Interstitial Lung Disease in ANCA-Associated Vasculitis: Pathogenic Considerations and Impact for Patients' Outcomes.

IF 5.7 2区 医学 Q1 RHEUMATOLOGY
Current Rheumatology Reports Pub Date : 2022-08-01 Epub Date: 2022-07-07 DOI:10.1007/s11926-022-01078-2
Kelly Sun, Jolene H Fisher, Christian Pagnoux
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引用次数: 3

Abstract

Purpose of review: This review provides an update on recent advances in the diagnosis, pathogenesis, clinical presentation, histopathological findings, and treatment approaches for antineutrophil cytoplasmic antibody (ANCA) vasculitis-associated interstitial lung disease (AAV-ILD) with a focus on literature published in the last 3 years.

Recent findings: Although there is no validated definition of AAV-ILD, which contributes to some of the heterogeneity seen in study results, there has been an increasing number of publications in recent years on this topic. Most patients with AAV-ILD have MPO-ANCA vasculitis, and this association appears to reduce their 5-year-survival to 60-66% (Sun et al. BMC Pulm Med 21(1), 2021, Maillet et al. J Autoimmun 106, 2020). Median age of diagnosis ranges from mid-60 s to mid-70 s (Ando et al. Respir Med 107(4), 2013), Kagiyama et al. BMJ Open Respir Res 2(1):1-9, 2015, Hozumi et al. Lung 194(2):235-42, 2016, Liu et al. Chest 156(4):715-23, 2019, Maillet et al. J Autoimmun 106, 2020, Wurmann et al. Sarcoidosis Vasc Diffuse Lung Dis 37(1):37-42, 2020, Watanabe et al. BMC Pulm Med 19(1), 2019). Computed tomography (CT) chest imaging for patients with AAV-ILD often shows a usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP) pattern (12-58% and 13-61%, respectively) (Sun et al. BMC Pulm Med 21(1), 2021, Maillet et al. J Autoimmun 106, 2020, Wurmann et al. Sarcoidosis Vasc Diffuse Lung Dis 37(1):37-42, 2020, Watanabe et al. BMC Pulm Med 19(1), 2019, Baqir at al. Sarcoidosis Vasc Diffuse Lung Dis Off J WASOG 36(3):195-201, 2019). Additionally, lung biopsies typically do not demonstrate active inflammation, or capillaritis, questioning whether these patients should be treated with either immunotherapy or anti-fibrotic therapy, or both (Hozumi et al. Lung 194(2):235-42, 2016, Liu et al. Chest 156(4):715-23, 2019, Kitching at al. Nat Rev Dis Prim 6(1):71, 2020, Tanaka et al. Respir Med 106(12):1765-70, 2012). Besides immunosuppressive treatments, recent advances in anti-fibrotic therapy may offer patients with progressive AAV-ILD an alternative and/or more effective and individualized treatment option.

Abstract Image

anca相关血管炎的间质性肺疾病:致病因素和对患者预后的影响
综述目的:本文综述了抗中性粒细胞胞浆抗体(ANCA)血管炎相关间质性肺疾病(AAV-ILD)的诊断、发病机制、临床表现、组织病理学表现和治疗方法的最新进展,重点介绍了近3年来发表的文献。最近的发现:虽然没有一个有效的AAV-ILD定义,这导致了研究结果的一些异质性,但近年来关于这一主题的出版物越来越多。大多数AAV-ILD患者患有MPO-ANCA血管炎,这种关联似乎将其5年生存率降低至60-66% (Sun等)。中华医学杂志,2013,31 (1);[J] .免疫学杂志,2020)。诊断的中位年龄范围为60岁中期至70岁中期(Ando等)。呼吸医学107(4),2013),Kagiyama等。中华呼吸杂志,2015(1):1-9。中国生物医学工程学报,2016,35(2):335 - 342。中华医学杂志(4):715- 723,2019,等。[J] .免疫学杂志,2020,Wurmann等。血管性弥漫性肺结节病[j], 2011,(1):37-42。中华医学杂志,2019(1)。AAV-ILD患者的计算机断层扫描(CT)胸部成像通常显示通常的间质性肺炎(UIP)或非特异性间质性肺炎(NSIP)模式(分别为12-58%和13-61%)(Sun等)。中华医学杂志,2013,31 (1);[J] .免疫学杂志,2020,Wurmann等。血管性弥漫性肺结节病[j], 2011,(1):37-42。[J] .中华肺科杂志,2019(1),王晓东。结节病血管弥漫性肺疾病杂志[J] .中华肺外科杂志,36(3):195- 2011,2019。此外,肺活检通常没有显示活动性炎症或毛细血管炎,这就质疑这些患者是否应该接受免疫治疗或抗纤维化治疗,或两者都接受(Hozumi等)。中国生物医学工程学报,2016,35(2):335 - 342。中国生物医学工程学报6(1):771 - 723,2019,田中等。中华呼吸医学杂志,2012(12):1245 - 1245。除了免疫抑制治疗,抗纤维化治疗的最新进展可能为进行性AAV-ILD患者提供一种替代和/或更有效和个性化的治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
11.20
自引率
0.00%
发文量
41
期刊介绍: This journal aims to review the most important, recently published research in the field of rheumatology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of rheumatologic conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas such as the many forms of arthritis, osteoporosis and metabolic bone disease, and systemic lupus erythematosus. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also occasionally provided.
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