Abstract：
OBJECTIVE: Data on ANCA-associated vasculitis (AAV) induced by anti-thyroid drugs (ATD) are scarce. We aimed to describe the characteristics and outcome of these patients in comparison to primary AAV.
METHODS: We performed a retrospective multicentre study including patients with ATD-induced AAV. We focused on ATD-induced microscopic polyangiitis (MPA) and compared them with primary MPA by matching each case with four controls by gender and year of diagnosis.
RESULTS: Forty-five patients with ATD-induced AAV of whom 24 MPA were included. ANCA were positive in 44 patients (98%), including myeloperoxidase (MPO)-ANCA in 21 (47%), proteinase 3 (PR3)-ANCA in six (13%), and double positive MPO- and PR3-ANCA in 15 (33%). Main clinical manifestations were skin involvement (64%), arthralgia (51%) and glomerulonephritis (20%). ATD was discontinued in 98% of cases, allowing vasculitis remission in seven (16%). All the remaining patients achieved remission after glucocorticoids, in combination with rituximab in 11 (30%) or cyclophosphamide in four (11%). ATD were reintroduced in seven cases (16%) without any subsequent relapse. Compared with 96 matched primary MPA, ATD-induced MPA were younger at diagnosis (48 vs 65 years, P < 0.001), had more frequent cutaneous involvement (54 vs 25%, P = 0.007), but less frequent kidney (38 vs 73%, P = 0.02), and a lower risk of relapse (adjusted HR 0.07; 95% CI 0.01, 0.65, P = 0.019).
CONCLUSIONS: ATD-induced AAV were mainly MPA with MPO-ANCA, but double MPO- and PR3-ANCA positivity was frequent. The most common manifestations were skin and musculoskeletal manifestations. ATD-induced MPA were less severe and showed a lower risk of relapse than primary MPA.
METHODS: We performed a retrospective multicentre study including patients with ATD-induced AAV. We focused on ATD-induced microscopic polyangiitis (MPA) and compared them with primary MPA by matching each case with four controls by gender and year of diagnosis.
RESULTS: Forty-five patients with ATD-induced AAV of whom 24 MPA were included. ANCA were positive in 44 patients (98%), including myeloperoxidase (MPO)-ANCA in 21 (47%), proteinase 3 (PR3)-ANCA in six (13%), and double positive MPO- and PR3-ANCA in 15 (33%). Main clinical manifestations were skin involvement (64%), arthralgia (51%) and glomerulonephritis (20%). ATD was discontinued in 98% of cases, allowing vasculitis remission in seven (16%). All the remaining patients achieved remission after glucocorticoids, in combination with rituximab in 11 (30%) or cyclophosphamide in four (11%). ATD were reintroduced in seven cases (16%) without any subsequent relapse. Compared with 96 matched primary MPA, ATD-induced MPA were younger at diagnosis (48 vs 65 years, P < 0.001), had more frequent cutaneous involvement (54 vs 25%, P = 0.007), but less frequent kidney (38 vs 73%, P = 0.02), and a lower risk of relapse (adjusted HR 0.07; 95% CI 0.01, 0.65, P = 0.019).
CONCLUSIONS: ATD-induced AAV were mainly MPA with MPO-ANCA, but double MPO- and PR3-ANCA positivity was frequent. The most common manifestations were skin and musculoskeletal manifestations. ATD-induced MPA were less severe and showed a lower risk of relapse than primary MPA.
摘要：
目的：关于抗甲状腺药物（ATD）引起的ANCA相关性血管炎（AAV）的数据很少。我们旨在描述这些患者与原发性AAV相比的特征和结果。
方法：我们进行了一项回顾性多中心研究，包括ATD诱导的AAV患者。我们专注于ATD引起的显微镜下多血管炎（MPA），并通过按性别和诊断年份将每个病例与4个对照进行匹配，将其与原发性MPA进行比较。
结果：纳入45例ATD诱导的AAV患者，其中24例MPA。ANCA阳性44例（98%），包括21例（47%）的髓过氧化物酶（MPO）-ANCA，蛋白酶3（PR3）-ANCA中的6（13％），MPO-和PR3-ANCA双阳性15例（33%）。主要临床表现为皮肤受累（64%），关节痛（51%），和肾小球肾炎（20%）。98%的病例停止了ATD，允许血管炎缓解7（16％）。其余患者在使用糖皮质激素后均达到缓解,与利妥昔单抗合用11（30％）或环磷酰胺合用4（11％）。7例（16％）ATD再次引入，无任何后续复发。与96个匹配的主要MPA相比，ATD诱导的MPA在诊断时更年轻（48vs.65岁,P<0.001)，皮肤受累更频繁(54vs.25%,P=0.007),但肾脏频率较低(38vs.73%,P=0.02),和较低的复发风险（校正HR0.07;95CI0.01-0.65，P=0.019）。
结论：ATD诱导的AAV主要是MPA和MPO-ANCA，但MPO-和PR3-ANCA双阳性是常见的。最常见的表现是皮肤和肌肉骨骼表现。与原发性MPA相比，ATD诱导的MPA较不严重，复发风险较低。
方法：我们进行了一项回顾性多中心研究，包括ATD诱导的AAV患者。我们专注于ATD引起的显微镜下多血管炎（MPA），并通过按性别和诊断年份将每个病例与4个对照进行匹配，将其与原发性MPA进行比较。
结果：纳入45例ATD诱导的AAV患者，其中24例MPA。ANCA阳性44例（98%），包括21例（47%）的髓过氧化物酶（MPO）-ANCA，蛋白酶3（PR3）-ANCA中的6（13％），MPO-和PR3-ANCA双阳性15例（33%）。主要临床表现为皮肤受累（64%），关节痛（51%），和肾小球肾炎（20%）。98%的病例停止了ATD，允许血管炎缓解7（16％）。其余患者在使用糖皮质激素后均达到缓解,与利妥昔单抗合用11（30％）或环磷酰胺合用4（11％）。7例（16％）ATD再次引入，无任何后续复发。与96个匹配的主要MPA相比，ATD诱导的MPA在诊断时更年轻（48vs.65岁,P<0.001)，皮肤受累更频繁(54vs.25%,P=0.007),但肾脏频率较低(38vs.73%,P=0.02),和较低的复发风险（校正HR0.07;95CI0.01-0.65，P=0.019）。
结论：ATD诱导的AAV主要是MPA和MPO-ANCA，但MPO-和PR3-ANCA双阳性是常见的。最常见的表现是皮肤和肌肉骨骼表现。与原发性MPA相比，ATD诱导的MPA较不严重，复发风险较低。
