Risk Factors Associated with Relapse in Japanese Patients with Microscopic Polyangiitis

Objective.We retrospectively studied the risk factors associated with relapse during remission maintenance therapy for myeloperoxidase-antineutrophil cytoplasmic autoantibody (MPO-ANCA)-positive microscopic polyangiitis (MPA).Methods.Sixty-two patients diagnosed with MPA according to the European Medicines Agency classification algorithm during a 2-year period from January 1, 2005, to December 31, 2006, and who achieved remission after the first remission-induction therapy, were examined (registration no. UMIN000001785).Results.The patient group comprised 25 men and 37 women aged 70.0 ± 8.9 years. The mean observation period was 30.2 ± 15.9 months. The rate of relapse was 24.2% (15/62), and mean interval between remission and relapse was 16.9 ± 13.5 months. During maintenance therapy following remission, the risk of relapse increased when the reduction rate of prednisolone increased above 0.8 mg/month (OR 12.6, 95% CI 2.2–97.9). Proteinuria at the start of maintenance therapy (regression coefficient 1.991 ± 0.758, p < 0.05) and the change in red blood cell counts in urine during the period from the start of maintenance therapy to the final observation (regression coefficient 0.126 ± 0.040, p < 0.01) were identified as risk factors influencing the vasculitis damage index.Conclusion.In Japan, relapse of MPO-ANCA-positive MPA may be associated with the reduction rate of oral prednisolone administration during maintenance therapy.

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Risk Factors for Relapse of Antineutrophil Cytoplasmic Antibody-associated Vasculitis in Japan: A Nationwide, Prospective Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.170508 ◽

2018 ◽

Vol 45 (4) ◽

pp. 521-528 ◽

Cited By ~ 4

Author(s):

Akinori Hara ◽

Takashi Wada ◽

Ken-ei Sada ◽

Koichi Amano ◽

Hiroaki Dobashi ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Maintenance Therapy ◽

Prospective Cohort Study ◽

Induction Therapy ◽

Prospective Cohort ◽

Oral Prednisolone ◽

Antineutrophil Cytoplasmic Antibody ◽

Remission Induction ◽

Factors Associated

Objective.The aim was to elucidate the prognosis and risk factors associated with relapse during longterm remission maintenance therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods.Patients with newly diagnosed AAV (n = 156) were registered in the Remission Induction Therapy in Japanese patients with ANCA-associated Vasculitides (RemIT-JAV) study, and among them, 83 patients who achieved remission were enrolled and followed up for 24 additional months in our nationwide, prospective cohort study (Co-RemIT-JAV; registration number UMIN 000006373). Patterns of maintenance therapy, effectiveness, and safety were evaluated from months 25 to 48 after the RemIT-JAV. The primary outcome measure was the rate of relapse. Secondary outcome measures included overall and renal survival, risk factors associated with relapse, and incidence rates of serious infections.Results.The patients comprised 35 men and 48 women aged 65.3 ± 12.6 years. Between months 25 and 48, the survival rate was 95% (79/83). Causes of death included 1 thyroid cancer, 1 infection, and 2 unknown reasons. Four patients had developed endstage renal disease (ESRD) by Month 24; 1 developed ESRD beyond Month 25. The relapse rate was 24% (20/83) from months 25 to 48. Multivariable analysis revealed that oral prednisolone ≤ 2.5 mg/day at Month 24 was a significant risk factor for relapse between months 25 and 48 (HR = 3.1, 95% CI 1.1–8.5).Conclusion.One-quarter of patients with AAV relapsed during maintenance therapy, and relapse was associated with the dose of oral prednisolone 24 months after the initiation of remission induction therapy in Japan.

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The prevalence of hock lesions in UK dairy cattle and the significance of risk factors associated with the development of the condition

Proceedings of the British Society of Animal Science ◽

10.1017/s1752756200029343 ◽

2009 ◽

Vol 2009 ◽

pp. 95-95

Author(s):

S Potterton ◽

M Green ◽

J Harris ◽

K Millar ◽

H Whay ◽

...

Keyword(s):

Risk Factors ◽

Dairy Cattle ◽

Clinical Mastitis ◽

Related Factors ◽

Death Rates ◽

Factors Associated ◽

Cell Counts ◽

East Midlands ◽

Potential Risk Factors ◽

The Uk

The term hock lesion describes incidences of hair loss, thickened skin, wounds, scabs, and swellings occurring over the tarsal joint. Hock lesions in dairy cattle are a widespread problem around the world. In the UK, a recent study found approximately 99% of examined cows had at least some callused area over a hock (Haskell et al., 2006). The presence of hock lesions is correlated with injuries of the teat, carpal joints and skin, as well as increases in mobility score, high somatic cell counts, a greater incidence of clinical mastitis, and higher culling and annual death rates. Differences in the prevalence and severity of hock lesions according to the lying surface and cubicle design have been identified. Cow-related factors and management variables have also been postulated as possible risk factors. Recognition of the condition and practical solutions aimed at resolving it have however, been limited. The aim of this study was to determine the prevalence of hock lesions in lactating cattle on dairy farms in the East Midlands of the UK, and the significance of potential risk factors in the development of the lesions.

