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      Localized Forms of Vasculitis

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          Abstract

          Purpose of Review

          To provide an updated review on epidemiology, clinical manifestations, diagnostic assessment, treatment, and prognosis of localized vasculitis, following the 2012 Revised International Chapel Hill Consensus Conference Nomenclature on single-organ vasculitis.

          Recent Findings

          Localized, single-organ vasculitides encompass a group of rare conditions in which there is no evidence of concomitant systemic vasculitis. Most data on this topic derives from case reports and small case series. Although some aspects of these diseases, such as clinical manifestations and histologic findings, have already been extensively investigated, there is still a lack of robust data concerning the pathogenesis, epidemiology, and treatment.

          Summary

          Localized vasculitides may have a wide range of clinical features depending on the organ affected. The inflammatory process may have a multifocal/diffuse or unifocal distribution. Diagnosis is usually based on histopathology findings and exclusion of systemic vasculitis, which may frequently pose a challenge. Further research on treatment is warranted.

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          Most cited references130

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          2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides.

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            Rituximab versus cyclophosphamide for ANCA-associated vasculitis.

            Cyclophosphamide and glucocorticoids have been the cornerstone of remission-induction therapy for severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis for 40 years. Uncontrolled studies suggest that rituximab is effective and may be safer than a cyclophosphamide-based regimen. We conducted a multicenter, randomized, double-blind, double-dummy, noninferiority trial of rituximab (375 mg per square meter of body-surface area per week for 4 weeks) as compared with cyclophosphamide (2 mg per kilogram of body weight per day) for remission induction. Glucocorticoids were tapered off; the primary end point was remission of disease without the use of prednisone at 6 months. Nine centers enrolled 197 ANCA-positive patients with either Wegener's granulomatosis or microscopic polyangiitis. Baseline disease activity, organ involvement, and the proportion of patients with relapsing disease were similar in the two treatment groups. Sixty-three patients in the rituximab group (64%) reached the primary end point, as compared with 52 patients in the control group (53%), a result that met the criterion for noninferiority (P<0.001). The rituximab-based regimen was more efficacious than the cyclophosphamide-based regimen for inducing remission of relapsing disease; 34 of 51 patients in the rituximab group (67%) as compared with 21 of 50 patients in the control group (42%) reached the primary end point (P=0.01). Rituximab was also as effective as cyclophosphamide in the treatment of patients with major renal disease or alveolar hemorrhage. There were no significant differences between the treatment groups with respect to rates of adverse events. Rituximab therapy was not inferior to daily cyclophosphamide treatment for induction of remission in severe ANCA-associated vasculitis and may be superior in relapsing disease. (Funded by the National Institutes of Allergy and Infectious Diseases, Genentech, and Biogen; ClinicalTrials.gov number, NCT00104299.) 2010 Massachusetts Medical Society
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              Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis.

              Cyclophosphamide induction regimens for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis are effective in 70 to 90% of patients, but they are associated with high rates of death and adverse events. Treatment with rituximab has led to remission rates of 80 to 90% among patients with refractory ANCA-associated vasculitis and may be safer than cyclophosphamide regimens. We compared rituximab with cyclophosphamide as induction therapy in ANCA-associated vasculitis. We randomly assigned, in a 3:1 ratio, 44 patients with newly diagnosed ANCA-associated vasculitis and renal involvement to a standard glucocorticoid regimen plus either rituximab at a dose of 375 mg per square meter of body-surface area per week for 4 weeks, with two intravenous cyclophosphamide pulses (33 patients, the rituximab group), or intravenous cyclophosphamide for 3 to 6 months followed by azathioprine (11 patients, the control group). Primary end points were sustained remission rates at 12 months and severe adverse events. The median age was 68 years, and the glomerular filtration rate (GFR) was 18 ml per minute per 1.73 m(2) of body-surface area. A total of 25 patients in the rituximab group (76%) and 9 patients in the control group (82%) had a sustained remission (P=0.68). Severe adverse events occurred in 14 patients in the rituximab group (42%) and 4 patients in the control group (36%) (P=0.77). Six of the 33 patients in the rituximab group (18%) and 2 of the 11 patients in the control group (18%) died (P=1.00). The median increase in the GFR between 0 and 12 months was 19 ml per minute in the rituximab group and 15 ml per minute in the control group (P=0.14). A rituximab-based regimen was not superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis. Sustained-remission rates were high in both groups, and the rituximab-based regimen was not associated with reductions in early severe adverse events. (Funded by Cambridge University Hospitals National Health Service Foundation Trust and F. Hoffmann-La Roche; Current Controlled Trials number, ISRCTN28528813.) 2010 Massachusetts Medical Society
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                Author and article information

                Contributors
                joanamartinsmartinho@gmail.com
                eduardojorgedd@gmail.com
                nkhmelinskii@gmail.com
                espinosapab@gmail.com
                cristinadbponte@gmail.com
                Journal
                Curr Rheumatol Rep
                Curr Rheumatol Rep
                Current Rheumatology Reports
                Springer US (New York )
                1523-3774
                1534-6307
                1 July 2021
                2021
                : 23
                : 7
                : 49
                Affiliations
                [1 ]GRID grid.411265.5, ISNI 0000 0001 2295 9747, Rheumatology Department, Hospital de Santa Maria, , Centro Hospitalar Universitário Lisboa Norte, ; 1649-035 Lisbon, Portugal
                [2 ]GRID grid.9983.b, ISNI 0000 0001 2181 4263, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, , Universidade de Lisboa, ; Lisbon, Portugal
                [3 ]GRID grid.411265.5, ISNI 0000 0001 2295 9747, Dermatology Department, Hospital de Santa Maria, , Centro Hospitalar Universitário Lisboa Norte, ; 1649-035 Lisbon, Portugal
                Article
                1012
                10.1007/s11926-021-01012-y
                8247627
                34196889
                10e62d0e-9804-4562-bd40-5dc83a606274
                © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 21 April 2021
                Categories
                Vasculitis (C Dejaco and C Duftner, Section Editors)
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2021

                Rheumatology
                single-organ vasculitis,cutaneous leukocytoclastic angiitis,cutaneous arteritis,isolated aortitis

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