Seasonal Influence on Development of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Cohort Study Conducted at Multiple Institutions in Japan (J-CANVAS)

Yusuke Yoshida; Naoki Nakamoto; Naoya Oka; Genki Kidoguchi; Yohei Hosokawa; Kei Araki; Michinori Ishitoku; Hirofumi Watanabe; Tomohiro Sugimoto; Sho Mokuda; Takashi Kida; Nobuyuki Yajima; Satoshi Omura; Daiki Nakagomi; Yoshiyuki Abe; Masatoshi Kadoya; Naoho Takizawa; Atsushi Nomura; Yuji Kukida; Naoya Kondo; Yasuhiko Yamano; Takuya Yanagida; Koji Endo; Kiyoshi Matsui; Tohru Takeuchi; Kunihiro Ichinose; Masaru Kato; Ryo Yanai; Yusuke Matsuo; Yasuhiro Shimojima; Ryo Nishioka; Ryota Okazaki; Tomoaki Takata; Takafumi Ito; Mayuko Moriyama; Ayuko Takatani; Yoshia Miyawaki; Toshiko Ito-Ihara; Takashi Kawaguchi; Yutaka Kawahito; Shintaro Hirata

doi:10.3899/jrheum.2023-0040

Seasonal Influence on Development of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Cohort Study Conducted at Multiple Institutions in Japan (J-CANVAS)

J Rheumatol. 2023 Sep;50(9):1152-1158. doi: 10.3899/jrheum.2023-0040. Epub 2023 Jun 1.

Authors

Yusuke Yoshida¹, Naoki Nakamoto², Naoya Oka², Genki Kidoguchi², Yohei Hosokawa², Kei Araki², Michinori Ishitoku², Hirofumi Watanabe², Tomohiro Sugimoto², Sho Mokuda², Takashi Kida³, Nobuyuki Yajima⁴, Satoshi Omura³, Daiki Nakagomi⁵, Yoshiyuki Abe⁶, Masatoshi Kadoya⁷, Naoho Takizawa⁸, Atsushi Nomura⁹, Yuji Kukida¹⁰, Naoya Kondo¹¹, Yasuhiko Yamano¹², Takuya Yanagida¹³, Koji Endo¹⁴, Kiyoshi Matsui¹⁵, Tohru Takeuchi¹⁶, Kunihiro Ichinose¹⁷, Masaru Kato¹⁸, Ryo Yanai⁴, Yusuke Matsuo¹⁹, Yasuhiro Shimojima²⁰, Ryo Nishioka²¹, Ryota Okazaki²², Tomoaki Takata²³, Takafumi Ito²⁴, Mayuko Moriyama²⁵, Ayuko Takatani²⁶, Yoshia Miyawaki²⁷, Toshiko Ito-Ihara²⁸, Takashi Kawaguchi²⁹, Yutaka Kawahito³, Shintaro Hirata²

Affiliations

¹ Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima; fisher37@hiroshima-u.ac.jp.
² Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima.
³ T. Kida, MD, PhD, MPH, S. Omura, MD, Y. Kawahito, MD, PhD, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto.
⁴ N. Yajima, MD, PhD, MPH, R. Yanai, MD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo.
⁵ D. Nakagomi, MD, PhD, Department of Rheumatology, University of Yamanashi Hospital, Chuo.
⁶ Y. Abe, MD, PhD, Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo.
⁷ M. Kadoya, MD, PhD, Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto.
⁸ N. Takizawa, MD, Department of Rheumatology, Chubu Rosai Hospital, Nagoya.
⁹ A. Nomura, MD, PhD, Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo.
¹⁰ Y. Kukida, MD, PhD, Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto.
¹¹ N. Kondo, PhD, Department of Nephrology, Kyoto Katsura Hospital, Kyoto.
¹² Y. Yamano, PhD, Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto.
¹³ T. Yanagida, MD, Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima.
¹⁴ K. Endo, MD, Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, and Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto.
¹⁵ K. Matsui, MD, PhD, Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya.
¹⁶ T. Takeuchi, MD, PhD, Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka.
¹⁷ K. Ichinose, MD, PhD, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, and Department of Rheumatology, Shimane University Faculty of Medicine, Izumo.
¹⁸ M. Kato, MD, PhD, Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Sapporo.
¹⁹ Y. Matsuo, MD, PhD, Department of Rheumatology, Tokyo Kyosai Hospital, and Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo.
²⁰ Y. Shimojima, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto.
²¹ R. Nishioka, MD, Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa.
²² R. Okazaki, MD, PhD, Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago.
²³ T. Takata, MD, PhD, Division of Gastroenterology and Nephrology, Tottori University, Yonago.
²⁴ T. Ito, MD, PhD, Division of Nephrology, Shimane University Hospital, Izumo.
²⁵ M. Moriyama, MD, Department of Rheumatology, Shimane University Faculty of Medicine, Izumo.
²⁶ A. Takatani, MD, PhD, Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo.
²⁷ Y. Miyawaki, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama.
²⁸ T. Ito-Ihara, MD, PhD, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto.
²⁹ T. Kawaguchi, PhD, Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.

PMID: 37263656
DOI: 10.3899/jrheum.2023-0040

Abstract

Objective: To clarify seasonal and other environmental effects on the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Methods: We enrolled patients with new-onset eosinophilic granulomatosis with polyangiitis (EGPA), microscopic polyangiitis (MPA), and granulomatosis with polyangiitis (GPA) registered in the database of a Japanese multicenter cohort study. We investigated the relationship between environmental factors and clinical characteristics. Seasons were divided into 4 (spring, summer, autumn, and winter), and the seasonal differences in AAV onset were analyzed using Pearson chi-square test, with an expected probability of 25% for each season.

Results: A total of 454 patients were enrolled, with a mean age of 70.9 years and a female proportion of 55.5%. Overall, 74, 291, and 89 patients were classified as having EGPA, MPA, and GPA, respectively. Positivity for myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA was observed in 355 and 46 patients, respectively. Overall, the seasonality of AAV onset significantly deviated from the expected 25% for each season (P = 0.001), and its onset was less frequently observed in autumn. In ANCA serotypes, seasonality was significant in patients with MPO-ANCA (P < 0.001), but not in those with PR3-ANCA (P = 0.97). Additionally, rural residency of patients with AAV was associated with PR3-ANCA positivity and biopsy-proven pulmonary vasculitis.

Conclusion: The onset of AAV was influenced by seasonal variations and was less frequently observed in autumn. In contrast, the occurrence of PR3-ANCA was triggered, not by season, but by rural residency.

Keywords: antineutrophil cytoplasmic antibody; antineutrophil cytoplasmic antibody–associated vasculitis; eosinophilic granulomatosis with polyangiitis; granulomatosis with polyangiitis; microscopic polyangiitis; seasonal variation.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*
Antibodies, Antineutrophil Cytoplasmic
Churg-Strauss Syndrome* / complications
Cohort Studies
Female
Granulomatosis with Polyangiitis* / complications
Humans
Japan / epidemiology
Microscopic Polyangiitis* / complications
Myeloblastin
Peroxidase
Retrospective Studies
Seasons

Substances

Antibodies, Antineutrophil Cytoplasmic
Myeloblastin
Peroxidase