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Analysis of somatic cell counts and risk factors associated with occurrence of bacteria in ewes of different primary purposes

Livestock Science ◽

10.1016/j.livsci.2013.09.008 ◽

2013 ◽

Vol 157 (2-3) ◽

pp. 597-604 ◽

Cited By ~ 6

Author(s):

G. Kern ◽

I. Traulsen ◽

N. Kemper ◽

J. Krieter

Keyword(s):

Risk Factors ◽

Somatic Cell ◽

Somatic Cell Counts ◽

Factors Associated ◽

Cell Counts

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P402 Discontinuation of short-term infliximab maintenance therapy in patients with Crohn's disease: outcomes and risk factors associated with relapse

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.527 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S281-S282

Author(s):

D. Zheng ◽

R. Mao ◽

B. Chen ◽

T. Feng ◽

S. Ben-Horin ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Therapy ◽

Short Term ◽

Factors Associated ◽

Disease Outcomes

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AB0442 RISK FACTORS ASSOCIATED WITH THROMBOTIC EVENTS IN KOREAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1674 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1519.3-1520

Author(s):

D. J. Park ◽

S. E. Choi ◽

H. Xu ◽

J. H. Kang ◽

S. S. Lee

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Systemic Lupus Erythematosus ◽

Venous Thrombosis ◽

Lupus Erythematosus ◽

Angiotensin Receptor Blockers ◽

Damage Index ◽

Systemic Lupus ◽

Factors Associated ◽

Thrombotic Complications

Background:Objectives:Up to 30~40% of all patients with systemic lupus erythematosus (SLE) experience thrombosis, presenting as stroke and myocardial infarction, and these thrombotic events cause substantial morbidity and mortality in SLE. We explored the risk factors associated with the occurrence of thrombotic events in SLE patients.Methods:This study enrolled 259 SLE patients (mean age, 34.0 ± 13.7; 239 females) with available clinical data at the time of SLE onset from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, and history of concomitant diseases were obtained. Thrombotic events were defined as the presence of arterial or venous thrombosis. The multivariable Cox’s model was performed to investigate the possible risk factors for thrombotic events.Results:During a mean follow-up of 103.3 months (SD, 53.4), 27 patients (10.4%) developed thrombotic events: stroke in 15 patients, venous thrombosis in five patients, myocardial infarction in four patients, and angina in three patients. In the multivariable Cox’s regression analysis, hypertension (hazard ratio [HR], 16.946; P=0.031), antiphospholipid syndrome (APS) (HR, 18.348; P=0.001), cumulative prednisolone >5 mg/day (HR, 14.374; P<0.001), use of ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB) (HR, 0.110; P=0.004), and Systemic Lupus International Collaborating Clinics Group (SLICC) damage index (HR, 1.972; P=0.004) were significant predictors of the development of thrombotic events in patients with SLE.Conclusion:Patients with SLE showed significant thrombotic events during the course of their disease. Risk factors associated with thrombotic complications were higher cumulative dose of prednisolone, diagnosis of APS, and higher SLICC damage index. On the other hand, the use of ACEi or ARBs was associated with a reduced risk of thrombotic complications in patients with SLE. Our results support the need for increased monitoring of thrombotic complications in SLE patients.Disclosure of Interests: :None declared

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Rituximab in Remission Induction and Maintenance Therapy for Microscopic Polyangiitis Associated with Gastric Cancer: A Case Report

Modern Rheumatology Case Reports ◽

10.1093/mrcr/rxab053 ◽

2021 ◽

Author(s):

Takafumi Aritomi ◽

Masao Nawata ◽

Aya Nawata ◽

Yoshihisa Himeno ◽

Kazuyoshi Saito ◽

...

