title: Clinical and imaging features predictive of orbital granulomatosis with polyangiitis and the risk of systemic involvement.
abstract: OBJECTIVE
  Granulomatosis with polyangiitis (GPA), previously Wegener's granulomatosis, requires prompt diagnosis and systemic review to exclude life-threatening disease. However, early diagnosis of orbital GPA may be difficult because anti-neutrophil cytoplasmic antibody (ANCA) and anti-PR3 antibody screening can be negative at presentation and orbital biopsies taken for diagnosis may not show the classic features of GPA. This study was designed to compare GPA with other causes of orbital inflammation and to identify the presenting clinical and imaging features most likely to predict GPA and its systemic spread.
  
  
  METHODS
  Retrospective noninterventional comparative case series.
  
  
  METHODS
  A total of 247 patients who had undergone orbital biopsies for clinical presentations with orbital inflammation were identified from the Institute of Ophthalmology pathology database.
  
  
  METHODS
  Patients were divided into GPA and non-GPA groups on the basis of their final clinical diagnosis. Clinical and imaging features of these 2 groups were compared to determine those predictive of GPA, and patients with GPA also had long-term evaluation for systemic involvement.
  
  
  METHODS
  A diagnosis of orbital GPA and development of systemic GPA were the main outcome measures.
  
  
  RESULTS
  Features highly suggestive of GPA were sinonasal symptoms, sinonasal changes, or paranasal bone erosion on imaging (P < 0.001). Bony erosion was independent of ANCA status or systemic involvement. Twenty-two percent of patients (8/37) with GPA had evidence of systemic involvement at presentation, and no patient presenting with solely orbital GPA developed later systemic disease over a median follow-up of 2.7 years.
  
  
  CONCLUSIONS
  A high index of suspicion should be maintained for GPA when a patient presents with an orbital mass and sinonasal symptoms or imaging shows sinonasal involvement or paranasal bone erosion. No patient with solely orbital GPA involvement at presentation developed systemic disease, suggesting that orbital GPA can remain localized in the long-term.
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom; Multidisciplinary Vasculitis Clinic, Hammersmith Hospital, London, United Kingdom.
authors.forename: Lee Teak
authors.initials: LT
authors.lastname: Tan
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom; Brain Repair & Rehabilitation Unit, Institute of Neurology, London, United Kingdom.
authors.forename: Indran
authors.initials: I
authors.lastname: Davagnanam
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom; Multidisciplinary Vasculitis Clinic, Hammersmith Hospital, London, United Kingdom; Department of Ophthalmology, Universiti Kebangsaan Malaysia, Selangor, Malaysia.
authors.forename: Hazlita
authors.initials: H
authors.lastname: Isa
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom; Multidisciplinary Vasculitis Clinic, Hammersmith Hospital, London, United Kingdom; Department of Ophthalmology, Imperial College London, London, United Kingdom.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Taylor
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Rose
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: David H
authors.initials: DH
authors.lastname: Verity
authors.affiliation: Multidisciplinary Vasculitis Clinic, Hammersmith Hospital, London, United Kingdom; Department of Ophthalmology, Imperial College London, London, United Kingdom.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Pusey
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom; Multidisciplinary Vasculitis Clinic, Hammersmith Hospital, London, United Kingdom. Electronic address: s.lightman@ucl.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Lightman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001706:Biopsy; D002648:Child; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D055953:Microscopic Polyangiitis / Q000175:diagnosis*; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic