title: ANCA-associated vasculitis in Hispanic Americans: an unrecognized severity.
abstract: This study aims to compare the severity and outcomes of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) between Hispanics and Caucasians living in the same geographical area. All patients diagnosed with AAV at two academic institutions in Chicago from January 2006 to December 2012 were retrospectively and prospectively identified. Disease activity was measured with the Birmingham Vasculitis Activity Score (BVAS), and disease damage was measured with the Vasculitis Damage Index (VDI). Student's t test and chi-square tests were employed; p ≤ 0.05 was considered significant. Seventy patients with AAV were identified; 15 patients were excluded. Fifty-five patients were included in the study: 23 Hispanics and 32 Caucasians, 35 patients with granulomatosis with polyangiitis (Wegener's), 12 with microscopic polyangiitis, 7 with eosinophilic granulomatosis with polyangiitis, and 1 with renal-limited vasculitis. Compared to Caucasians, Hispanics had a higher BVAS at presentation (16.3 ± 7.6 versus 10.7 ± 7.5, p = 0.006), a higher VDI at presentation (2.90 ± 1.50 versus 2.06 ± 1.30, p = 0.030), and a cumulative VDI (3.90 ± 1.70 versus 2.50 ± 1.90, p = 0.010). Renal involvement was more common among Hispanics (85 % of Hispanics versus 48 % of Caucasians, p = 0.01). Seventy percent of Hispanics had acute renal failure (mean creatinine = 3.37 ± 4.4 mg/dl) of whom seven (50 %) required dialysis, versus 25 % of Caucasians (mean creatinine = 1.78 ± 1.57 mg/dl, p = 0.03) and only two requiring dialysis. Compared to Caucasians, Hispanics with AAV present with more severe disease and higher damage indices. Larger studies are required to confirm these findings and delineate the respective roles of environment and genetics in the pathogenesis of the disease.
authors.affiliation: Division of Rheumatology, University of Pennsylvania, 1407 Penn Tower, 3400 Spruce Street, Philadelphia, PA, 19104, USA, Antoine.Sreih@uphs.upenn.edu.
authors.forename: Antoine G
authors.initials: AG
authors.lastname: Sreih
authors.forename: Ranadeep
authors.initials: R
authors.lastname: Mandhadi
authors.forename: Fadi
authors.initials: F
authors.lastname: Aldaghlawi
authors.forename: Asad
authors.initials: A
authors.lastname: Khan
authors.forename: Vajiha
authors.initials: V
authors.lastname: Irshad
authors.forename: Katherine
authors.initials: K
authors.lastname: Finn
authors.forename: Joel A
authors.initials: JA
authors.lastname: Block
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000208:ethnology* / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D002641:Chicago; D015267:Churg-Strauss Syndrome / Q000150:complications / Q000208:ethnology / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000208:ethnology / Q000503:physiopathology; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D055953:Microscopic Polyangiitis / Q000150:complications / Q000208:ethnology / Q000503:physiopathology; D008875:Middle Aged; D006435:Renal Dialysis; D012720:Severity of Illness Index; D044465:White People
chemical_list: D003404:Creatinine
references.citation: N Engl J Med. 2005 Jan 27;352(4):351-61
references.pmid: 15673801
references.citation: Kidney Int. 1993 Jun;43(6):1329-32
references.pmid: 8315946
references.citation: Ann Rheum Dis. 2011 Feb;70(2):393-4
references.pmid: 20627945
references.citation: Arthritis Rheum. 1997 Feb;40(2):371-80
references.pmid: 9041949
references.citation: Ann Rheum Dis. 2009 Dec;68(12):1827-32
references.pmid: 19054820
references.citation: Clin Exp Immunol. 2000 Mar;119(3):574-7
references.pmid: 10691933
references.citation: Ann Rheum Dis. 2001 Feb;60(2):170-2
references.pmid: 11156552
references.citation: QJM. 1994 Nov;87(11):671-8
references.pmid: 7820541
references.citation: Rheumatology (Oxford). 2001 May;40(5):492-8
references.pmid: 11371656
references.citation: Curr Rheumatol Rep. 2012 Dec;14(6):481-93
references.pmid: 22927039
references.citation: Arthritis Rheum. 1998 Jul;41(7):1161-72
references.pmid: 9663471
references.citation: Ann N Y Acad Sci. 2007 Jun;1107:400-9
references.pmid: 17804568
references.citation: QJM. 2005 Feb;98(2):97-111
references.pmid: 15655098
references.citation: Arthritis Rheum. 2004 Feb 15;51(1):92-9
references.pmid: 14872461
references.citation: Rev Med Chil. 2005 Mar;133(3):273-8
references.pmid: 15880180
references.citation: Ann Rheum Dis. 2001 Dec;60(12):1156-7
references.pmid: 11760724
references.citation: Arthritis Rheum. 1994 Feb;37(2):187-92
references.pmid: 8129773
references.citation: Rheumatology (Oxford). 2012 May;51(5):805-12
references.pmid: 22237046
references.citation: Rheumatology (Oxford). 2011 Oct;50(10):1916-20
references.pmid: 21798892
references.citation: Kidney Int. 2006 May;69(10):1846-51
references.pmid: 16598205
references.citation: Arthritis Rheum. 1990 Aug;33(8):1135-6
references.pmid: 2202312
references.citation: Arthritis Rheum. 2005 Feb 15;53(1):93-9
references.pmid: 15696553
references.citation: Lupus. 1999;8(3):197-209
references.pmid: 10342712
references.citation: Scand J Rheumatol. 2010;39(1):71-6
references.pmid: 20132074
references.citation: Intern Med J. 2007 Apr;37(4):242-6
references.pmid: 17388864