scholarly journals The Safe Use of Rituximab In The Management of ANCA-Associated Vasculitis In A Patient With Suspicious Renal Cyst – A Case Report

ANCA- Associated Vasculitis (AAV) is a multi-system immune small vessel vasculitis. The use of traditional immunosuppressive agents in the management of ANCA vasculitis is known to increase baseline susceptibility to malignancy [1]. Renal cyst is a commonly encountered incidental finding in clinical practice. Although most cysts found are benign, the identification of complex cysts warrants further diagnostic investigation to exclude a neoplastic process. To shed light on this complex area, the Bosniak system has provided a framework for the classification of cystic renal lesions. The system defines five categories of renal lesions based on radiological features seen on CT or MRI, to stratify the lesions associated risk of malignancy [2].

2019 ◽  
Vol 46 (10) ◽  
pp. 1415-1420 ◽  
Author(s):  
Nataliya Milman ◽  
Eilish McConville ◽  
Joanna C. Robson ◽  
Annelies Boonen ◽  
Peter Tugwell ◽  
...  

Objective.Aspects of antineutrophil cytoplasmic antibodies–associated vasculitis (AAV) prioritized by patients with AAV were described using the International Classification of Function, Disability, and Health (ICF).Methods.Items identified during 14 individual interviews were incorporated into an ICF-based questionnaire administered to participants of 2 vasculitis patient symposia: 36 in the United Kingdom and 63 in the United States.Results.Categories identified as at least “moderately relevant” by ≥ 5% of subjects included 44 body functions, 14 body structures, 35 activities and participation, 31 environmental factors, and 38 personal factors.Conclusion.Identified categories differ from those identified by the current Outcome Measures in Rheumatology (OMERACT) core set and those prioritized by vasculitis experts.


2021 ◽  
Vol 23 (6) ◽  
Author(s):  
Martin Windpessl ◽  
Erica L. Bettac ◽  
Philipp Gauckler ◽  
Jae Il Shin ◽  
Duvuru Geetha ◽  
...  

Abstract Purpose of Review There is ongoing debate concerning the classification of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. That is, whether classification should be based on the serotype (proteinase 3 (PR3)- or myeloperoxidase (MPO)-ANCA) or on the clinical phenotype (granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)). To add clarity, this review focused on integration of the most recent literature. Recent Findings Large clinical trials have provided evidence that a serology-based risk assessment for relapses is more predictive than distinction based on the phenotype. Research conducted in the past decade indicated that a serology-based approach more closely resembles the genetic associations, the clinical presentation (i.e., lung involvement), biomarker biology, treatment response, and is also predicting comorbidities (such as cardiovascular death). Summary Our review highlights that a serology-based approach could replace a phenotype-based approach to classify ANCA-associated vasculitides. In future, clinical trials and observational studies will presumably focus on this distinction and, as such, translate into a “personalized medicine.”


2021 ◽  
Vol 2 (2) ◽  
pp. 114-122
Author(s):  
Esther Diana Rossi

Salivary gland masses are often encountered in the everyday practice of cytopathology. It is commonly known that the cytologic interpretation of these lesions can pose diagnostic problems due to overlapping cytomorphologic features. Fine needle aspiration (FNA) of salivary lesions shows good to excellent sensitivity and specificity in differentiating a neoplastic from a non-neoplastic process and in diagnosing common tumors such as pleomorphic adenoma. However, its value is limited in diagnosing specific neoplastic entities especially those with well-differentiated morphology. In light of this gap, an international group of pathologists has proposed a management-oriented, tiered classification for reporting salivary gland FNA specimens, “The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)”. Similar to other classification systems, the MSRSGC scheme comprises six diagnostic categories, which were linked with a specific risk of malignancy (ROM) and management. In this review article, the author evaluated the published literature on FNA in diagnosing salivary gland lesions with the adoption of the Milan system since its introduction in the daily practice of salivary cytopathology.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 196.1-197
Author(s):  
S. Perera ◽  
D. Krafcsik ◽  
P. Rutherford

