 |
|
|
 |
Propylthiouracil-Associated Antineutrophil Cytoplasmic Autoantibody-Positive Vasculitis: Retrospective Study of 19 Cases
YONG-XI CHEN, HAI-JIN YU, LI-YAN NI, WEN ZHANG, YAO-WEN XU, HONG REN, XIAO-NONG CHEN, XIANG-LING WANG, XIAO LI, XIAO-XIA PAN, WEI-MING WANG, and NAN CHEN
ABSTRACT. Methods. Nineteen patients with PTU-associated ANCA-positive vasculitis diagnosed in our hospital from 2000 to 2006 were analyzed retrospectively. Results. Our data showed a female predominance among the patients. Eleven patients had involvement of more than one organ. Renal involvement was the most common manifestation. Fourteen patients underwent renal biopsy. Four patients had focal proliferative glomerulonephritis with crescent formation. Two had necrotizing glomerulonephritis with crescent formation. Two patients had minor glomerular abnormalities, 2 had IgA nephropathy, one had membranous nephropathy, one had focal proliferative glomerulonephritis, one had granulomatous interstitial nephritis, and the remaining one had focal segmental glomerular sclerosis. Immune complex glomerulonephritis was found in 3 patients. On indirect immunofluorescence, 17 patients were perinuclear-pattern ANCA-positive, one was positive for atypical ANCA, and one was positive for cytoplasmic-pattern-ANCA. By ELISA, 4 patients were positive for both myeloperoxidase (MPO)-ANCA and proteinase-3 (PR3)-ANCA, one was positive for PR3-ANCA only, and the others were positive for MPO-ANCA only. For the treatment of vasculitis, 5 patients received prednisone alone, 10 received prednisone and cyclophosphamide, and the remaining 4 did not receive prednisone or cyclophosphamide. During followup, 15 patients achieved remission, 3 patients died, and one patient depended on dialysis. In general, MPO-ANCA concentration did not correlate with disease progression, and a delayed decrease of MPO-ANCA concentration was found in most patients who achieved remission. Conclusion. Most patients with PTU-associated ANCA-positive vasculitis had good outcomes; however, severe cases existed. We suggest early recognition and adequate treatment are necessary to improve outcome. (First Release Nov 1 2007; J Rheumatol 2007;34:2451-6) Key Indexing Terms:
PROPYLTHIOURACIL
From the Department of Nephrology, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine (formerly Shanghai Second Medical University), Shanghai, China. Supported by a grant from the National Natural Science Foundation of China (No. 30670814), a grant from the Leading Academic Discipline Project of Shanghai Health Bureau (No. 05III001), and a grant from the Shanghai Leading Academic Discipline Project (No. T0201). Y-X. Chen, MD; H-J. Yu, MD; L-Y. Ni, MD; W. Zhang, MD; Y-W. Xu, MD; H. Ren, MD; X-N. Chen, MD; X-L. Wang, MD; X. Li, MD; X-X. Pan, MD; W-M. Wang, MD; N. Chen, MD, Department of Nephrology, Shanghai Ruijin Hospital. Dr. Chen and Dr. Yu contributed equally to this article. Address reprint requests to Prof. N. Chen, No. 197 Ruijin Er Road, Department of Nephrology, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200025, PR China. E-mail: chen-nan@medmail.com.cn Accepted for publication July 5, 2007. |
