Article Text

Correspondence on: ‘What comes after the lockdown? Clustering of ANCA-associated vasculitis: single-centre observation of a spatiotemporal pattern’
  1. Alojzija Hočevar1,2,
  2. Aleš Ambrožič1,
  3. Matija Tomšič1,2
  1. 1 Department of Rheumatology, University Medical Centre Ljubljana Division of Internal Medicine, Ljubljana, Slovenia
  2. 2 Internal Medicine, University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
  1. Correspondence to Dr Alojzija Hočevar, Department of Rheumatology, University Medical Centre Ljubljana Division of Internal Medicine, Ljubljana 1000, Slovenia; alojzija.hocevar{at}

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It was with great interest that we read the article by Gauckler et al titled ‘What comes after the lockdown? Clustering of ANCA-associated vasculitis: single-centre observation of a spatiotemporal pattern’, published in Ann Rheum Dis in December 2020.1 Its authors reported a twofold increase of the incidence rate of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) diagnoses and a threefold increase in incidence rate of de novo AAV manifestations at their centre compared with previous years. Furthermore, they found the clustering of cases following the end of the pandemic’s first wave. The increase in the incidence could not be attributed to a deferral of symptoms or delayed diagnoses.

Indeed, the SARS-CoV-2 virus pandemic significantly affected our daily rheumatological routine and the management of systemic vasculitides. We had to adjust our daily practice practically overnight, finding new ways to take optimal care of our patients. Therefore, how successful were we in managing patients with systemic vasculitides? At our secondary/tertiary rheumatological department, for the past decade we have been following the variations in the frequency, delays to diagnosis (the symptom duration time until diagnosis) and the baseline activity of the most commonly diagnosed vasculitides, that is, giant cell arteritis (GCA), IgA vasculitis and AAV. In the present study, we examined whether these characteristics have changed significantly during the COVID-19 pandemic. In 2020, we diagnosed a total of 79 new adult cases of GCA, IgAV and AAV (30, 28 and 21 cases, respectively). Temporal variations of GCA, IgAV and AAV over the last decade (2010–2020) are presented in the online supplemental figure S1A. Table 1 shows the median (IQR) symptom duration time and disease activity at presentation. In spite of the COVID-19 pandemic, neither was the symptom duration time longer nor was the baseline disease activity higher (determined by the Birmingham vasculitis activity score (version 3)2 for small vessel vasculitides, and by permanent vision defects) in 2020 compared with the previous decade (2010–2019). In addition, we did not observe the clustering of vasculitides after the end of spring lockdown in May 2020 as reported by Gauckler et al 1 (online supplemental figure S1B). Our experience with GCA is in fact quite the opposite to that reported by Luther et al, who recently identified an increase of GCA cases as well as of cases with visual impairment during the COVID-19 pandemic.3

Table 1

Characteristics of vasculitides before and during COVID-19 19 pandemics year 2020

In conclusion, our experience shows that patients with systemic vasculitis sought help and did not suffer from significant delays in receiving healthcare even during the pandemic.

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Patient consent for publication

Ethics approval

The study was approved by the Slovenian National medical ethics committee, approval number 0120-554/2020/3.


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  • Contributors AH contributed to the acquisition, analysis and interpretation of data. AA and MT helped to revise the manuscript. All authors have read and approved the manuscript for submission.

  • Funding The study was funded by the Slovenian Research Agency - research core funding P3-0314.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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