Background:ANCA-associated Vasculitis (AAV) is a rare, severe small vessel vasculitis that affects multiple organs with a high acute mortality risk. As every patient presents differently, diagnosis is often delayed. Although treatments exist, responses vary, and remission is often not achieved or sustained. From the time of initial diagnosis onwards, patients suffer from an impaired quality of life. Coping with pain, fatigue, ongoing symptoms and combating challenges becomes a complex task and patients may be challenged in how best to communicate these emotions with health care professionals. We aimed to develop an initiative with Art and Voice, that would seek to empower people living with AAV and their carers in feeling understood, seen and heard in a meaningful way. This would invite a collective understanding of ‘how people make sense of key life experiences and what it means to them’ by creating a common language to address poorly addressed issues.Objectives:This project aims to provide a voice to patients to express personal experiences and complexity of everyday living and empower people to feel in control of their own health through an online platform. It should also allow practitioners to gain new awareness about issues faced by their patients, to better understand the relationships between caring and curing, hearing and listening.Methods:We collaborated with 10 patient association groups representatives, 17 AAV patients and 9 of their carers across 7 European countries. A series of workshops were set up to discuss issues faced and aid the subsequent production of a range of materials designed to provide clear, comprehensive content that would help individuals cope with the physical and emotional impact of AAV from diagnosis to living with it. This work was supported by a digital artist who is a rheumatologist living with vasculitis.Results:The co-creation of patient information materials featuring real life patients was successful and led to the development of a creative initiative called SEE ME.HEAR ME with an online platformwww.myancavasculitis.com. This includes: (1) an awareness programme featuring artwork created by the digital artist and advised by the patients which captures the essence of AAV from the patients view (see Figure). (2) a series of first-hand patient and carer stories capturing their authentic voice on ‘what it is like to live with the disease’. (3) extensive written content designed to fill information gaps around AAV diagnosis, investigations and treatment and what to expect during clinical follow up. The platform supports patients in asking questions and seeking information while signposting them to their own healthcare professional for advice and their local country patient association for support.Table 1.Sensitivities and specificities of examinations in gout and calcium pyrophosphate deposition diseaseConclusion:People with AAV need support throughout life, the profound psychosocial influence from illness makes the lived experience, challenging. SEE ME. HEAR ME online patient platform aims to generate awareness around AAV, improve physician and patient dialog, and enhance people’s experiences of living and coping with the disease. In addition it provides support for carers and giving valuable insights to friends, family and the general public about what the lived experience with AAV looks like.Acknowledgments:We wish to thank all European patients and patient association leads who worked on this projectDisclosure of Interests:Shanali Perera Consultant of: Vifor Pharma, Dijana krafcsik Employee of: Vifor Pharma, Peter Rutherford Shareholder of: Vifor Pharma, Employee of: Vifor Pharma, Baxter Healthcare


2016 ◽  
Vol 50 (6) ◽  
pp. 445-451 ◽  
Author(s):  
Jan Edenberg ◽  
Kaja Gløersen ◽  
Herzi Abdi Osman ◽  
Magne Dimmen ◽  
Geir V. Berg

2021 ◽  
pp. 550-560
Author(s):  
Miguel Esperança-Martins ◽  
Vasco Evangelista ◽  
Salomão Fernandes ◽  
Raquel Almeida

Diffuse alveolar haemorrhage related to an anti-neutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis is an extremely rare form of presentation of breast cancer. Here we report the case of a 77-year-old woman with a histological diagnosis of a papillary ductal carcinoma of the breast presenting with a diffuse alveolar haemorrhage secondary to a perinuclear ANCA-associated vasculitis. To our knowledge, this is the first case ever reported of a diffuse alveolar haemorrhage related to an ANCA-associated small vessel vasculitis as a form of presentation of breast cancer. The therapeutic approach of this paraneoplastic vasculitis included the use of corticosteroids and plasmapheresis, a very useful technique to remove endothelial aggressors (circulating antibodies) as a strategy to earn time for a proper therapeutic decision specifically directed for disease modification, but that can also be associated with several severe adverse effects, which are illustrated in our case.


2014 ◽  
Vol 73 (Suppl 2) ◽  
pp. 552.2-552
Author(s):  
C. Rahmattulla ◽  
A. Göçeroğlu ◽  
M.E. Reinders ◽  
E.C. Hagen ◽  
J.A. Bruijn ◽  
...  

2021 ◽  
Author(s):  
Jan Wildhirth

Capital market players are regularly part of a group of companies. The classification of a company as a subsidiary has significant effects on the subsidiary and the parent company. In the law on transparency of shareholdings and takeover law, membership in such a group of companies is decided based on the concept of subsidiary in Section 35 (1) of the German Securities Trading Act (WpHG) and Section 2 (6) of the German Securities Acquisition and Takeover Act (WpÜG). These definitions are analysed in depth to shed light on capital market group law. The European foundations as well as the purpose of the regulations are particularly examined. Finally, the results found are verified by analyzing GmbH & Co. KG structures.


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