Farm Exposure as a Differential Risk Factor in ANCA-Associated Vasculitis.
OBJECTIVE
To investigate the association of farm exposure and the development of ANCA-associated vasculitis (AAV).


METHODS
One hundred eighty-nine well defined patients with AAV (n = 119 with granulomatosis with polyangiitis [GPA], n = 48 with microscopic polyangiitis [MPA], n = 22 patients with eosinophilic granulomatosis with polyangiitis [EGPA]) and 190 controls (n = 119 patients with rheumatoid arthritis, n = 71 with large vessel vasculitis) were interrogated using a structured questionnaire. Factors investigated were occupation, farm exposure, contact to different livestock, participation in harvesting, residence next to a farm, MRSA status, and contact to domestic pets at disease onset or ever before. The odds ratio (OR) and 95% confidence interval [95%CI] were calculated for each item.


RESULTS
Univariate analysis revealed a strong association of AAV with regular farm exposure; OR 3.44 [95%CI 1.43-8.27]. AAV was also associated with regular contact to cattle 4.30 (1.43-8.27), pigs 2.75 (1.12-6.75) and MRSA carriage 3.38 (1.11-10.3). This association was stronger in the subgroup of GPA patients. OR in this group for farm exposure was 4.97; [2.02-12.2], for cattle 6.71 [95% CI 2.19-20.7], for pigs 4.34 [1.75-10.9], and MRSA carriage 5.06 [1.62-15.8]). There was no significant association of MPA or EGPA with these parameters.


CONCLUSIONS
A significant association between farm exposure or farm animal exposure and AAV especially in the subgroup of patients with GPA has been identified. This suggests that these entities are distinct and have different triggers for the immune process.
Department of Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Münster, Münster, Germany.
P
P
Willeke
Centre for Laboratory Medicine, University Hospital Münster, Münster, Germany.
B
B
Schlüter
Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
C
C
Sauerland
Department of Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Münster, Münster, Germany.
H
H
Becker
Department of Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Münster, Münster, Germany.
S
S
Reuter
Division of Rheumatology and Clinical Immunology, Brandenburg Medical School, Neuruppin, Germany.
A
A
Jacobi
Department of Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Münster, Münster, Germany.
H
H
Schotte
D000328:Adult; D000368:Aged; D000822:Animal Husbandry; D000818:Animals; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D016022:Case-Control Studies; D002417:Cattle; D015267:Churg-Strauss Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D006801:Humans; D008297:Male; D055953:Microscopic Polyangiitis / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013552:Swine
D019268:Antibodies, Antineutrophil Cytoplasmic