Fiona Pearce

Does smoking reduce the progression of osteoarthritis? Meta-analysis of observational studies.

To determine whether smoking reduces the progression of osteoarthritis (OA).

The incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK Clinical Practice Research Datalink

Objective. To estimate the incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK. Methods. We conducted a historical cohort study using data from the Clinical Practice Research Datalink and Hospital Episode Statistics (HES). We calculated incidence rate ratios, adjusted for age, gender and ethnicity, using Poisson regression. Results. We identified 462 cases diagnosed between 1997 and 2013. Our overall estimate of incidence was 11.8 (95% CI: 10.7, 12.9)/million person‐years. The incidence was 0.88 (95% CI: 0.40, 1.96) in children (aged <16 years) and 14.0 (95% CI: 12.8, 15.4) in adults. The incidence was lower in females (adjusted incidence rate ratio = 0.68; 95% CI: 0.56, 0.81) and highest in the 55‐69 year age group (adjusted incidence rate ratio = 6.8, 95% CI: 4.9, 9.6; reference group 16‐39 years). The incidence was not significantly different in the Black/Minority Ethnic population from that in the White population (adjusted odds ratio = 0.78, 95% CI: 0.53, 1.13, P = 0.13). The prevalence in 2013 was 134.9 (95% CI: 121.3, 149.6)/million. Mortality was 13.6% at 1‐year, and higher in the HES‐ than in the Clinical Practice Research Datalink‐identified cases (hazard ratio = 3.16, 95% CI: 2.19, 4.56, P < 0.001). Conclusion. By combining primary and secondary care datasets, we have found the incidence and mortality of granulomatosis with polyangiitis to be higher than previously reported. We predict that at present each year in the UK there will be ˜700 new cases, of whom 95 will die within 12 months.

Incidence of ANCA-associated vasculitis in a UK mixed ethnicity population

OBJECTIVES We aimed to estimate the incidence of ANCA-associated vasculitis in the UK and how this varied by ethnic group. METHODS We identified incident cases of ANCA-associated vasculitis between March 2007 and June 2013 in the Nottingham-Derby urban area from medical records using multiple sources. We derived the denominator population from the 2011 census, and we calculated incidence rate ratios using Poisson regression. RESULTS Overall, we identified 107 cases of ANCA-associated vasculitis, giving an incidence of 23.1 per million person-years (95% CI: 18.9, 27.9). The incidence among the white population was 25.8 per million person-years (95% CI: 21.0, 31.3) and among the black and minority ethnic (BME) population 8.4 per million person-years (95% CI: 3.1, 18.3). After adjustment for age and sex, the difference between ethnic groups was not statistically significant (incidence rate ratio 0.7, 95% CI: 0.3, 1.5, P = 0.3). CONCLUSION Overall, the incidence of ANCA-associated vasculitis was similar to other epidemiological studies. Crude incidence rates were lower in the BME than in the white population, but this was partly explained by the older age profile among the white compared with BME population.

Global ethnic and geographic differences in the clinical presentations of anti-neutrophil cytoplasm antibody–associated vasculitis

Objectives There are few data on clinical profiles of ANCA-associated vasculitis (AAV) in different ethnic populations. The aim of this study was to examine the differences in the ANCA type and clinical features of AAV between populations using the Diagnostic and Classification Criteria in Vasculitis Study (DCVAS) dataset. Methods The DCVAS is an international, multicentre, observational study recruiting in 133 sites. Eight ethnic categories were analysed: Northern European, Caucasian American, Southern European, Middle Eastern/Turkish, Chinese, Japanese, Indian subcontinent and other. ANCA type was categorized as myeloperoxidase (MPO), PR3 and ANCA negative. Organ system involvement was recorded using a standard dataset. Differences were analysed by chi-squared tests using a Bonferroni correction and logistic regression (adjusting for age and sex). Northern European was the reference population. Results Data from 1217 patients with AAV were available and the 967 (79.5%) patients recruited by rheumatology departments were analysed to reduce confounding by recruitment specialty. There were differences in ANCA type between ethnic categories (P < 0.001): MPO-ANCA was more common than PR3-ANCA in Japanese, Chinese and Southern Europeans; PR3-ANCA was more common in the other groups. Compared with Northern Europeans, Japanese had a nearly 60-fold increased chance of having MPO-ANCA (vs PR3-ANCA) [odds ratio (OR) 59.2 (95% CI 8.0, 440.7), P < 0.001] and Chinese had a nearly 7-times increased chance [OR 6.8 (95% CI 2.6, 17.8), P < 0.001]. Ophthalmologic and otorhinolaryngologic involvement were less common in Japanese and Chinese populations than Northern Europeans; otherwise, there were few differences in organ involvement between ethnic groups. Conclusion This study confirms the previously observed differential occurrence of MPO-AAV and PR3-AAV between different ethnic groups.

