DIFFICULTIES IN THE EARLY DIAGNOSIS OF EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (CHURGSTRAUSS SYNDROME) IN THE CLINIC OF INTERNAL DISEASES

Cover Page

Cite item

Abstract

Systemic vasculitis are characterized by heterogeneity of clinical-immunological forms and determined the need for differential diagnostic search to except a wide range of diseases, such as allergic, infectious, hematological, oncological, which often presents significant difficulties for physicians of various specialties. The article presents clinical observations demonstrating the difficulties of diagnostic search in establishing the diagnosis of systemic vasculitis associated with antineutrophil cytoplasmic antibodies, which include a rare disease — eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome). Carefully collected anamnesis, participation of specialists of different profiles, retrospective analysis of laboratory and instrumental data allowed to verify the diagnosis, to prescribe adequate therapy. The aim of the publication is to discuss the need for early diagnosis of eosinophilic granulomatosis with polyangiitis, which can improve the effectiveness of therapy and improve the overall prognosis for this disease, taking into account modern approaches based on the main provisions of international recommendations that were prepared in 2015 with the participation of leading experts from Europe, USA and Canada and were called to become the basis for choosing a personalized patient therapy strategy.

About the authors

D. V. Cherkashin

S. M. Kirov Military Medical Academy

Email: fake@neicon.ru

Dmitrij V. Cherkashin

St. Petersburg

Russian Federation

S. A. Turdialieva

S. M. Kirov Military Medical Academy

Author for correspondence.
Email: turdialieva@mail.ru

Sayora A. Turdialieva 

St. Petersburg

Russian Federation

E. A. Mozharovskaya

Clinical rheumatological hospital № 25

Email: fake@neicon.ru

Elena A. Mozharovskaya 

St. Petersburg

Russian Federation

O. M. Kudrina

S. M. Kirov Military Medical Academy

Email: fake@neicon.ru

Ol’ga M. Kudrina  

St. Petersburg

Russian Federation

A. I. Taranov

S. M. Kirov Military Medical Academy

Email: fake@neicon.ru

Andrej I. Taranov 

St. Petersburg

Russian Federation

References

  1. Jennette J.C. et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum., 1994, Vol. 37, рр. 187–192.
  2. Churg J., Strauss L. Allergic granulomatosis, allergic angiitis and periarteritis nodosa. Am. J. Pathol., 1951, Vol. 27, рр. 277–301.
  3. Койлубаева Г.М. и др. Эффективность применения ритуксимаба у больной с генерализованной формой гранулематоза c полиангиитом (описание клинического случая) // Современная ревматология. 2014. № 4. С. 43–47
  4. Jennette J.C. et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum., 2013, Vol. 65 (1), рр. 1–11.
  5. Guerry M.J. et al. Recommendations for the use of rituximab in anti-neutrophil cytoplasm antibody-associated vasculitis. Rheumatology (Oxford), 2012, Vol. 51 (4), рр. 634–643.
  6. Mukhtyar C. et al. EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann. Rheum. Dis., 2009, Vol. 68 (3), рр. 310–317.
  7. Ntatsaki E. et al. BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis. Rheumatology (Oxford), 2014, Vol. 53 (12), рр. 2306–2309.
  8. Lyons P.A. et al. Genetically distinct subsets within ANCA-associated vasculitis. N. Engl. J. Med., 2012, Vol. 367 (3), рр. 214–223.
  9. Mahr A. et al. Prevalences of polyarteritis nodosa, microscopic polyangiitis, Wegener’s granulomatosis, and ChurgStrauss syndrome in a French urban multiethnic population in 2000: a capture-recapture estimate. Arthritis Rheum., 2004, Vol. 51 (1), рр. 92–99.
  10. Ревматология: национальное руководство / под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2010. 720 с. [Revmatologiya: nacional’noe rukovodstvo / pod red. E.L. Nasonova, V.A. Nasonovoj. Moscow: Izdatel’stvo GEHOTAR-Media, 2010, 720 р. (In Russ.).
  11. Насонов Е.Л. и др. Антинейтрофильные цитоплазматические антитела при системных васкулитах // Клиническая медицина. 1992. № 11. С. 21–27.
  12. Comarmond C. et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): clinical characteristics and longterm follow up of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis Rheum., 2013, Vol. 65 (1), рр. 270–281.
  13. Бекетова Т.В., Волков М.Ю. Международные рекомендации по диагностике и лечению эозинофильного гранулематоза с полиангиитом 2015 // Научно-практическая ревматология. 2016. Т. 54, № 2. С. 129–137.
  14. Groh M. et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. Eur. J. Intern. Med., 2015, Vol. 26 (7), рр. 545–553.
  15. Бекетова Т.В., Волков М.Ю., Насонов Е.Л. Современные подходы к диагностике и лечению эозинофильного гранулематоза с полиангиитом: международные рекомендации 2015 г. // Терапевтический архив. 2016. Т. 88, № 5. С. 86–92.
  16. Dennert R.M. et al. Cardiac involvement in Churg-Strauss syndrome. Arthritis Rheum., 2010, Vol. 6 (2), рр. 627–634.
  17. Стрижаков Л.А., Моисеев С.В., Коган Б.А. Поражение сердца при системных васкулитах: патогенетические звенья, значение факторов риска развития сердечно-сосудистых осложнений и диагностика // Терапевтический архив. 2014. Т. 12, № 2. С. 35–42.
  18. Korantzopoulos P., Papaioannides D., Siogas K. The heart in Wegener’s granulomatosis. Cardiology, 2004, Vol. 102, No. 1, рр. 7–10.
  19. Moosig F. et al. A vasculitis centre based management strategy leads to improved outcome in eosinophilic granulomatosis and polyangiitis (Churg-Strauss, EGPA): monocentric experiences in 150 patients. Ann. Rheum. Dis., 2013, Vol. 72 (6), рр. 1011–1017.
  20. Masi A.T. et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis angiitis). Arth. and Rheum., 1990, Vol. 33, рр. 1094–1100.
  21. Lanham J. et al. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine, 1984, Vol. 63, рр. 65–81.
  22. Valent P. et al. Contemporary consensus proposal on criteria and classiёcation of eosinophilic disorders and related syndromes. J. Allergy Clin. Immunol., 2012, Vol. 130 (3), рр. 607–612.
  23. Taylor M.R. et al. The expanded spectrum of toxocaral disease. Lancet, 1988, Vol. 1 (8587), рр. 692–695.
  24. Jones R. et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N. Engl. J. Med., 2010, Vol. 363 (3), рр. 211–220.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c)


 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies