Infection is associated with increased risk of MPO- but not PR3-ANCA-associated vasculitis

Author:

Rathmann Jens1ORCID,Stamatis Pavlos1ORCID,Jönsson Göran2ORCID,Englund Martin3ORCID,Segelmark Mårten4ORCID,Jayne David5ORCID,Mohammad Aladdin J135ORCID

Affiliation:

1. Department of Clinical Sciences, Rheumatology

2. Department of Clinical Sciences Lund, Department of Infectious Diseases

3. Department of Clinical Sciences Lund, Clinical Epidemiology Unit

4. Department of Clinical Sciences Lund, Nephrology, Lund University , Lund, Sweden

5. Department of Medicine, University of Cambridge, Cambridge , UK

Abstract

Abstract Objectives To determine whether development of ANCA-associated vasculitis (AAV) shows a relationship with a prior infection and if prior infection affects disease characteristics and outcome. Methods All incident cases of AAV diagnosed in a defined region of Sweden from 2000 through 2016 were identified. For each case, 10 individuals from the general population, matched for age, sex and area of residence, were selected. Infections occurring in AAV patients and controls prior to the date of AAV diagnosis (index date for respective controls) were identified using an administrative database. Conditional logistic regression models were used to calculate odds ratios (OR) of developing AAV. Occurrence, clinical characteristics and outcome of AAV were analysed with respect to prior infection. Results Two-hundred and seventy patients with AAV (48% female) and 2687 controls were included. Prior to diagnosis/index date, 146 (54%) AAV patients had been diagnosed with infection vs 1282 (48%) controls, with OR for AAV 1.57 (95% CI 1.18, 2.19) in those with infections of the upper respiratory tract and 1.68 (1.02, 2.77) in those with pneumonia. Difference from controls was significant in patients with MPO-ANCA 1.99 (95% CI 1.25, 3.1) but not in those with PR3-ANCA 1.0 (0.61, 1.52). Patients with prior infection showed higher disease activity at AAV diagnosis. No differences in disease characteristics, comorbidities or outcome in those with and without prior infections were observed. Conclusions Respiratory tract infections are positively associated with development of MPO- but not PR3-ANCA vasculitis. Prior infection is associated with higher disease activity at AAV diagnosis.

Funder

Swedish Research Council

Faculty of Medicine, Lund University

Alfred Österlunds Foundation

National Institute for Health Research Cambridge Biomedical Research Centre

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

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