Arthritis as a clinical manifestation of antineutrophil cytoplasmic antibody-associated systemic vasculitis: diagnostic difficulties

The clinical picture of the symptomatic phase of antineutrophil cytoplasmic antibody-associated systemic vasculitis (ANCA-SV) can vary widely and be accompanied by joint damage, which complicates the early diagnosis of the disease. The paper presents a case of ANCA-SV with acute kidney injury, the manifestations of the symptomatic phase of which were confined to joint damage, myalgia, and Raynaud's syndrome, which led to delayed diagnosis at the stage of renal failure requiring hemodialysis (HD). Urgent adequate induction therapy could preserve kidney function, despite 10-day anuria and 5-week HD.

The paper discusses the need for a systematic detailed examination of patients with the onset of a joint inflammatory lesion, especially in those with its systemic manifestations, and the inclusion of serum ANCA tests in the standards of diagnosis in early arthritis. 

1. Aletaha D, Neogi T, Silman A, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010 Sep;62(9):2569-81. doi: 10.1002/art.27584.

2. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013 Jan; 65(1):1-11. doi: 10.1002/art.37715.

3. Moroni G, Ponticelli C. Rapidly progressive crescentic glomerulonephritis: Early treatment is a must. Autoimmun Rev. 2014 Jul;13(7):723-9. doi: 10.1016/j.autrev.2014. 02.007. Epub 2014 Mar 19.

4. Hoffman GS, Kerr GS, Leavitt RY, et al. Wegener granulomatosis: An analysis of 158 patients. Ann Intern Med. 1992 Mar 15; 116(6):488-98.

5. Reinhold-Keller E, Beuge N, Latza U, et al. An interdisciplinary approach to the care of patients with Wegener`s granulomatosis: Long-term outcome in 155 patients. Arthritis Rheum. 2000 May;43(5):1021-32.

6. Guillevin L, Durand-Gasselin B, Cevallos R, et al. Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. Arthritis Rheum. 1999 Mar;42(3): 421-30.

7. Ahn JK, Hwang JW, Lee J, et al. Clinical features and outcome of microscopic polyangiitis under a new consensus algorithm of ANCA-associated vasculitides in Korea. Rheumatol Int. 2012 Oct;32(10):2979-86. Epub 2011 Sep 7.

8. Sable-Fourtassou R, Cohen P, Mahr A, et al. Antineutrophil cytoplasmic antibodies and the Churg Strauss syndrome. Ann Intern Med. 2005 Nov 1;143(9):632-8.

9. Comarmond C, Pagnoux C, Khellaf M, et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis Rheum. 2013 Jan;65(1):270-81. doi: 10.1002/art.37721.

10. Фролова НФ. Быстропрогрессирующий гломерулонефрит-ассоциированный с ANCA васкулитом, лечение, прогноз. Автореф. дисc. канд. мед. наук. Москва; 2017. 24 с. [Frolova NF. Rapidly progressive glomerulonephritis associated with ANCA vasculitis, treatment, prognosis. Autoref. diss. cand. med. sci. Moscow; 2017. 24 p.]

11. Rodgers H, Guthrie J, Brownjohn A, Turney J. Microscopic polyarteritis:clinical features and treatment. Postgrad Med J. 1989 Aug;65(766):515-8.

12. Pagnoux C, Seror R, Berezne A, et al. Remittent non-destructivepolysynovitis in P-ANCA-positive vasculitis patients with anti-CCPantibodies. Joint Bone Spine. 2010 Dec;77(6):604-7. doi: 10.1016/j.jbspin.2010.02. 013. Epub 2010 May 18.

13. Фролова НФ, Корсакова ЛВ, Столяревич ЕС, Бекетова ТВ. Дебют АНЦА-ассоциированного системного васкулита под маской ревматоидного артрита. Научно-практическая ревматология. 2015;53(6): 653–6. [Frolova NF, Korsakova LV, Stolyarevich ES, Beketova TV. The onset of ANCA-associated systemic vasculitis masking rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2015;53(6):653–6. (In Russ.)]. doi: 10.14412/1995-4484-2015-633-656