Outcome and prognostic factors during the course of primary small-vessel vasculitides.

Objective. Toidentify the prognostic factors of relapse and/or death during the course of primary smauvessel vasculitides (PSVV), and to differentiae their prognostic relevance by the type of vasculitis. Methods. Sventy-five patients were retrospectively followed up after diagnosis: 36 with Wegener’s granulomatosis (WG), 23 with Churg-Strauss syndrome (CSS), and 16 with microscopic polyanglitis. Cox regression analisys was used to identify the significant predictors of replase and death. Results. Gastrointestinal (GI) involvement was associated with an increased risk of replase, mainly in the patients with CSS, whereas renal disease and perinuclear antineutrophil cytoplasmic antibody positivity were correlated with a lower risk of replase. Presence of nasal Staphylococcus aureus tended to increase the risk of replase in CSS (hazard ratio (HR) 4.45, p=0.087), but to decrease it in WG (HR 0.12,p =0.066). Olger age, renal and hepatic involyement, erythrocyte sedimentation rate > 100 mm/h, and serum creatinine level 1.5 mg/dl were alol related to higher risk of death in univariate analysis; however, only cerebral (HR 8.52, p = 0.021) and hepaticinvolvement (HR 4.40, p=0.028 and serum creatinine level > 1.5 mg/dl (HR 5.72,p = 0-044) were independently correlated with an favorable prognosis for survival. The risk of death associated with eact of these indicators did non depend on the form of PSVV. Conclusion. Gli involvement increases the risk of relapse in CSS, whereas the prognostic significance of nasal S. aureas in terms of relapse seems to be opposite in patients whit CSS and those whit WG. Patients with cerebral, hepatic, and renal involvement have the poorest prognosis for survival. Our data do not show that the prognostic relevance of these factors depends on the from of PSVV )J. Rheumatol First Release June 15 20’06)