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Drugs & Aging

, Volume 36, Issue 1, pp 53–63 | Cite as

Aging in Primary Systemic Vasculitis: Implications for Diagnosis, Clinical Manifestations, and Management

  • Alvise Berti
  • Roberto Caporali
  • Carlomaurizio Montecucco
  • Giuseppe Paolazzi
  • Sara Monti
Review Article
  • 51 Downloads

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) usually affect adults and older populations. The well recognized clinical (i.e., granulomatosis with polyangiitis [GPA], microscopic polyangiitis, and eosinophilic GPA) and serological phenotypes (i.e., anti-MPO-ANCA, anti-PR3-ANCA and ANCA negative) within AAV differ substantially for clinical, demographic, and epidemiological features, including age at presentation. Whether and how aging could contribute to the clinical expression of these disease phenotypes is intriguing and still overlooked. In addition, despite being predominantly a disease of the elderly, most of the studies analyzing drug interventions and the clinical trials on AAV explicitly excluded older patients, limiting the understanding of the disease in this subset of patients. In elderly patients induced with cyclophosphamide, a lower dose of treatment for patients aged 60 years or older and with reduced renal function has been recommended. Giant cell arteritis (GCA) and Takayasu’s arteritis (TAK) are two primary systemic vasculitides involving large vessels that differ in age at presentation, with GCA patients being at least 10 years older than TAK patients. Different treatment approaches are effective in these conditions. However, a few authors have suggested that they might be considered expressions of the same clinical syndrome, rather than two different diseases. Novel insights into the role of senescence-related immunological and vascular processes might help to interpret the link between these two conditions. Overall, the impact of aging on all these vasculitides is complex and not easy to analyze. So far, few studies focusing on this topic have been published. We reviewed data on the clinical presentation, epidemiology, therapy, and disease- and treatment-related complications in patients affected by these vasculitides, highlighting the differences in young versus elderly subjects.

Notes

Compliance with ethical standards

Conflict of interest

Alvise Berti, Roberto Caporali, Carlomaurizio Montecucco, Giuseppe Paolazzi, and Sara Monti have no financial or non-financial potential conflicts of interest to declare related to this project. All authors were involved in the writing and editing of the manuscript, and approved the final version.

Funding

The study was not supported by grants from any organization or institution.

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Rheumatology DepartmentSanta Chiara HospitalTrentoItaly
  2. 2.Centre for Integrative BiologyUniversity of TrentoTrentoItaly
  3. 3.Rheumatology Department, Policlinico S. Matteo, Fondazione IRCCSUniversity of PaviaPaviaItaly
  4. 4.University of PaviaPaviaItaly

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