QJM Advance Access originally published online on January 17, 2005
QJM 2005 98(2):97-111; doi:10.1093/qjmed/hci015
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QJM vol. 98 no. 2 © Association of Physicians 2005; all rights reserved.
Primary systemic vasculitis: clinical features and mortality
From the Department of Rheumatology, Ipswich Hospital, Ipswich, 1School of Medicine, University of East Anglia, Norwich, and 2Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
Received 2 February 2004 and in revised form 25 August 2004
Background: Wegener's granulomatosis (WG), Churg Strauss syndrome (CSS) and microscopic polyangiitis (MPA) are primary systemic vasculitides (PSV), the clinical features of which have been described from tertiary centres.
Aim: To provide the first clinical description of MPA from a general hospital and compare clinical features with WG and CSS.
Design: Retrospective analysis of patient records.
Methods: Records of 99 PSV patients attending a single hospital, from 1988 to 2000, were reviewed for: clinical features, date/age at diagnosis, sex, duration of illness, anti-neutrophil cytoplasmic antibodies (ANCA), treatment, comorbidity and deaths. Cases were classified using ACR, CHCC and Lanham criteria/definitions. Birmingham vasculitis activity scores (BVAS) and damage index (VDI) were calculated. Survival was assessed using Cox proportional hazards model and standardized mortality ratios (SMRs).
Results: Compared to previous reports there was more ENT (29%) and respiratory (29%) but less renal (92%) involvement in MPA, and less ENT involvement in WG (81%). CSS showed high neurological (72%), cardiovascular (28%) and gastrointestinal (17%) involvement and the highest median (range) VDI (p = 0.01 vs. WG; p = 0.001 vs. MPA). BVAS1 was significantly lower in MPA than in WG [median (range) 15 (4–29) vs. 21 (6–39), (p = 0.001)] but not in CSS [20 (7–28), p = 0.08]. SMR (95%CI) for PSV was 4.8 (3.0–6.6); 5-year survival was 45.1% for MPA, 75.9% for WG and 68.1% for CSS. Age was a significant risk, but only to the same extent as in the reference population. When age was adjusted for, no other significant factor was found.
Discussion: The clinical characteristics seen here are similar to those in previous series. There are difficulties in using the MPA CHCC definitions in classification. There is a high proportion of neurological involvement in CSS, causing permanent damage. MPA may have a poorer prognosis than WG or CSS.
Address correspondence to Dr S.E. Lane, Department of Rheumatology, Ipswich Hospital, Heath Rd, Ipswich IP4 5PD. e-mail: suzanne.lane{at}ipswichhospital.nhs.uk
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