Granulomatosis con poliangeítis: actualización y conceptos claves

Simón Hoyos Patiño

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Resumen

La granulomatosis con poliangeítis es una enfermedad multisistémica que hace parte de las vasculitis de pequeños vasos asociadas a ANCA (anticuerpos contra el citoplasma de los neutrófilos), junto con la granulomatosis eosinofílica con poliangeítis, la poliangeítis microscópica y la vasculitis asociada a ANCA limitada a un órgano. Esta patología se caracteriza por ser una vasculitis necrotizante, inflamatoria, con formación de granulomas. Afecta principalmente el tracto respiratorio y el sistema renal, con una mayor incidencia entre los 40-55 años. Tiene una mayor prevalencia en caucásicos y en el norte de Europa. Su etiología es desconocida, sin embargo en su aparición intervienen diversos aspectos ambientales, infecciosos, farmacológicos, inmunológicos y tóxicos, sumados a una predisposición genética. El objetivo del presente texto es hacer una revisión de los aspectos claves de la enfermedad con base a los nuevos avances en la literatura, incluyendo aspectos como la epidemiología, fisiopatología, manifestaciones clínicas, diagnóstico y tratamiento. Haciendo especial énfasis en la fisiopatología y en las manifestaciones clínicas, los cuales son fundamentales para el desarrollo de nuevas terapias para el manejo de la enfermedad, junto con un diagnóstico oportuno que permita limitar al máximo las complicaciones derivadas de esta.

Palabras clave

Granulomatosis con poliangeítis; vasculitis; ANCA; NETs.

Referencias

Khasnis A, Langford CA. Update on vasculitis. J Allergy Clin Immunol. 2009 Jun;123(6):1226-36.

Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;Jan;65(1):1-11.

Flores-Suárez LF. Antineutrophil cytoplasm autoantibodies: usefulness in rheumatology. Reumatol Clin. 2012 Nov-Dec;8(6):351-7.

Comarmond C, Cacoub P. Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. Autoimmun Rev. 2014 Nov;13(11):1121-5.

Lutalo PM, D'Cruz DP. Diagnosis and classification of granulomatosis with polyangiitis (aka Wegener's granulomatosis). J Autoimmun. 2014 Feb-Mar;48-49:94-8.

Fujimoto S, Watts RA, Kobayashi S, Suzuki K, Jayne DR, Scott DG, et al. Comparison of the epidemiology of anti-neutrophil cytoplasmic antibody-associated vasculitis between Japan and the U.K. Rheumatology (Oxford). 2011 Oct;50(10):1916-20.

Katsuyama T, Sada KE, Makino H. Current concept and epidemiology of systemic vasculitides. Allergol Int. 2014 Dec;63(4):505-13.

Herlyn K, Buckert F, Gross WL, Reinhold-Keller E. Doubled prevalence rates of ANCA-associated vasculitides and giant cell arteritis between 1994 and 2006 in northern Germany. Rheumatology (Oxford). 2014;53:882-9.

Catanoso M, Macchioni P, Boiardi L, Manenti L, Tumiati B, Cavazza A, et al. Epidemiology of granulomatosis with polyangiitis (Wegener's granulomatosis) in Northern Italy: a 15-year population-based study. Semin Arthritis Rheum. 2014 Oct;44(2):202-7.

Cartin-Ceba R, Peikert T, Specks U. Pathogenesis of ANCA-associated vasculitis. Curr Rheumatol Rep. 2012 Dec;14(6):481-93.

Stegeman CA, Tervaert JW, Sluiter WJ, Manson WL, de Jong PE, Kallenberg CG. Association of chronic nasal carriage of Staphylococcus aureus and higher relapserates in Wegener granulomatosis. Ann Intern Med. 1994 Jan 1;120(1):12-7.

Holle JU, Windmöller M, Lange C, Gross WL, Herlyn K, Csernok E. Toll-like receptor TLR2 and TLR9 ligation triggers neutrophil activation in granulomatosis with polyangiitis. Rheumatology (Oxford). 2013 Jul; 52(7):1183-9.

Lyons PA, Rayner TF, Trivedi S, Holle JU, Watts RA, Jayne DR, et al. Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med. 2012 Jul 19;367(3):214-23.

Rowaiye OO, Kusztal M, Klinger M. The kidneys and ANCA-associated vasculitis: from pathogenesis to diagnosis. Clin Kidney J. 2015 Jun;8(3):343-50.

