Background ANCA associated vasculitides (AAV) are a group of diseases that can transversally affect all age groups (1).
Objectives To identify peculiar characteristics in clinical presentation and long-term outcome of patients with AAV according to age at diagnosis.
Methods Medical records of patients followed at our Department up to December 2015 with a diagnosis of AAV were analysed. Patients were stratified according to age at diagnosis <65 or ≥65 years old.
Results A total of 96 patients with AAV were identified. General characteristics of the study population are presented in table 1. 72.91% of patients were diagnosed before the age of 65 (group A), while 27.09% presented with an elderly-onset disease (group B). Mean age at symptoms onset was 43.09±12.55 and 68.49±8.03, respectively (p<0.0001). Mean follow up was 70.19±73.41 without significant differences between the two groups. The diagnosis of granulomatosis with polyangiitis (GPA) was more frequent in group A (33.33% Vs 9.37%; p=0.03). Accordingly, c-ANCA (PR3) were significantly more detectable in group A (p=0.03). Eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis (MPA) were more represented in group A without reaching statistical significance. The clinical presentation at disease onset was characterised by a higher rate of ocular and musculoskeletal involvement in group A (p=0.004) and more frequent systemic symptoms (p=0.01) and peripheral nervous system involvement (p=0.008) in group B. A compromised renal function due to the vasculitic process was more reported in the elderly-onset group (p=0.007). Comorbidities were more relevant in group B (p<0.0001). Treatment approach did not differ between the two groups, except for a lower mean corticosteroid (CS) dosage in the elderly group at induction, counterbalanced by a lower rate of CS suspension at the end of follow up. Rituximab was only prescribed to 3 female patients of group A. Despite the different organ involvement, indices of disease activity, prognosis and damage did not differ between the two groups. Outcome was generally favorable in both groups, with a 2% mortality rate in group B.
Conclusions Elderly-onset AAV shows some peculiar characteristics of organ involvement at disease onset, a higher rate of comorbidities, and slightly different therapeutic approach compared to younger-onset patients; nevertheless, long-term outcome is generally equally favorable.
Scott DG, Watts RA. Epidemiology and clinical features of systemic vasculitis. Clin Exp Nephrol 2013;17:607–10.
Disclosure of Interest None declared