EN PL
REVIEW PAPER
Clinical forms of granulomatosis with polyangiitis
 
More details
Hide details
 
Submission date: 2014-01-12
 
 
Final revision date: 2014-08-19
 
 
Acceptance date: 2014-09-25
 
 
Online publication date: 2014-11-17
 
 
Publication date: 2014-10-31
 
 
Reumatologia 2014;52(5):332-338
 
KEYWORDS
TOPICS
ABSTRACT
Granulomatosis with polyangitis (GPA) is one of systemic connective tissue diseases. Necrotizing vasculitis affects small- and medium-sized vessels. Antineutrophil cytoplasmic antibodies directed against the neutrophil serine protease proteinase-3 (cANCA, PR3-ANCA) have been identified in approximately 80–95% of patients with GPA. In typical cases upper and lower respiratory tract and kidneys are involved. However GPA produce a broad spectrum of clinical symptomes, that includes: ocular and ear involvement, peripheral and central nervous system manifestations, heart and digestive tract involvement. The diffuse alveolar hemorrhage and pulmonary-renal syndrome may also occur. The diagnosis of granulomatosis with polyangiitis may cause many difficulties, specially in cases with limited organ involvement, with untypical spectrum of clinical features and in ANCA-negative patients. We attempt to present differential diagnosis of GPA in this review article.
 
REFERENCES (36)
1.
Morales-Angulo C, García-Zornoza R, Obeso-Agüera S, et al. Ear, nose and throat manifestations of Wegener’s granulomatosis (granulomatosis with polyangitis). Acta Otorrinolaringol Esp 2012; 63: 206-211. .
 
2.
Jennette JC, Falk RJ, Bacon PA, et al. Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65: 1-11. .
 
3.
Langford C. Clinical features and diagnosis of small-vessel vasculitis. Cleve Clin J Med 2012; 79 Suppl 3: S3-S7. .
 
4.
Holle JU, Voigt C, Both M, et al. Orbital masses in granulomatosis with polyangiitis are associated with a refractory course and a high burden of local damage. Rheumatology (Oxford) 2013; 52: 875-882. .
 
5.
Zalesska-Kręcicka M, Jankowska A, Morawska-Kochman M, Kręcicki T. Objawy laryngologiczne w ziarniniakowatości Wegenera. Otolaryngologia 2004; 3: 162-165. .
 
6.
Wódecki M, Brzosko I, Przepiera-Będzak H, Brzosko M. Zajęcie narządu słuchu w ziarniniaku Wegenera. Wiad Lek 2007; 60: 574-577. .
 
7.
Trimarchi M, Bussi M, Sinico RA, et al. Cocaine-induced midline destructive lesions – an autoimmune disease? Autoimmun Rev 2013; 12: 496-500. .
 
8.
Wiesner O, Russell KA, Lee AS, et al. Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase as a diagnostic marker for cocaine-induced midline destructive lesions but not autoimmune vasculitis. Arthritis Rheum 2004; 50: 2954-2965. .
 
9.
Vega Braga FL, Machado de Carvalho G, Caixeta Guimarães A, et al. Otolaryngological manifestations of Wegener’s disease. Acta Otorrinolaringol Esp 2013; 64: 45-49. .
 
10.
Ruokonen H, Helve T, Arola J, et al. “Strawberry like” gingivitis being the first sign of Wegener’s granulomatosis. Eur J Intern Med 2009; 20: 651-653. .
 
11.
Glass EG, Lawton LR, Truelove EL. Oral presentation of Wegener granulomatosis. J Am Dent Assoc 1990; 120: 523-525. .
 
12.
Sadlak-Nowicka J, Łaska M, Bochniak M, Weber-Dubaniewicz M. Aspekty stomatologiczne ziarniniaka Wegenera. Dent Med Probl 2003; 40: 417-422. .
 
13.
Szczeklik A, Musiał J, Sznajd J. Zapalenia naczyń. In: Zimmermann-Górska I (ed.). Choroby reumatyczne. Interna Szczeklika. Podręcznik chorób wewnętrznych 2013. Wydawnictwo Medycyna Praktyczna, Kraków 2013; 1884-1887. .
 
14.
Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 1983; 98: 76-85. .
 
15.
Lee KS, Kim TS, Fujimoto K, et al. Thoracic manifestation of Wegener’s granulomatosis: CT findings in 30 patients. Eur Radiol 2003; 13: 43-51. .
 
16.
Pełkowska A, Sancewicz-Pach K, Słowiaczek E, Ogarek I. Trudności diagnostyczne w ziarniniaku Wegenera u 15-letniego chłopca. Przegl Pediatr 2005; 35: 174-177. .
 