Keyword(s):

Gastric Cancer ◽

Maintenance Therapy ◽

Microscopic Polyangiitis ◽

Early Stage ◽

High Titer ◽

Immunosuppressive Agents ◽

Remission Induction ◽

Upper Gastrointestinal Endoscopy ◽

High Dose ◽

Protein Levels

Abstract We herein report a case of a patient with gastric cancer-associated microscopic polyangiitis (MPA) who was treated with combination glucocorticoids and rituximab (RTX) for remission induction and maintenance, and finally to discontinue glucocorticoids without recurrence of gastric cancer or MPA in a year. A 69-year-old man was suspected of having MPA because of fever, high C-reactive protein levels, neuritis, and a high titer of myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA). Upper gastrointestinal endoscopy indicated early-stage gastric cancer, for which he underwent surgery preceded by immunosuppressive therapy for vasculitis. Histopathological images showed vasculitis in the vicinity of the cancerous tissue, suggesting an association between gastric cancer and vasculitis. Postoperatively, fever and inflammatory response improved, but MPO-ANCA increased further and the patient developed alveolar hemorrhage. He resulted in remission with high-dose glucocorticoids and RTX, and he received maintenance therapy with RTX without additional immunosuppressive agents. After 1 year of treatment, he was able to discontinue glucocorticoids without recurrence of gastric cancer or vasculitis. There is no established treatment for malignancy-associated vasculitis other than glucocorticoids. Although more cases need to be accumulated in the future, RTX is expected to be useful in malignancy-associated vasculitis.

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Venous Thrombotic Events in ANCA-Associated Vasculitis: Incidence and Risk Factors

Kidney360 ◽

10.34067/kid.0000572019 ◽

2020 ◽

Vol 1 (4) ◽

pp. 258-262 ◽

Cited By ~ 2

Author(s):

Bradley Isaacs ◽

Eric J. Gapud ◽

Brendan Antiochos ◽

Philip Seo ◽

Duvuru Geetha

Keyword(s):

Risk Factors ◽

Granulomatosis With Polyangiitis ◽

Multivariate Analyses ◽

Microscopic Polyangiitis ◽

Common Complication ◽

Birmingham Vasculitis Activity Score ◽

Factors Associated ◽

Anca Associated Vasculitis ◽

The Mean ◽

Univariate Analyses

BackgroundThe incidence of venous thromboembolism (VTE) is increased in ANCA-associated vasculitis (AAV). We assessed the frequency of VTE observed among patients with AAV evaluated at our center and identified risk factors.MethodsPatients from the Johns Hopkins Vasculitis Center cohort who were evaluated between 1998 and 2018 and had a diagnosis of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) were eligible for analysis. Baseline demographics and clinical and serologic data were extracted. Univariate and multivariate analyses were performed to identify factors associated with VTE in AAV.ResultsA total of 162 patients with AAV were identified, 105 (65%) with GPA; 22 (14%) of these patients had a recorded VTE with a median time to VTE of 1 month. The mean (SD) age in the VTE versus non-VTE groups was 54±20 versus 55±17 years (P=0.99), 64% versus 60% female (P=0.93), 82% versus 49% PR3-ANCA positive (P=0.01), with a total mean BMI of 33.3±5.7 versus 28.3±6.1 kg/m2, (P<0.001) respectively. The median Birmingham Vasculitis Activity Score (BVAS version 3) was 19 versus 14 (P=0.02). Univariate analyses identified PR3-ANCA, rapidly progressive GN (RPGN), and hypoalbuminemia. In multivariate analysis, the significant associations with VTE included PR3-ANCA (OR, 4.77; P=0.02), hypoalbuminemia (OR, 4.84; P=0.004), and BMI (OR, 1.18; P<0.001).ConclusionsVTE is a surprisingly common complication of AAV. PR3-ANCA and hypoalbuminemia are risk factors for developing VTEs. Further studies are needed to confirm these findings.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_04_30_KID0000572019.mp3

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Maintenance periodontal therapy.

Brazilian Journal of Implantology and Health Sciences ◽

10.36557/2674-8169.2021v3n5p31-48 ◽

2021 ◽

Vol 3 (5) ◽

pp. 31-48

Author(s):

Juan Arada

Keyword(s):

Risk Factors ◽

Maintenance Therapy ◽

Periodontal Diseases ◽

Periodontal Therapy ◽

Periodontal Treatment ◽

Long Term Results ◽

Clinical Parameters ◽

Factors Associated

Introduction: Maintenance is a fundamental phase of the therapy and prevention of periodontal diseases. The objectives of this review are: a) To determine what are the aspects of maintenance periodontal therapy; b) know the value of maintenance on the long-term results of periodontal treatment; c) review the risk factors of the patient, the tooth and the location; d) establish a protocol of action in the different situations. Material, methods and results: To carry out this work, 46 scientific articles have been analyzed. The MEDLINE and Cochrane databases were used for the search. Discussion:The goals of maintenance therapy are to prevent the initiation and recurrence of periodontal diseases. Regardless of the type of treatment we perform, the clinical parameters will not improve if maintenance by the professional is not carried out. To establish the intervals for the appointments and the locations to be treated, it will be essential to assess the risk factors associated with the patient, the tooth and the location.

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