Outcomes and compliance with standards of care in anti-neutrophil cytoplasmic antibody–associated vasculitis—insights from a large multiregion audit

Abstract Objectives We aimed to conduct a large audit of routine care for patients with ANCA-associated vasculitis. Methods We invited all 34 hospitals within one health region in England to undertake a retrospective case note audit of all patients newly diagnosed or treated with CYC or rituximab (RTX) for ANCA-associated vasculitis from April 2013 to December 2014. We compared clinical practice to the British Society for Rheumatology guidelines for the management of adults with ANCA-associated vasculitis and the use of RTX with the National Health Service (NHS) England commissioning policy and National Institute for Health and Care Excellence (NICE) technology appraisal. Results We received data from 213 patients. Among 130 newly diagnosed patients, delay from admission to diagnosis ranged from 0 to 53 days (median 6, interquartile range 3–10.5) for those diagnosed as inpatients. BVAS was recorded in 8% of patients at diagnosis. Remission at 6 months was achieved in 83% of patients. The 1-year survival was 91.5%. A total of 130 patients received CYC for new diagnosis or relapse. The correct dose of i.v. CYC (within 100 mg of the target dose calculated for age, weight and creatinine) was administered in 58% of patients. A total of 25% of patients had an infection requiring hospital admission during or within 6 months of completing their CYC therapy. Seventy-six patients received RTX for new diagnosis or relapse. A total of 97% of patients met the NHS England or NICE eligibility criteria. Pneumocystis jiroveci pneumonia prophylaxis (recommended in the summary of product characteristics) was given in only 65% of patients. Conclusion We identified opportunities to improve care, including compliance with safety standards for delivery of CYC. Development of a national treatment protocol/checklist to reduce this heterogeneity in care should be considered as a priority.

Novel insights into the aetiology of granulomatosis with polyangiitis—a case–control study using the Clinical Practice Research Datalink

Abstract Objectives We aimed to provide insights into the aetiology of granulomatosis with polyangiitis (GPA), by conducting a large case–control study using a general population-based, prospectively collected database of healthcare records. Methods We compared all incident cases of GPA in the Clinical Practice Research Datalink 1990–2014, with up to 10 age-, sex- and general practice-matched controls. We identified potential risk factors, recorded numbers of cases and controls exposed to each, and calculated odds ratios (ORs) using conditional logistic regression. Our main analysis excluded data recorded during 1 year before diagnosis, to prevent early symptoms being mistaken for risk factors. Results We identified 757 people with GPA and matched 7546 controls. People with GPA were five times more likely to have a previous diagnosis of bronchiectasis (OR = 5.1, 95% CI: 2.7, 9.4; P < 0.0001), and these effects remained stable in diagnoses recorded >5 years prior to diagnosis. People with GPA were two to three times more likely than controls to have previous diagnoses of autoimmune diseases or chronic renal impairment, and these effects also remained stable >5 years prior to diagnosis. People with GPA were more likely to have a diagnosis of pulmonary fibrosis (OR = 5.7, 95% CI: 1.7, 19.5; P = 0.01) and sinus infections (OR = 2.7, 95% CI: 1.8, 4.2; P < 0.0001) recorded in the 3 years before diagnosis, but not before this. We also found former smoking, some medications and higher socio-economic status significantly, but less strongly, associated. Conclusion We found novel long-term associations between GPA and pre-existing bronchiectasis and autoimmune diseases.

