Short-term outcome of patients with adult IgA vasculitis: a single-center experience

Alojzija Hočevar; Jaka Ostrovršnik; Vesna Jurčić; Matija Tomšič; Žiga Rotar

doi:10.3389/fmed.2023.1210307

Short-term outcome of patients with adult IgA vasculitis: a single-center experience

Front Med (Lausanne). 2023 Jul 17:10:1210307. doi: 10.3389/fmed.2023.1210307. eCollection 2023.

Authors

Alojzija Hočevar^{1

2}, Jaka Ostrovršnik¹, Vesna Jurčić³, Matija Tomšič^{1

2}, Žiga Rotar^{1

2}

Affiliations

¹ Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
² Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
³ Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

Abstract

Background: Follow-up data on IgA vasculitis (IgAV) in adults are scarce. We aimed to investigate the outcome of adult IgAV in a well-defined cohort.

Methods: Data from histologically proven patients diagnosed between January 2010 and July 2022 with at least a 3-month follow-up were analyzed. The frequency and type of relapses and information on kidney function were extracted. Risk factors for IgAV relapse and decline in renal function were studied using the Cox hazards regression analysis. Mortality in IgAV was assessed using the Kaplan-Meier analysis and the standardized mortality ratio (SMR).

Results: In total, 265 patients were followed for a median of 24 months. At baseline, 38.9, 29.8, and 44.5% had articular, gastrointestinal, and renal involvement, respectively. Initially, 189 (71.3%) patients received systemic glucocorticoids, and 32 (12.1%) patients received an additional immunomodulator. During follow-up, 42 (15.8%) patients relapsed. Relapses were more common in younger patients (HR 1.03 [95%CI 1.01-1.05]) and those without baseline glucocorticoid treatment (HR 3.70 [95%CI 2.0-6.67]). Furthermore, 74 (27.9%) patients had persistent abnormal urinalysis and a substantial (≥20%) decline in glomerular filtration rate (eGFR) was recorded in 41 (15.5%) patients. The factors associated with persistent abnormal urinalysis were an absence of IgAV joint involvement and baseline immunomodulatory treatment. Pre-existent chronic kidney disease and heart failure were associated with eGFR decline. The overall SMR was 1.4 (95%CI 1.14-1.71) compared to the Slovenian general population.

Conclusion: IgAV relapses occurred in 15% of patients, with younger patients with symptomatically managed IgAV experiencing it more frequently. Heart failure emerged as a predictor of persistent abnormal urinalysis and a decline in eGFR. Adults with IgAV had increased mortality compared to the general population.

Keywords: adult IgA vasculitis; follow-up; mortality; persistent urinary abnormalities; relapse.

Grants and funding

The study was funded by the Slovenian Research Agency (research core funding P3-0314).