Cao Y, Schmitz JL, Yang J et al. DRB1*15 allele is a risk factor for PR3-ANCA disease in African Americans. J Am Soc Nephrol. 2011;22:1161-7.

Homeister JW, Jennette JC, Falk RJ. Immunologic mechanisms of vasculitis. In: Alpern RJ, Moe OW, Caplan M (eds). Seldin and Giebisch’s The Kidney. Amsterdam: Ed. Elsevier, 2013, pp. 2817-46.

Kallenberg CG. Pathogenesis of ANCA-associated vasculitides. AnnRheumDis. 2011;70:59-63.

Gou SJ, Yuan J, Wang C et al. Alternative complement pathway activation products in urine and kidneys of patients with ANCA-associated GN. Clin J Am Soc Nephrol. 2013;8:1884-91.

Gou SJ, Yuan J, Chen M et al. Circulating complement activationinpatientswithanti-neutrophilcytoplasmicantibody-associatedvasculitis.KidneyInt. 2013;83:129-37.

Nakazawa D, Tomaru U, Suzuki A et al. Abnormal conformation and impaired degradation of propylthiouracil-induced neutrophil extracellular traps: implications of disordered neutrophil extracellular traps in a rat model of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis. ArthritisRheum. 2012;64:3779-87.

Flint SM, McKinney EF, Smith KG. Emerging concepts in the pathogenesis of antineutrophil cytoplasmic antibody-associated vasculitis. Curr Opin Rheumatol. 2015 Mar;27(2):197-203.

Tognarelli S, Gayet J, Lambert M, Dupuy S, Karras A, Cohen P, et al. Tissue-specific microvascular endothelial cells show distinct capacity to activate NK cells: implications for the pathophysiology of granulomatosis with polyangiitis. J Immunol. 2014 Apr 1;192(7):3399-408.

Jayne D. The diagnosis of vasculitis. Best Pract Res Clin Rheumatol. 2009 Jun;23(3):445-53.

Jha V. Renal and systemic vasculitis. In: Floege J, Johnson RJ, Feehally J (eds). Comprehensive Clinical Nephrology. St. Louis, MO: Ed. Saunders; 2010. p. 292–307.

Firestein GS, Budd RC, Gabriel SE, Mcinnes IB, O’dell. Kelley’s Textbook of Rheumatology. 9th ed. Philadelphia: Ed. Saunders; 2012. p: 1486-9.

Knopf A, Chaker A, Stark T, Hofauer B, Lahmer T, Thürmel K, et al. Clinical aspects of granulomatosis with polyangiitis affecting the head and neck. Eur Arch Otorhinolaryngol. 2015 Jan;272(1):185-93.

Morales-Angulo C, García-Zornoza R, Obeso-Agüera S, Calvo-Alén J, González-Gay MA. [Ear, nose and throat manifestations of Wegener's granulomatosis (granulomatosis with polyangiitis)]. Acta Otorrinolaringol Esp. 2012 May-Jun;63(3):206-11.

Seo p, Stone JH. The antineutrophil cytosplasmatic antibody-associated vasculitides. Am J Med. 2004;117(1):39-50.

Gomez-Puerta JA, Hernández Rodriguez J, Lopez Soto A, Bosch X. Antineutrophil cytoplasmatic antibody-associated vasculitides and respiratory disease. Chest. 2009;136(4): 1101-11.

Gómez-Gómez A, Martínez-Martínez MU, Cuevas-Orta E, Bernal-Blanco JM, Cervantes-Ramírez D, Martínez-Martínez R, Abud-Mendoza C. Pulmonary manifestations of granulomatosis with polyangiitis. Reumatol Clin. 2014 Sep-Oct;10(5):288-93.

Hruskova Z, Casian AL, Konopasek P et al. Long-term outcomeofsevere alveolarhaemorrhageinANCA-associated vasculitis: a retrospective cohort study. Scand J Rheumatol. 2013;42:211-4.

Homma S, Suzuki A, Sato K. Pulmonary involvement in ANCA-associated vasculitis from the view of the pulmonologist. Clin Exp Nephrol. 2013 Oct;17(5):667-71.

Tang W, Bose B, McDonald SP et al. The outcomes of patients with ESRD and ANCA-associated vasculitis in Australia and NewZealand.ClinJAmSocNephrol. 2013;8:773-80.

