Malignancy is increased in ANCA-associated vasculitis.
OBJECTIVE
In the light of previous reports of an association between malignancy and renal vasculitis, we aimed to investigate the association of malignancy in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, either Wegener's granulomatosis (WG) or microscopic polyangiitis (MPA), and compare it with the general population and disease control groups comprising patients with systemic lupus erythematosus (SLE) or Henoch-Schonlein purpura (HSP).


METHODS
A retrospective review of 200 consecutive patients with WG or MPA was performed. Malignancies preceding or concurrent with vasculitis were recorded and the incidence of malignancy was compared with those in a population of 129 patients with HSP, 333 patients with SLE and a normal population in the West Midlands of the UK.


RESULTS
Twenty patients had a diagnosis of malignancy, 14 had MPA and six had WG. Patients with ANCA-associated vasculitis had an increased risk of malignancy compared with HSP patients, of whom six patients had malignancy (relative risk 0.85, confidence interval 0.69-1.05; P = 0.034), or SLE patients, of whom five patients had malignancy (relative risk 0.31, 95% confidence interval 0.14-0.7; P<0.0001). The rate of malignancy compared with an age-matched control group was increased in patients with ANCA-associated vasculitis and HSP (ANCA-associated vasculitis, relative risk 6.02, 95% confidence interval 3.72-9.74; HSP, relative risk 5.25, 95% confidence interval 2.4-11.5). The presence of ANCA was not predictive of malignancy.


CONCLUSIONS
In conclusion, patients with ANCA-associated vasculitis have an increased risk of preceding or concurrent malignancy.
Division of Medical Sciences, The Medical School, University of Birmingham, Birmingham, UK.
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T
Pankhurst
C O S
CO
Savage
C
C
Gordon
L
L
Harper
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001327:Autoimmune Diseases / Q000150:complications* / Q000276:immunology; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000276:immunology; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000276:immunology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D018570:Risk Assessment; D014657:Vasculitis / Q000150:complications* / Q000276:immunology
D019268:Antibodies, Antineutrophil Cytoplasmic