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Extended report
Prospective long-term follow-up of patients with localised Wegener's granulomatosis: does it occur as persistent disease stage?
  1. Julia U Holle1,
  2. Wolfgang L Gross1,
  3. Konstanze Holl-Ulrich2,
  4. Petra Ambrosch3,
  5. Bernhard Noelle4,
  6. Marcus Both5,
  7. Elena Csernok1,
  8. Frank Moosig1,
  9. Susanne Schinke1,
  10. Eva Reinhold-Keller1
  1. 1Department of Rheumatology and Clinical Immunology, Vasculitis Center, University Hospital Schleswig-Holstein, Campus Luebeck and Klinikum Bad Bramstedt, Germany
  2. 2Institute for Pathology, University of Luebeck, Germany
  3. 3Department of Otorhinolaryngology, University of Kiel, Germany
  4. 4Department of Ophthalmology, University of Kiel, Germany
  5. 5Department of Diagnostic Radiology, University of Kiel, Germany
  1. Correspondence to Dr Julia U Holle, Department of Rheumatology and Clinical Immunology, Vasculitis Center of University Hospital Schleswig-Holstein/Klinikum Bad Bramstedt, Oskar-Alexander-Str. 26, 24576 Bad Bramstedt, Germany; holle{at}klinikumbb.de

Abstract

Objective To identify patients with localised Wegener's granulomatosis (locWG) to assess whether it occurs as a long-term disease stage or phenotype and to characterise its outcome.

Methods Patients in a ‘localised stage’ with histological criteria compatible with WG and a follow-up period of ≥1 year were included. They were prospectively followed at the Vasculitis Center Schleswig-Holstein from 1989 to 2009 and the clinical manifestations, antineutrophil cytoplasmic autoantibodies (ANCA) status and damage were evaluated. Immunosuppression was adapted to disease activity and severity in a step-up regimen.

Results Of 1024 patients with suspected WG, 99 were clinically diagnosed with locWG and 50 fulfilled the inclusion criteria (72% women, median age 43 years, 46% ANCA-positive). The median follow-up was 48 months. All achieved a response to treatment, 34% achieved complete remission, 1–4 relapses occurred in 46%, 5 (10%) had generalised disease (median 6 years after onset). ANCA status was not associated with relapse (p=0.98), transition to generalised disease (p=0.51) or refractory manifestations (p=0.60). 47% required cyclophosphamide for localised manifestations, 36% of them for pulmonary masses and 24% for orbital masses. 66% developed organ damage, mostly due to bony destruction or space obturation (28% saddle nose, 24% septal perforation, 10% orbital wall destruction). There were two deaths that were not related to WG.

Conclusion There is evidence that locWG is a long-term disease stage or phenotype (5% of all patients with WG), 46% of whom are ANCA-positive. LocWG is characterised by destructive and/or space-consuming lesions associated with high relapse rates (46%) and local damage.

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Footnotes

  • Competing interests None.

  • Ethics approval All patients sign a form when entering our department in case they agree to have their data analysed for research purposes. This form is used for several of our observational studies and is approved by the ethics committee of the University of Luebeck. No specific approval for this study was therefore needed.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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