Dufour JF, Le Gallou T, Cordier JF, Aumaître O, Pinède L, Aslangul E, et al. Urogenital manifestations in Wegener granulomatosis: a study of 11 cases and review of the literature. Medicine (Baltimore). 2012 Mar;91(2):67-74.

Tarabishy AB, Schultte M, Papaliodis GN, Hoffman GS. Wegener’s Granulomatosis: clinical manifestations, diferential diagnosis, and management of ocular and systemic disease. Surv Ophthalmol. 2010;55(5):429-44.

Sarlon G, Durant C, Grandgeorge Y, Bernit E, Veit V, Hamidou M, Schleinitz N, Harlé JR. [Cardiac involvement in Wegener's granulomatosis: report of four cases and review of the literature]. Rev Med Interne. 2010 Feb;31(2):135-9.

Pagnoux C, Mahr A, Cohen P, Guillevin L. Presentation and outcome of gastrointestinal incolvement in systemia nectrozing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangeitis, Wegener’s Granulomatosis, Churg-Strauss síndrome, or rheumatoid arthritis-associated vasculitis. Med (Baltimore). 2005;84(2):115-28.

Zheng Z, Ding J, Li X, Wu Z. Gastric presentation (vasculitis) mimics a gastric cancer as initial symptom in granulomatosis with polyangiitis: a case report and review of the literature. Rheumatol Int. 2015 Nov; 35(11):1925-9.

Sharma A, Dogra S, Sharma K. Granulomatous Vasculitis. Dermatol Clin. 2015 Jul;33(3):475-87.

Berden A, Göçeroglu A, Jayne D, Luqmani R, Rasmussen N, Bruijn JA, Bajema I. Diagnosis and management of ANCA associated vasculitis. BMJ. 2012 Jan 16;344:e26.

Martínez-Morillo M, Grados D, Naranjo-Hans D, Mateo L, Holgado S, Olivé A.[Granulomatosis with polyangiitis (Wegener). Description of 15 cases]. Reumatol Clin. 2012 Jan-Feb;8(1):15-9.

Hagen EC, Daha MR, Hermans J, Andrassy K, Csernok E, Gaskin G, et al. Diagnostic value of standardized assays for anti-neutrophil cytoplasmatic antibodies in idiopathic systemic vasculitis. EC/BCR Project for ANCA Assay Standardization. Kidney int. 1998;53:743-53.

Abdou NI, Kullman GJ, Hoffman GS, Sharp GC, Specks U, McDonald T, et al. Wegener’s granulomatosis: survey of 701 patients in North America. Changes in outcome in the 1990s. J Rheumatol. 202; 29:309-16.

Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum. 1990;33:1101-7.

Mahr AD, Neogi T, Lavalley MP, Davis Jc, Hoffman GS, McCune WJ, et al. Assessment of the ítem selection and weighting in Birmingham vasculitis activity score for Wegener’s Granulomatosis. Arthritis Rheum. 2008; 59(6): 884-91.

Ntatsaki E, Carruthers D, Chakravarty K, D'Cruz D, Harper L, Jayne D,et al. BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis. Rheumatology (Oxford). 2014 Dec;53(12):2306-9.

Faurschou M, Westman K, Rasmussen N et al. Brief report: long-term outcome of a randomized clinical trial comparing methotrexate to cyclophosphamide for remission induction in early systemic antineutrophi cytoplasmatic antibody-associated vasculitis. Arthritis Rheum. 2012;64: 3472-7.

Monach PA, Arnold LM, Merkel PA. Incidence and prevention of bladder toxicity from cyclophosphamide in the tratment of rheumatic diseases: a data-driven review. Arthritis Rheum. 2010: 62:9-21.

Lutalo PM, D'Cruz DP. Biological drugs in ANCA-associated vasculitis. Int Immunopharmacol. 2015 Aug;27(2):209-12.

Jayne DR, Gaskin G, Rasmussen N, Abramowicz D, Ferrario F, Guillevin L, et al. Randomized trial of plasma Exchange or high dosage methylprednisolona as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol. 2007; 18(7):2180-8.

Jayne D, Rasmussen N, Andrassy K, Bacon P, Tervaert J, Dadoniene J, et al. A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmatic autoantibodies. N Engl J Med. 2003;349(1):36-44.

Al-Ani B. Simvastatin inhibits neutrophil degranulation induced by antineutrophil cytoplasm autoantibodies and Nformyl-methionine-leucine phenylalanine (fMLP) peptide. SaudiMedJ. 2013;34:477-83.

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