Background ANCA-associated vasculitides (AAVs) are a group of systemic inflammatory disorders with substantial morbidity and mortality. Alveolar hemorrhage and gastrointestinal involvement are major causes of death in these disorders. Markers that measure activity and predict prognosis are needed. Serum ferritin levels are shown to be associated with activity and prognosis of certain rheumatic diseases such as antiphospholipid syndrome, dermatomyositis and systemic lupus erythematosus.

Objectives To investigate association between serum ferritin with acute phase reactants and major disease manifestations in AAV.To investigate association between serum ferritin with acute phase reactants and major disease manifestations in AAV.

Methods Retrospective charts of 40 patients (22 males, mean age 49±15 years) with AAV were utilized. Patients fulfilling Chapel hill classification criteria for AAV and those with at least 6 months of follow up were included. Disease activity of AAV was assessed with Birmingham vasculitis activity score (BVAS). Serum ferritin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and creatinine values were obtained from hospital records. Creatinine clearance (CrCl) was calculated with MDRD formula. Association between serum ferritin with acute phase reactants and major disease manifestations were analyzed with Spearman rank and Mann Whitney U tests.

Results Among 40 patients with AAV, 14 had pulmonary hemorrhage, eight had end stage renal disease, three mesenteric ischemia and four died in the follow up (two due to alveolar, one cerebral and one GI hemorrhage). Serum ferritin was not correlated with ESR and CRP. However, there was a significant correlation between BVAS and initial CrCl (r=0.61, p<0.001 and r= -0.59, p<0.001, respectively). Serum ferritin values were higher in patients with pulmonary hemorrhage (median (IQR), 65.8 (207) vs 1041 (1281) ng/mL, p<0.001) and in those four patients who died in the initial six-moths follow up period (206.8 (556) vs 1362 (1292) ng/mL, p<0.014).

Conclusions Serum ferritin could be used as a marker of activity because of its ability to reflect disease severity which has already been shown in other systemic inflammatory disorders. Association between serum ferritin with other manifestations of AAVs remain to be elucidated in the large population studies.

1. Chen, Y.X., et al., Analyzing fatal cases of Chinese patients with primary antineutrophil cytoplasmic antibodies-associated renal vasculitis: a 10-year retrospective study. Kidney Blood Press Res, 2008. 31(5): p. 343–9.

2. Hogan, P.C., et al., Biomarkers Predict Relapse in Granulomatosis with Polyangiitis. J Biomark, 2014.

Disclosure of Interest None declared