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      Examining the role of patient-reported external factors and risk of relapse in anti-neutrophilic cytoplasmic autoantibody vasculitis

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          Abstract

          The role of stressors, insect bites, and infections on disease relapse of ANCA vasculitis has yet to be entirely explored, with limited retrospective studies focused on disease onset from small participant cohorts. Our study analyzes longitudinal survey data from 2011–2022 to evaluate this perspective from a large ANCA vasculitis cohort. We collected surveys every three to six months to obtain information on self-reported psychological stressors and significant life events, insect bites, and infections throughout clinical disease. We defined cohorts as those who relapsed (Relapse Cohort) and controls as those who did not relapse (Remission Cohort) during the study period. Survey responses were retrospectively reviewed during a 15-month timeframe prior to relapse or during 15 months of remission and categorized by type of stress event, insect bite, and infections at every available 3-month interval. There were no significant differences in stress and insect bites between the relapse and remission cohorts. Patients who relapsed reported more frequent upper respiratory infections and other infections, such as those affecting the skin and eyes, but there were no significant differences in the incidence of pulmonary or urinary infections compared to the remission cohort. There was a significant difference in reported upper respiratory infections 9 to 15 months prior to the relapse date, indicating a remote history of infections as a potentially significant physical stressor that may contribute to disease relapse. More frequent patient-reported infections, specifically upper respiratory infections, may contribute to patient vulnerability to relapse. Counseling and close monitoring of patients after infectious symptoms could aid in earlier detection of disease flares. Future studies are essential to further understand the importance of distal risk factors and how they impact relapse.

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          Most cited references23

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          2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides.

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            Psychological stress and disease.

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              Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry.

              The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.
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                Author and article information

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                Journal
                Front Nephrol
                Front Nephrol
                Front. Nephrol.
                Frontiers in Nephrology
                Frontiers Media S.A.
                2813-0626
                02 July 2024
                2024
                : 4
                : 1404451
                Affiliations
                [1] 1 University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine , Chapel Hill, NC, United States
                [2] 2 Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina School of Medicine , Chapel Hill, NC, United States
                [3] 3 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of North Carolina School of Medicine , Chapel Hill, NC, United States
                [4] 4 Department of Neurology, University of North Carolina School of Medicine , Chapel Hill, NC, United States
                Author notes

                Edited by: Sophia Lionaki, National and Kapodistrian University of Athens, Greece

                Reviewed by: Georgios Lioulios, Hippokration General Hospital, Greece

                Ioannis Petrakis, University of Crete, Greece

                *Correspondence: Dhruti P. Chen, dhruti_chen@ 123456med.unc.edu

                †These authors have contributed equally to this work and share senior authorship

                Article
                10.3389/fneph.2024.1404451
                11249541
                39015144
                ca8569fa-df30-4c5a-93d8-e7ea489ecac8
                Copyright © 2024 Collie, Chen, Hu, Blazek, Derebail, Wu, Jain, Orzechowski, Poulton, Henderson, Falk and Hogan

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 21 March 2024
                : 27 May 2024
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 23, Pages: 7, Words: 3793
                Funding
                Funded by: National Institutes of Health , doi 10.13039/100000002;
                Award ID: 5R01DK125350
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Study funded in part by National Institute of Health (NIH) grants 5P01DK058335 and 5R01DK125350.
                Categories
                Nephrology
                Original Research
                Custom metadata
                Glomerular disease

                anca vasculitis,survey study,psychological events,insect bites,infections,disease relapse

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