Clinical Analysis Of ANCA-associated Vasculitis Accompanied By Rheumatoid Arthritis

Objective:This paper aims at discussing the disease characteristics,clinical manifestations,pathological features and prognosis of ANCA-associated vasculitis(AAV)accompanied by rheumatoid arthritis(RA)through comparison with primary AAV,thus deepening the understanding of AAV accompanied by RA.Methods:Retrospective case controlled study was made,using the data from Jiuchuang Computerized Patient Record Management System and Medical Record Room Management System of patients definitively diagnosed as AAV from Jan.2010 to Dec.2016 at the Second Hospital of Jilin University.All patients were eligible for P-ANCA / MPO or C-ANCA / PR3 positive.Drug-induced AAV and AAV accompanied by diabetes,tumor or other autoimmune diseases were excluded.Among the 56 patients included in the study,44 were primary AAV sufferers,who were assigned to the AAV group,and 12 were AAV+RA sufferers,who were assigned to the AAV+RA group.The general information,clinical manifestations,laboratory examinations,renal biopsy pathology and follow-up data were compared between these two groups of patients,and data analysis was conducted on the results using statistical method.Results:1、With 17 male patients(39%)and 27 female patients(61%),the male to female ratio of the AAV group was 1:1.58.Their average age was 63.84±11.7,median age was 66,and 9 patients(20%)were below the age of 55.The AAV+RA group,with 2 male patients(17%)and 10 female patients(83%),carried a male to female ratio of 1:5.Their average age was 54.67±15.35,median age was 53,and 6 patients(50%)were below the age of 55.Compared with primary AAV patients,patients in the AAV+RA group were younger,with a higher percentage of them below the age of 55.The difference was statistically significant(P<0.05).2、In the AAV+RA group,17% of the patients reported arthralgia as their first symptom.In the AAV group,no patient reported arthralgia as their first symptom.The difference carries obvious statistical significance(P<0.01).3、Patients in the AAV+RA group had a lower semi-quantitative value of MPO(based on enzyme-linked immunoassay)than those in the AAV group.The difference carried obvious statistical significance(P<0.01).Patients in the AAV+RA group showed higher C-reactive protein and quantitative value and positive rate of rheumatoid factor than those in the AAV group.The differences were statistically significant(P<0.05).4、Compared with AAV patients,patients in the AAV+RA group had lower positive rates of renal damage indices such as proteinuria,higher U-RBC/HPF or higher creatinine.The differences were statistically significant(P<0.05).Differences of Pathogenic changes revealed by renal biopsy(percentage of crescent,percentage of glomerulosclerosis and the positive rates of capillary loops necrosis,tubular atrophy and interstitial fibrosis)between AAV group and AAV+RA group were not statistically significant(P>0.05).5、The 24 patients with complete follow-up data in the AAV group received a follow-up observation of 1-55 months.The 9 patients with complete follow-up data in the AAV+RA group received a follow-up observation of 1-84 months.The difference of follow-up periods between the two groups was not statistically significant(P>0.05).6、In the AAV group,among the 23 renal damage sufferers with complete follow-up data,13(57%)were clinically dead,3(13%)entered end-stage renal failure(depending on maintenance hemodialysis),3(13%)achieved complete remission,and 4(17%)achieved partial remission.In the AAV+RA group,among the renal damage suffers with complete follow-up data,3(37%)were clinically dead,1(13%)entered end-stage renal failure(depending on maintenance hemodialysis),and 4(50%)achieved complete remission.Renal damage sufferers in the AAV+RA group gained a higher rate of complete remission than those in the AAV group.The difference was statistically significant.Conclusion:1.Compared with primary AAV patients,AAV+RA patients had a lower age of onset and were relatively younger.2.AAV+RA group of myeloperoxidase(MPO)semi-quantitative value than the AAV group was low,suggesting that the group may have a weak degree of vasculitis activity.3.Compared with primary AAV,AAV +RA patients suffered a lower rate of renal damage and the got better treatment effects of affected kidney.