ANCA-associated vasculitis: a comparison of cases presenting to nephrology and rheumatology services.
BACKGROUND
Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV) is a disease characterized by inflammation of small vessels and detectable ANCA in the circulation. Patients may develop a broad spectrum of clinical features ranging from indolent sino-nasal disease and rashes to fulminant renal failure or acute life-threatening pulmonary haemorrhage. Consequently, patients with AAV present to a variety of specialties including nephrology and rheumatology, whose training and approaches to management of such patients may differ. There is little literature comparing patients presenting to different specialties and their outcomes.


METHODS
We compared two cohorts of patients with ANCA-positive AAV presenting to either the rheumatology or nephrology department at Galway University Hospitals from June 2002 to July 2011. A standardized data collection form was used to collect information regarding baseline demographics, manifestations of AAV, initial management, relapses and complications.


RESULTS
Forty-five patients were included in this study (15 rheumatology/30 nephrology). The nephrology cohort was older, had a higher C-reactive protein, Birmingham Vascular Activity Score and ANCA titer at presentation compared to the rheumatology group. Induction treatment varied between the cohorts with rheumatology patients most commonly receiving a combination of oral corticosteroids (73%) and methotrexate (60%) and nephrology patients receiving a combination of intravenous corticosteroids (93%) and cyclophosphamide (90%). Fifty-three percent of the rheumatology patients who completed induction therapy relapsed compared to 30% of the nephrology patients.


CONCLUSIONS
This study presents two different cohorts of patients with the same disease that were managed by two different disciplines. It highlights the heterogeneity of AAV and the importance of interdisciplinary communication and cooperation when managing these patients.
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.|School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
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McNicholas
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland matthew.griffin@nuigalway.ie.|School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.|Rheumatology Department, Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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Griffin
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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Donnellan
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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Ryan
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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A
Garrahy
School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.|Rheumatology Department, Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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Coughlan
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.|School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
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Giblin
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.|School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
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Lappin
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.|School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
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Reddan
School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.|Rheumatology Department, Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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Carey
From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland.|School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
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Griffin
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000737:chemistry; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007494:Ireland; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009398:Nephrology; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012219:Rheumatology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D008727:Methotrexate