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Incidence and prevalence of granulomatosis with polyangiitis and microscopic polyangiitis in health management organization in Argentina: a 15-year study

  • Florencia S. PieriniEmail author
  • Marina Scolnik
  • Valeria Scaglioni
  • Florencia Mollerach
  • Enrique R. Soriano
Original Article
  • 3 Downloads

Abstract

Background/objective

Our objective was to estimate incidence and prevalence rates of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) using data from a university hospital-based health management organization (HIMCO) in Latin America.

Methods

Multiple methods for case finding were used to ensure complete ascertainment. GPA was diagnosed if fulfilling ACR 1990 criteria or a clinical diagnosis was made by an experienced rheumatologist. For MPA, a clinical diagnosis made by an experienced rheumatologist in concordance with Chapel Hill 2012 consensus. Renal limited vasculitis (RLV) ANCA-P positive was considered along with MPA. Global, age-specific, and sex-specific incidence and prevalence rates were calculated for members of the HIMCO with continuous affiliation ≥ 1 year from January 2000 to January 2015. Each person was followed up until GPA or MPA were diagnosed, voluntarily withdraw of the HIMCO, death, or study finalization. Prevalence was calculated on January 1, 2015.

Results

Nineteen incident cases of GPA and 28 of MPA were identified from January 2000 to January 2015. During this period, a total of 349,775 HIMCO persons contributed a total of 2,073,438 person-years. GPA and MPA overall incidence rate per 1,000,000 person-years were 9 (95% CI 5–13) and 14 (95% CI 9–19), respectively. Age-specific incidence rates in both female and male patients peaked in the seventh decade of life in our population. On January 1, 2015, prevalence rates were 7.4 per 100,000 (95% CI 2.8–12) for GPA and 5.2 per 100,000 (95% CI 1.3–9) for MPA. Prevalence rates were higher in ages over 70 for both genders and both diseases.

Conclusion

In this first study from Latin America, incidence and prevalence rates were in ranges of previous reports from other sites of the world. In our population, GPA and MPA were more frequent in women and in older ages, and the incidence of MPA was higher than that of GPA.

Key points

In Argentina, MPA incidence was higher than GPA, similar to that reported in other parts of the world.

Prevalence and incidence rates were higher in ages over 70 for both sexes and both diseases.

Keywords

Anti-neutrophil cytoplasmic antibody-associated vasculitis (C20.111.193) Granulomatosis with polyangiitis (C20.111.193.875) Microscopic lyangiitis (C20.111.193.750) Statistics (V02.925) 

Notes

Compliance with ethical standards

Disclosures

None.

Ethical approval

This study was approved by the Clinical Research Ethics Committee of Hospital Italiano de Buenos Aires (protocol number 3089). Since this is a retrospective study, formal consent is not required.

