title: Seasonal Influence on the Risk of Relapse at a Rise of Antineutrophil Cytoplasmic Antibodies in Vasculitis Patients with Renal Involvement.
abstract: The objective of this study was to identify risk factors for a relapse at the time of an increase in antineutrophil cytoplasmic antibodies (ANCA) in patients with renal ANCA-associated vasculitis (AAV).
  
  
  
  All patients between January 2000 and November 2011 with renal AAV having an ANCA rise during remission were included. Differences in time to relapse since the ANCA rise were assessed using a Cox regression model. The level of 25-hydroxy Vitamin D (25(OH)D) was assessed at the ANCA rise and at a subsequent relapse or time-matched during remission.
  
  
  
  Sixty patients had an ANCA rise, of whom 36 patients relapsed. Three risk factors were associated with a relapse at the time of the ANCA increase: previous disease activity not treated with cyclophosphamide or rituximab (HR 3.48, 95% CI 1.60-7.59), an ANCA rise during the fall season (HR 4.37, 95% CI 1.60-11.90), and an extended ANCA rise (HR 3.57, 95% CI 1.50-8.48). Levels of 25(OH)D significantly decreased during followup in relapsing patients, but not in patients who remained in remission (difference -6.3 ± 14.4, p = 0.017 vs 2.7 ± 16.3, p = 0.430).
  
  
  
  ANCA rises occurring during the fall season are more frequently followed by a relapse than ANCA rises occurring during other seasons. Although it is tempting to speculate that decreasing Vitamin D levels following the ANCA rise can be held responsible for the subsequent relapse, this remains to be determined.
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University; Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht; Noordoever Academy, Sint Franciscus Gasthuis, Rotterdam; Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.|M.J. Kemna has received the Kolff Student Researcher grant from the Nierstichting.|M.J. Kemna, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.W. Cohen Tervaert, MD, PhD, CARIM, Maastricht University, and Noordoever Academy, Sint Franciscus Gasthuis; K. Broen, MSc, PhD, Department of Clinical Chemistry and Hematology, Zuyderland Medical Center; S.A. Timmermans, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; P. van Paassen, MD, PhD, Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.G. Damoiseaux, MSc, PhD, Central Diagnostic Laboratory, Maastricht University Medical Center.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kemna
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University; Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht; Noordoever Academy, Sint Franciscus Gasthuis, Rotterdam; Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.|M.J. Kemna has received the Kolff Student Researcher grant from the Nierstichting.|M.J. Kemna, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.W. Cohen Tervaert, MD, PhD, CARIM, Maastricht University, and Noordoever Academy, Sint Franciscus Gasthuis; K. Broen, MSc, PhD, Department of Clinical Chemistry and Hematology, Zuyderland Medical Center; S.A. Timmermans, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; P. van Paassen, MD, PhD, Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.G. Damoiseaux, MSc, PhD, Central Diagnostic Laboratory, Maastricht University Medical Center.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Cohen Tervaert
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University; Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht; Noordoever Academy, Sint Franciscus Gasthuis, Rotterdam; Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.|M.J. Kemna has received the Kolff Student Researcher grant from the Nierstichting.|M.J. Kemna, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.W. Cohen Tervaert, MD, PhD, CARIM, Maastricht University, and Noordoever Academy, Sint Franciscus Gasthuis; K. Broen, MSc, PhD, Department of Clinical Chemistry and Hematology, Zuyderland Medical Center; S.A. Timmermans, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; P. van Paassen, MD, PhD, Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.G. Damoiseaux, MSc, PhD, Central Diagnostic Laboratory, Maastricht University Medical Center.
authors.forename: Kelly
authors.initials: K
authors.lastname: Broen
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University; Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht; Noordoever Academy, Sint Franciscus Gasthuis, Rotterdam; Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.|M.J. Kemna has received the Kolff Student Researcher grant from the Nierstichting.|M.J. Kemna, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.W. Cohen Tervaert, MD, PhD, CARIM, Maastricht University, and Noordoever Academy, Sint Franciscus Gasthuis; K. Broen, MSc, PhD, Department of Clinical Chemistry and Hematology, Zuyderland Medical Center; S.A. Timmermans, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; P. van Paassen, MD, PhD, Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.G. Damoiseaux, MSc, PhD, Central Diagnostic Laboratory, Maastricht University Medical Center.
authors.forename: Sjoerd A M E G
authors.initials: SAMEG
authors.lastname: Timmermans
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University; Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht; Noordoever Academy, Sint Franciscus Gasthuis, Rotterdam; Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.|M.J. Kemna has received the Kolff Student Researcher grant from the Nierstichting.|M.J. Kemna, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.W. Cohen Tervaert, MD, PhD, CARIM, Maastricht University, and Noordoever Academy, Sint Franciscus Gasthuis; K. Broen, MSc, PhD, Department of Clinical Chemistry and Hematology, Zuyderland Medical Center; S.A. Timmermans, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; P. van Paassen, MD, PhD, Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.G. Damoiseaux, MSc, PhD, Central Diagnostic Laboratory, Maastricht University Medical Center.
authors.forename: Pieter
authors.initials: P
authors.lastname: van Paassen
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University; Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht; Noordoever Academy, Sint Franciscus Gasthuis, Rotterdam; Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands. jan.damoiseaux@mumc.nl.|M.J. Kemna has received the Kolff Student Researcher grant from the Nierstichting. jan.damoiseaux@mumc.nl.|M.J. Kemna, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.W. Cohen Tervaert, MD, PhD, CARIM, Maastricht University, and Noordoever Academy, Sint Franciscus Gasthuis; K. Broen, MSc, PhD, Department of Clinical Chemistry and Hematology, Zuyderland Medical Center; S.A. Timmermans, MD, CARIM, Maastricht University, and Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; P. van Paassen, MD, PhD, Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center; J.G. Damoiseaux, MSc, PhD, Central Diagnostic Laboratory, Maastricht University Medical Center. jan.damoiseaux@mumc.nl.
authors.forename: Jan G M C
authors.initials: JGMC
authors.lastname: Damoiseaux
mesh_terms: D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood / Q000276:immunology* / Q000473:pathology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D005260:Female; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012621:Seasons; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: ANCA-ASSOCIATED VASCULITIS; ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; FOLLOWUP STUDY; GRANULOMATOSIS WITH POLYANGIITIS; SEASON; VITAMIN D