Interstitial lung disease and bronchiectasis may be preexisting comorbidities of microscopic polyangiitis, a type of antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV), according to a new study published in Annals of Medicine.
For this study, the researchers retrospectively reviewed the data of 97 patients with a definitive diagnosis of microscopic polyangiitis based on the 2012 revised Chapel Hill Consensus Conference criteria.
They collected and analyzed baseline clinical information and laboratory parameters of each study participant.
According to the results, there were 47 (48.5%) patients with microscopic polyangiitis with pulmonary involvement. Of those, 37 participants had interstitial lung disease, 12 had bronchiectasis, and 2 had a diffuse alveolar hemorrhage.
Read more about AAV comorbidities
Interstitial lung disease and bronchiectasis preceded the development of microscopic polyangiitis in 56.76% and 75.00% of the patients, respectively. Patients with bronchiectasis had lower serum lactate dehydrogenase levels in comparison with the group of patients who had interstitial lung disease.
Multivariate Cox analysis identified elevated serum creatinine levels as an independent risk factor for shorter survival among patients with microscopic polyangiitis and pulmonary involvement. However, glucocorticoid pulse cyclophosphamide treatment appeared to be linked to prolonged survival.
Moreover, acute exacerbations of interstitial lung disease and elevated levels of serum creatinine were independently associated with poor prognosis in patients with microscopic polyangiitis and interstitial lung disease. In these patients, glucocorticoid treatment was correlated with higher survival rates.
“Because interstitial lung disease and bronchiectasis are pre-existing comorbidities of microscopic polyangiitis, early antifibrotic treatment for fibrotic interstitial lung disease patients and appropriate phlegm treatment for bronchiectasis patients are necessary. Standardized treatment regimens for patients with microscopic polyangiitis and interstitial lung disease or bronchiectasis should be retrospectively clarified by studies with larger samples and randomized controlled studies,” Zhang and colleagues wrote.
Scientists have long contemplated the association between microscopic polyangiitis and pulmonary involvement. It is unclear whether interstitial lung disease and bronchiectasis are disease manifestations, preexisting comorbidities, or important complications.
Zhang Y, Ding Q, Lv C, et al. Clinical significance of microscopic polyangiitis with interstitial lung disease and bronchiectasis: probability of preexisting comorbidities. Ann Med. Published online April 26, 2023. doi:10.1080/07853890.2023.2204449