17.
Tomasiewicz B, Rozumek G, Świerkot J. Gruźlica płuc u chorej z ziarniniakowatością z zapaleniem naczyń (dawniej Wege­nera) leczonej immunosupresyjnie. Reumatologia 2013; 51: 156-160. .
 
18.
Rothschild PR, Pagnoux C, Seror R, et al. Ophthalmologic manifestations of systemic necrotizing vasculitides at diagnosis: retrospective study of 1286 patients and review of the literature. Semin Arthritis Rheum 2013; 42: 507-514. .
 
19.
Jiang B, Zhao YY, Wei SH. Granulomatosis with polyangiitis: the relationship between ocular and nasal disease. Ocul Immunol Inflamm 2013; 21: 115-118. .
 
20.
Green I, Szyper-Kravitz M, Shoenfeld Y. Parotitis as the presenting symptom of Wegener’s granulomatosis: case report and meta-analysis. Isr Med Assoc J 2013; 15: 188-192. .
 
21.
Nahlieli O. Wegener’s granulomatosis and the salivary glands. Isr Med Assoc J 2013; 15: 178-179. .
 
22.
Bray VJ, Hasbargen JA. Prostatic involvement in Wegener’s granulomatosis. Am J Kidney Dis 1991; 17: 578-580. .
 
23.
Chawla S, Atten MJ, Attar BM. Acute pancreatitis as a rare initial manifestation of Wegener’s granulomatosis. A case based review of literature. JOP 2011; 12: 167-169. .
 
24.
Allende DS, Booth CN. Wegener’s granulomatosis of the breast: a rare entity with daily clinical relevance. Ann Diagn Pathol 2009; 13: 351-357. .
 
25.
Małdyk H. Zapalenia małych naczyń. In: Reumatologia kliniczna. Zimmermann-Górska I (ed.). Wydawnictwo Lekarskie PZWL, Warszawa 2009; 662-671. .
 
26.
Morales-Angulo C, García-Zornoza R, Obeso-Agüera S, et al. Ear, nose and throat manifestations of Wegener’s granulomatosis (granulomatosis with polyangiitis). Acta Otorinolaringol Esp 2012; 63: 206-211. .
 
27.
McCabe C, Jones Q, Nikolopoulou A, et al. Pulmonary-renal syndromes: an update for respiratory physicians. Respir Med 2011; 105: 1413-1421. .
 
28.
Papiris SA, Manali ED, Kalomenidis I, et al. Bench-to-bedside review: pulmonary-renal syndromes – an update for the intensivist. Crit Care 2007; 11: 213. .
 
29.
Fatma LB, El Ati Z, Lamia R, et al. Alveolar hemorrhage and kidney disease: characteristics and therapy. Saudi J Kidney Dis Transpl 2013; 24: 743-750. .
 
30.
de Groot K, Harper L, Jayne DR, et al. EUVAS (European Vasculitis Study Group). Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med 2009; 150: 670-680. .
 
31.
Jones RB, Tervaert JW, Hauser T, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med 2010; 363: 211-220. .
 
32.
Wegener’s Granulomatosis Etanercept Trial (WGET) Research Group. Etanercept plus standard therapy for Wegener’s granulomatosis. N Engl J Med 2005; 352: 351-361. .
 
33.
Silva F, Seo P, Schroeder DR, et al. Solid malignances among etanercept-treated patients with granulomatosis with polyangiitis (Wegener’s): long-term followup of a multicenter longitudinal cohort. Arthritis Rheum 2011; 63: 2495-2503. .
 
34.
de Menthon M, Cohen P, Pagnoux C, et al. Infliximab or rituximab for refractory Wegener’s granulomatosis: long-term follow up. A prospective randomised multicentre study on 17 patients. Clin Exp Rheumatol 2011; 29 (1 Suppl 64): S63-71. .
 
35.
Langford CA, Monach PA, Specks U, et al. An open-label trial of abatacept (CTLA4-IG) in non-severe relapsing granulomatosis with polyangiitis (Wegener’s). Ann Rheum Dis 2014; 73: 1376-1379. .
 
36.
Wygoda A, Rutkowski T, Składowski K, Hejduk B. Low dose radiotherapy as an effective treatment in a patient with a solitary Wegener’s granulomatosis resistant to systemic treatment – case report. Contemp Oncol (Pozn) 2013; 17: 107-111.
 
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
eISSN:2084-9834
ISSN:0034-6233
Journals System - logo
Scroll to top