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[Wegener's granulomatosis and microscopic polyangiitis]

K de Groot1, E Reinhold-Keller

  • 1Medizinische Klinik III (Innere Medizin, Nephrologie, Rheumatologie), Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach. kirsten@de-groot.de

Zeitschrift Fur Rheumatologie
|February 3, 2009
PubMed

Insights

Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) are small vessel vasculitides diagnosed via ANCA testing. Treatment involves immunosuppressants and corticosteroids, with relapse rates around 50% within five years.

Area of Science:

  • Rheumatology
  • Immunology
  • Nephrology

Context:

  • Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) are primary systemic small vessel vasculitides.
  • These conditions are associated with specific autoantibodies: C/PR3-ANCA in WG and P/MPO-ANCA in MPA.
  • Key organs affected include the respiratory tract and kidneys.

Purpose:

  • To outline the diagnostic and therapeutic strategies for WG and MPA.
  • To highlight factors influencing prognosis and relapse rates.

Summary:

  • Diagnosis requires an interdisciplinary approach to assess disease stage and extent.
  • Treatment involves cytotoxic agents and corticosteroids, tailored to disease severity.
  • Remission induction for early disease may use methotrexate; severe cases often require cyclophosphamide, potentially with plasmapheresis.
  • Maintenance therapy typically involves azathioprine, with alternatives like leflunomide, mycophenolate, or methotrexate.
  • Age over 50, renal dysfunction, and pulmonary involvement are linked to increased mortality.

Impact:

  • Understanding these vasculitides is crucial for timely diagnosis and effective management.
  • Identifying prognostic factors aids in patient stratification and treatment intensity.
  • High relapse rates necessitate long-term monitoring and management strategies.

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