References

  1. 1.
    Jennette JC, Falk RJ (2014) Pathogenesis of antineutrophil cytoplasmic autoantibody-mediated disease. Nat Rev Rheumatol 10:463–473.  https://doi.org/10.1038/nrrheum.2014.103 CrossRefGoogle Scholar
  2. 2.
    Lionaki S, Blyth ER, Hogan SL, Hu Y, Senior BA, Jennette CE, Nachman PH, Jennette JC, Falk RJ (2012) Classification of antineutrophil cytoplasmic autoantibody vasculitides: the role of antineutrophil cytoplasmic autoantibody specificity for myeloperoxidase or proteinase 3 in disease recognition and prognosis. Arthritis Rheum 64:3452–3462.  https://doi.org/10.1002/art.34562 CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Watts RA, Mahr A, Mohammad AJ, Gatenby P, Basu N, Flores-Suárez LF (2015) Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant 30(Suppl 1):i14–i22.  https://doi.org/10.1093/ndt/gfv022 CrossRefGoogle Scholar
  4. 4.
    Watts RA, Lane SE, Scott DG, Koldingsnes W, Nossent H, Gonzalez-Gay MA, Garcia-Porrua C, Bentham GA (2001) Epidemiology of vasculitis in Europe. Ann Rheum Dis 60:1156–1157CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Catanoso M, Macchioni P, Boiardi L, Manenti L, Tumiati B, Cavazza A, Luberto F, Pipitone N, Salvarani C (2014) Epidemiology of granulomatosis with polyangiitis (Wegener’s granulomatosis) in Northern Italy: a 15-year population-based study. Semin Arthritis Rheum 44:202–207.  https://doi.org/10.1016/j.semarthrit.2014.05.005 CrossRefGoogle Scholar
  6. 6.
    Mohammad AJ, Jacobsson LTH, Mahr AD, Sturfelt G, Segelmark M (2007) Prevalence of Wegener’s granulomatosis, microscopic polyangiitis, polyarteritis nodosa and Churg Strauss syndrome within a defined population in southern Sweden. Rheumatology 46:1329–1337.  https://doi.org/10.1093/rheumatology/kem107 CrossRefGoogle Scholar
  7. 7.
    Fujimoto S, Watts RA, Kobayashi S, Suzuki K, Jayne DRW, Scott DGI, Hashimoto H, Nunoi H (2011) Comparison of the epidemiology of anti-neutrophil cytoplasmic antibody-associated vasculitis between Japan and the U.K. Rheumatology (Oxford) 50:1916–1920.  https://doi.org/10.1093/rheumatology/ker205 CrossRefGoogle Scholar
  8. 8.
    Di WT, Vergara F, Bertiller E et al (2016) Incidence and prevalence of rheumatoid arthritis in a health management organization in Argentina: a 15-year study. J Rheumatol 43:1306–1311.  https://doi.org/10.3899/jrheum.151262 CrossRefGoogle Scholar
  9. 9.
    Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP, Calabrese LH, Fries JF, Lie JT, Lightfoot RW Jr, Masi AT, McShane DJ, Mills JA, Stevens MB, Wallace SL, Zvaifler NJ (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 33:1101–1107.  https://doi.org/10.1002/art.1780330807 CrossRefGoogle Scholar
  10. 10.
    Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CGM, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DGI, Specks U, Stone JH, Takahashi K, Watts RA (2013) 2012 revised international Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65:1–11.  https://doi.org/10.1002/art.37715 CrossRefGoogle Scholar
  11. 11.
    Robson JC, Grayson PC, Ponte C et al (2018) OP0021 Draft classification criteria for the anca associated vasculitides. Ann Rheum Dis 77:60–61.  https://doi.org/10.1136/annrheumdis-2018-eular.2892 CrossRefGoogle Scholar
  12. 12.
    Mahr A, Guillevin L, Poissonnet M, Aymé S (2004) Prevalences of polyarteritis nodosa, microscopic polyangiitis, Wegener’s granulomatosis, and Churg-Strauss syndrome in a French urban multiethnic population in 2000: a capture-recapture estimate. Arthritis Rheum 51:92–99.  https://doi.org/10.1002/art.20077 CrossRefGoogle Scholar
  13. 13.
    Gonzalez-Gay MA, Garcia-Porrua C, Guerrero J, Rodriguez-Ledo P, Llorca J (2003) The epidemiology of the primary systemic vasculitides in northwest Spain: implications of the Chapel Hill Consensus Conference definitions. Arthritis Rheum 49:388–393.  https://doi.org/10.1002/art.11115 CrossRefGoogle Scholar
  14. 14.
    Watts RA, Al-Taiar A, Scott DGI, Macgregor AJ (2009) Prevalence and incidence of Wegener’s granulomatosis in the UK general practice research database. Arthritis Rheum 61:1412–1416.  https://doi.org/10.1002/art.24544 CrossRefGoogle Scholar
  15. 15.
    Mohammad AJ, Jacobsson LTH, Westman KWA et al (2009) Incidence and survival rates in Wegener’s granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and polyarteritis nodosa. Rheumatology (Oxford).  https://doi.org/10.1093/rheumatology/kep304
  16. 16.
    Pearce FA, Grainge MJ, Lanyon PC, Watts RA, Hubbard RB (2016) The incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK clinical practice research datalink. Rheumatology 56:kew413.  https://doi.org/10.1093/rheumatology/kew413 CrossRefGoogle Scholar
  17. 17.
    Pamuk ÖN, Dönmez S, Calayır GB, Pamuk GE (2016) The epidemiology of antineutrophil cytoplasmic antibody-associated vasculitis in northwestern Turkey. Clin Rheumatol 35:2063–2071.  https://doi.org/10.1007/s10067-016-3232-y CrossRefGoogle Scholar
  18. 18.
    Berti A, Cornec D, Crowson CS et al (2017) The epidemiology of ANCA associated vasculitis in Olmsted County, Minnesota (USA): a 20 year population-based study. Arthritis Rheumatol.  https://doi.org/10.1002/art.40313

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Rheumatology Unit, Internal Medicine ServicesHospital Italiano de Buenos AiresBuenos AiresArgentina

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