James Bateman, Mir Nadeem, James Barraclough, Tochukwu Adizie, Mark Pucci, Tom Sheeran
{"title":"尿毒理学筛查减少了可卡因诱导的anca阳性疾病误诊为特发性肉芽肿病合并多血管炎。","authors":"James Bateman, Mir Nadeem, James Barraclough, Tochukwu Adizie, Mark Pucci, Tom Sheeran","doi":"10.1093/rap/rkaf018","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Study aims were to assess the impact of urine cocaine screening in distinguishing cocaine-induced midline destruction lesions (CIMDLs) from idiopathic ANCA-associated systemic vasculitis (AASV), to evaluate the adoption and effectiveness of screening and to explore its clinical implications.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre case series, reviewing rheumatology patients with suspected new or relapsing AASV, ages 18-55 years, from April 2021 to July 2024. Patients were in two groups: an active screening group offering urinary cocaine testing for all patients and a standard care group, with ad hoc testing based on clinical suspicion. Demographics, clinical presentations and diagnostic pathways were analysed.</p><p><strong>Results: </strong>Of 11 cases in the active screening group, all denied cocaine use, 7 were diagnosed with CIMDL from urine screening and 4 patients were treated for vasculitis. In the standard care group of 15 patients, 2 patients had CIMDLs (admitted cocaine use), no patients had urine screening and 13 were treated for AASV. In total, there were nine CIMDL cases [mean age 38.2 years (interquartile range 11; six females), most [7/9 (78%)] were from active screening. CIMDL presentations were heterogeneous, including vocal cord palsy, lymphadenopathy and cutaneous vasculitis. CIMDL cases were positive for perinuclear ANCA (6/9) and PR3 (7/9), with no MPO positivity, and 5/9 (71%) failed to provide an adequate initial urine sample. There were no formal complaints or concerns from screening.</p><p><strong>Conclusion: </strong>These data support the effectiveness and acceptability of systematic screening for cocaine to improve the identification of CIMDLs, reducing misdiagnosis and unnecessary treatment. A protocol for systematic screening is proposed to improve the care for these patients.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf018"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993301/pdf/","citationCount":"0","resultStr":"{\"title\":\"Urine toxicology screening reduces misdiagnosis of cocaine-induced ANCA-positive disease as idiopathic granulomatosis with polyangiitis.\",\"authors\":\"James Bateman, Mir Nadeem, James Barraclough, Tochukwu Adizie, Mark Pucci, Tom Sheeran\",\"doi\":\"10.1093/rap/rkaf018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Study aims were to assess the impact of urine cocaine screening in distinguishing cocaine-induced midline destruction lesions (CIMDLs) from idiopathic ANCA-associated systemic vasculitis (AASV), to evaluate the adoption and effectiveness of screening and to explore its clinical implications.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre case series, reviewing rheumatology patients with suspected new or relapsing AASV, ages 18-55 years, from April 2021 to July 2024. Patients were in two groups: an active screening group offering urinary cocaine testing for all patients and a standard care group, with ad hoc testing based on clinical suspicion. Demographics, clinical presentations and diagnostic pathways were analysed.</p><p><strong>Results: </strong>Of 11 cases in the active screening group, all denied cocaine use, 7 were diagnosed with CIMDL from urine screening and 4 patients were treated for vasculitis. In the standard care group of 15 patients, 2 patients had CIMDLs (admitted cocaine use), no patients had urine screening and 13 were treated for AASV. In total, there were nine CIMDL cases [mean age 38.2 years (interquartile range 11; six females), most [7/9 (78%)] were from active screening. CIMDL presentations were heterogeneous, including vocal cord palsy, lymphadenopathy and cutaneous vasculitis. CIMDL cases were positive for perinuclear ANCA (6/9) and PR3 (7/9), with no MPO positivity, and 5/9 (71%) failed to provide an adequate initial urine sample. There were no formal complaints or concerns from screening.</p><p><strong>Conclusion: </strong>These data support the effectiveness and acceptability of systematic screening for cocaine to improve the identification of CIMDLs, reducing misdiagnosis and unnecessary treatment. A protocol for systematic screening is proposed to improve the care for these patients.</p>\",\"PeriodicalId\":21350,\"journal\":{\"name\":\"Rheumatology Advances in Practice\",\"volume\":\"9 2\",\"pages\":\"rkaf018\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-02-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993301/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Rheumatology Advances in Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/rap/rkaf018\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Rheumatology Advances in Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/rap/rkaf018","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Urine toxicology screening reduces misdiagnosis of cocaine-induced ANCA-positive disease as idiopathic granulomatosis with polyangiitis.
Objectives: Study aims were to assess the impact of urine cocaine screening in distinguishing cocaine-induced midline destruction lesions (CIMDLs) from idiopathic ANCA-associated systemic vasculitis (AASV), to evaluate the adoption and effectiveness of screening and to explore its clinical implications.
Methods: We conducted a retrospective single-centre case series, reviewing rheumatology patients with suspected new or relapsing AASV, ages 18-55 years, from April 2021 to July 2024. Patients were in two groups: an active screening group offering urinary cocaine testing for all patients and a standard care group, with ad hoc testing based on clinical suspicion. Demographics, clinical presentations and diagnostic pathways were analysed.
Results: Of 11 cases in the active screening group, all denied cocaine use, 7 were diagnosed with CIMDL from urine screening and 4 patients were treated for vasculitis. In the standard care group of 15 patients, 2 patients had CIMDLs (admitted cocaine use), no patients had urine screening and 13 were treated for AASV. In total, there were nine CIMDL cases [mean age 38.2 years (interquartile range 11; six females), most [7/9 (78%)] were from active screening. CIMDL presentations were heterogeneous, including vocal cord palsy, lymphadenopathy and cutaneous vasculitis. CIMDL cases were positive for perinuclear ANCA (6/9) and PR3 (7/9), with no MPO positivity, and 5/9 (71%) failed to provide an adequate initial urine sample. There were no formal complaints or concerns from screening.
Conclusion: These data support the effectiveness and acceptability of systematic screening for cocaine to improve the identification of CIMDLs, reducing misdiagnosis and unnecessary treatment. A protocol for systematic screening is proposed to improve the care for these patients.