Correction to: The incidence, prevalence, and survival of systemic sclerosis in the UK Clinical Practice Research Datalink

The above article originally published with an error present in the 2nd sentence in the 4th paragraph of the discussion section and is now presented correctly in this article. The remainder of the article remains unchanged.

The global burden of anti-neutrophil cytoplasmic antibody vasculitis:High but unquantified

The global burden of anti-neutrophil cytoplasmic antibody vasculitis is high but currently unquantified

SAT0267 Epidemiology of ANCA Associated Vasculitis in A Multi-Ethnic Urban Population

Background The epidemiology of ANCA-associated vasculitis (AAV) varies geographically, due to both genetic and environmental factors. The epidemiology of AAV is well-described in White Caucasian populations in which there is an incidence of ∼20/million, although the relative incidence of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) varies. Most studies suggest AAV is less common in Blacks and Asians, but there are no detailed epidemiological studies. However, preliminary data from West London in 2011 suggested that there was an increasing number of patients of Indo-Asian origin being diagnosed with AAV, comprising 20% of new referrals1. Objectives To describe the epidemiology of AAV in a multi-ethnic population. Methods Retrospective case note review of incident cases of ANCA +ve AAV within the urban area of Nottingham March 2007 – June 2013. Self-reported ethnicity was collected from hospital records. Incidence rates for different ethnic groups by age, sex were calculated using the 2011 census data for the denominator population. The area included had an adult (≥16 years) population of 451,056, and an ethnic breakdown of White 82.8%, mixed race 3.2%, Asian 8.8%, Black 4.3%, Other 1.0%. Nottingham University Hospitals Trust is the central referral hospital for the denominator population. Patients were identified as part of a local institution approved audit of the management of AAV and included reviewing the notes of all patients with positive MPO/PR3 ANCA results. All diagnoses were confirmed by review of the hospital notes using the EMEA classification. Incidence rates were calculated using the appropriate corresponding ethnic population as the denominator. 95% CI were calculated using the Poisson distribution for the observed number of cases. Results Overall 53 incident cases of AAV occurred over the 6.25 year period. Annual incidence of AAV was 18.8/million (95% CI 14.1-24.6). Incidence of GPA, MPA and eosinophilic granulomatosis with polyangiitis (EGPA) were 6.7/million (4.1–10.5), 11.0/million (7.5–15.6) and 1.1/million (0.2–3.1) respectively. Incidence of AAV among the White population was 21.4/million (15.9–28.2), and among the whole non-White population was 6.2 (1.3-18.1). Among the Black population the incidence was 16.7/million (2.0–60.2) and for the Indian subcontinent 6.1/million (0.2–33.9). There were no cases identified from South East Asian ethnicities or those of mixed race. The non-White cases were 1 Pakistani 65 yrs lady with MPO+ve MPA, 1 76 yrs Black Caribbean man with MPO+ve EGPA, and 1 48 yrs Black (not African, not Caribbean) man with PR3+ve MPA. We did not find any non-White cases of GPA. There was a higher than expected proportion of MPO+ve patients (52.8%) compared to PR3+ve (45.3%), and 1 patient (1.9%) was p-ANCA+ve but MPO/PR3-ve. Conclusions We conclude that AAV has a similar incidence in Whites, Asians and Blacks. It is possible that AAV may be lower in patients of non-White ethnicity and especially in Indian subcontinent ethnicities. GPA may be less common in non-Whites. The non-White population studied was small. These findings need confirmation in a larger multiethnic population. References Tanna A et al. The changing ethnic prevalence of ANCA associated vasculitis in London: Increasing Indo-Asian influence with critical differences in disease outcome. Renal Association Conference Proceedings 2011; Poster 263. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2410