Seasonal variation in incidence and relapse of granulomatosis with polyangiitis: A retrospective cohort study from Central Anatolia

Gülşah Soytürk; Hatice Ecem Konak; Pınar Akyüz Dağlı; Rezan Koçak Ulucaköy; Ebru Atalar; Esra Kayacan Erdoğan; Hakan Babaoğlu; Berkan Armağan; Kevser Orhan; İsmail Dogan; Yüksel Maraş; Ahmet Omma; Şükran Erten; Orhan Küçükşahin; Serdar Can Güven

doi:10.36141/svdld.vi.16537

Authors

Gülşah Soytürk Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Hatice Ecem Konak Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Pınar Akyüz Dağlı Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Rezan Koçak Ulucaköy Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Ebru Atalar Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Esra Kayacan Erdoğan Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Hakan Babaoğlu Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Berkan Armağan Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
Kevser Orhan Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey
İsmail Dogan Yıldırım Beyazıt University, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey
Yüksel Maraş University of Health Sciences, Ankara City Hospital, Division of Rheumatology, Ankara, Turkey
Ahmet Omma University of Health Sciences, Ankara City Hospital, Division of Rheumatology, Ankara
Şükran Erten Yıldırım Beyazıt University, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey
Orhan Küçükşahin Yıldırım Beyazıt University, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey
Serdar Can Güven Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey

Keywords:

granulomatosis with polyangiitis, ANCA-associated vasculitis, Environmental exposure, disease flares

Abstract

Background and aim: The etiology of granulomatosis with polyangiitis (GPA) remains under discussion. This study aims to explore patterns of organ involvement, ANCA antibody profiles, seasonal attack rates, and their interrelationship among patients diagnosed with ANCA-associated vasculitis (AAV) in Central Anatolia, shedding light on its multifactorial etiology involving drugs, genetics and environmental factors.

Methods: We conducted a retrospective study involving patients aged 18 to 65 diagnosed with GPA and receiving care at Ankara Bilkent City Hospital Rheumatology Clinic. Diagnosis criteria followed the 2012 Chapel Hill Consensus Conference guidelines and the 2022 American College of Rheumatology/European Association of Rheumatology Societies classification for AAV. Patient data included demographics, antibody test results, seasons of diagnosis and flare, affected organs, and Birmingham Vasculitis Activity Score (BVAS). Organ involvement was determined based on biopsy findings or established criteria.

Results: Our study included 75 patients, with the majority exhibiting cANCA-IFA positivity (94.7%) and PR3-ANCA ELISA positivity (98.3%). During follow-up, 70.7% experienced their first flare, with 37.7% experiencing a second flare. Lung involvement was most common at diagnosis and during flares, followed by ear-nose-throat and renal involvement. Seasonal analysis revealed peaks in disease onset in March, November, and April, with flares more common in September, May, October, and November. Autumn was the most common season for the first flare.

Conclusions: This study provides novel insights into ANCA-associated vasculitis epidemiology in Central Anatolia. Our findings underscore the intricate seasonal variation and infectious triggers of GPA exacerbations, highlighting the importance of tailored management strategies to mitigate disease flares.

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