ANCA vasculitis in the elderly

Deana D. Hoganson, Aaron M. From, Clement Michet

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

BACKGROUND: In population-based estimates of disease, the incidence of ANCA-associated vasculitides is increasing, with the peak age of onset in middle aged and older adults. Clinical characteristics of the very elderly have not been fully elucidated. METHODS: Patients who met the criteria for Wegener granulomatosis and microscopic polyangiitis were included in the study. The following characteristics were analyzed by retrospective review: time interval from first symptoms to date of diagnosis, age at diagnosis, laboratory values on initial presentation, and Birmingham Vasculitis Activity Score when diagnosed. RESULTS: Patients >75 years old were more often female, had fewer ear, nose, or throat symptoms, and had lower hemoglobin values. At date of latest follow-up, 40% of the older patients died compared with 11% of the younger cohort (P = 0.0006). Of the deceased elderly patients, nearly one-half died within 6 months. Age >75 carried an elevated risk of mortality (hazard ratio = 2.69, 95% confidence interval = 1.55-4.96; P = 0.0005) as did elevated serum creatinine (hazard ratio = 1.25 per 1 mg/dL, 95% confidence interval = 1.06-1.43; P = 0.0109). Survival was worse in those presenting with Birmingham Vasculitis Activity Score >20 and those >75-year-old. CONCLUSION: The clinical presentation of ANCA-associated vasculitis is relatively similar among elderly and younger patients. In patients aged 75 years or older, ANCA vasculitis is associated with higher mortality, and related to the presence of renal involvement. Elderly patients have a greater risk for death within the first 6 months after diagnosis.

Original languageEnglish (US)
Pages (from-to)78-81
Number of pages4
JournalJournal of Clinical Rheumatology
Volume14
Issue number2
DOIs
StatePublished - Apr 1 2008

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Antineutrophil Cytoplasmic Antibodies
Vasculitis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Microscopic Polyangiitis
Confidence Intervals
Granulomatosis with Polyangiitis
Mortality
Clinical Laboratory Techniques
Pharynx
Age of Onset
Nose
Ear
Creatinine
Hemoglobins
Kidney
Survival
Incidence
Serum
Population

Keywords

  • ANCA
  • Elderly
  • Microscopic polyangiitis
  • Vasculitis
  • Wegener granulomatosis

ASJC Scopus subject areas

  • Rheumatology

Cite this

ANCA vasculitis in the elderly. / Hoganson, Deana D.; From, Aaron M.; Michet, Clement.

In: Journal of Clinical Rheumatology, Vol. 14, No. 2, 01.04.2008, p. 78-81.

Research output: Contribution to journalArticle

Hoganson, Deana D. ; From, Aaron M. ; Michet, Clement. / ANCA vasculitis in the elderly. In: Journal of Clinical Rheumatology. 2008 ; Vol. 14, No. 2. pp. 78-81.
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abstract = "BACKGROUND: In population-based estimates of disease, the incidence of ANCA-associated vasculitides is increasing, with the peak age of onset in middle aged and older adults. Clinical characteristics of the very elderly have not been fully elucidated. METHODS: Patients who met the criteria for Wegener granulomatosis and microscopic polyangiitis were included in the study. The following characteristics were analyzed by retrospective review: time interval from first symptoms to date of diagnosis, age at diagnosis, laboratory values on initial presentation, and Birmingham Vasculitis Activity Score when diagnosed. RESULTS: Patients >75 years old were more often female, had fewer ear, nose, or throat symptoms, and had lower hemoglobin values. At date of latest follow-up, 40{\%} of the older patients died compared with 11{\%} of the younger cohort (P = 0.0006). Of the deceased elderly patients, nearly one-half died within 6 months. Age >75 carried an elevated risk of mortality (hazard ratio = 2.69, 95{\%} confidence interval = 1.55-4.96; P = 0.0005) as did elevated serum creatinine (hazard ratio = 1.25 per 1 mg/dL, 95{\%} confidence interval = 1.06-1.43; P = 0.0109). Survival was worse in those presenting with Birmingham Vasculitis Activity Score >20 and those >75-year-old. CONCLUSION: The clinical presentation of ANCA-associated vasculitis is relatively similar among elderly and younger patients. In patients aged 75 years or older, ANCA vasculitis is associated with higher mortality, and related to the presence of renal involvement. Elderly patients have a greater risk for death within the first 6 months after diagnosis.",
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AB - BACKGROUND: In population-based estimates of disease, the incidence of ANCA-associated vasculitides is increasing, with the peak age of onset in middle aged and older adults. Clinical characteristics of the very elderly have not been fully elucidated. METHODS: Patients who met the criteria for Wegener granulomatosis and microscopic polyangiitis were included in the study. The following characteristics were analyzed by retrospective review: time interval from first symptoms to date of diagnosis, age at diagnosis, laboratory values on initial presentation, and Birmingham Vasculitis Activity Score when diagnosed. RESULTS: Patients >75 years old were more often female, had fewer ear, nose, or throat symptoms, and had lower hemoglobin values. At date of latest follow-up, 40% of the older patients died compared with 11% of the younger cohort (P = 0.0006). Of the deceased elderly patients, nearly one-half died within 6 months. Age >75 carried an elevated risk of mortality (hazard ratio = 2.69, 95% confidence interval = 1.55-4.96; P = 0.0005) as did elevated serum creatinine (hazard ratio = 1.25 per 1 mg/dL, 95% confidence interval = 1.06-1.43; P = 0.0109). Survival was worse in those presenting with Birmingham Vasculitis Activity Score >20 and those >75-year-old. CONCLUSION: The clinical presentation of ANCA-associated vasculitis is relatively similar among elderly and younger patients. In patients aged 75 years or older, ANCA vasculitis is associated with higher mortality, and related to the presence of renal involvement. Elderly patients have a greater risk for death within the first 6 months after diagnosis.

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