, Li ZY, Chang DY, Zhao MH, Chen M. Predictors for mortality in patients with antineutrophil cytoplasmic autoantibody-associated vasculitis: a study of 398 Chinese patients. J Rheumatol 2014;41:1849–1855.
9. Koldingsnes W, Jacobsen EA, Sildnes T, Hjalmarsen A, Nossent HC. Pulmonary function and high-resolution CT findings five years after disease onset in patients with Wegener’s granulomatosis. Scand J Rheumatol 2005;34:220–28.
10. Newall C, Schinke S, Savage CO, Hill S, Harper L. Impairment of lung function, health status and functional capacity in patients with ANCA-associated vasculitis. Rheumatology 2005;44:623–628.
11. Rosenberg DM, Weinberger SE, Fulmer JD, et al. Functional Correlates of Lung Involvement in Wegener’s Granulomatosis Use of Pulmonary Function Tests in Staging and Follow-up. Am J Med 1980;69:387–394.
12. Grayson PC, Ponte C, Suppiah R, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis. Ann Rheum Dis 2022;81.
13. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013;65:1–11.
14. Robson JC, Grayson PC, Ponte C, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis. Ann Rheum Dis 2022;81.
15. Suppiah R, Robson JC, Grayson PC, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis. Ann Rheum Dis 2022;81.
16. Quanjer P. Standardized lung function testing. Report working party. Bull Eur Physiopathol Respir 1983;5:1–95.
17. Quanjer P, Tammeling G, Cotes J, Pederson O, Peslin R, Yernault J. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Supp 1993;16:5–40.
18. Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations Stocks and the ERS Global Lung Function Initiative. Eur Respir J 2012;40:1324–1343.
19. Empey DW. Assessment of upper airways obstruction. Br Med J 1972;3:503–505.
20. Mukhtyar C, Lee R, Brown D, et al. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis 2009;68:1827–1832.
21. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697–722.
22. Members of the American Thoracic Society/European Respiratory Society. American Thoracic Society American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Med. 2002;165:277-304.
23. C-P Criée A, Baur X, Berdel D, et al. Leitlinie zur Spirometrie Leitlinie der Deutschen Atemwegsliga, der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin zur Spirometrie of Occupational and Environmental Medicine. Pneumologie 2015;69:147–164.
24. Suppiah R, Robson JC, Grayson PC, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis. Ann Rheum Dis 2022;81.
25. Grayson PC, Ponte C, Suppiah R, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis. Ann Rheum Dis 2022;81
26. Robson JC, Grayson PC, Ponte C, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis. Ann Rheum Dis 2022;81.
27. Sacoto G, Boukhlal S, Specks U, Flores-Suárez LF, Cornec D. Lung involvement in ANCA-associated vasculitis. Presse Medicale 2020;49:104039.
28. West S, Arulkumaran N, Ind PW, Pusey CD. Diffuse alveolar haemorrhage in ANCA-associated vasculitis. Intern Med 2013;52:5–13.
29. Baroni RH, Feller-Kopman D, Nishino M, et al. Tracheobronchomalacia: comparison between end-expiratory and dynamic expiratory CT for evaluation of central airway collapse. Radiology 2005;235:635–641.
30. Quinn KA, Gelbard A, Sibley C, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology (Oxford) 2019;58:2203–2211
31. Hozumi H, Kono M, Hasegawa H, et al. Clinical Significance of Interstitial Lung Disease and Its Acute Exacerbation in Microscopic Polyangiitis. Chest 2021;159:2334–2345.
32. Bando M, Homma S, Harigai M. MPO-ANCA positive interstitial pneumonia: Current knowledge and future perspectives. Sarcoidosis Vasculitis and Diffuse Lung Diseases 2021;38:e2021045.