Aging in Primary Systemic Vasculitis: Implications for Diagnosis, Clinical Manifestations, and Management

Alvise Berti, Roberto Caporali, Carlomaurizio Montecucco, Giuseppe Paolazzi, Sara Monti

Research output: Contribution to journalArticle

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Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) usually affect adults and older populations. The well recognized clinical (i.e., granulomatosis with polyangiitis [GPA], microscopic polyangiitis, and eosinophilic GPA) and serological phenotypes (i.e., anti-MPO-ANCA, anti-PR3-ANCA and ANCA negative) within AAV differ substantially for clinical, demographic, and epidemiological features, including age at presentation. Whether and how aging could contribute to the clinical expression of these disease phenotypes is intriguing and still overlooked. In addition, despite being predominantly a disease of the elderly, most of the studies analyzing drug interventions and the clinical trials on AAV explicitly excluded older patients, limiting the understanding of the disease in this subset of patients. In elderly patients induced with cyclophosphamide, a lower dose of treatment for patients aged 60 years or older and with reduced renal function has been recommended. Giant cell arteritis (GCA) and Takayasu’s arteritis (TAK) are two primary systemic vasculitides involving large vessels that differ in age at presentation, with GCA patients being at least 10 years older than TAK patients. Different treatment approaches are effective in these conditions. However, a few authors have suggested that they might be considered expressions of the same clinical syndrome, rather than two different diseases. Novel insights into the role of senescence-related immunological and vascular processes might help to interpret the link between these two conditions. Overall, the impact of aging on all these vasculitides is complex and not easy to analyze. So far, few studies focusing on this topic have been published. We reviewed data on the clinical presentation, epidemiology, therapy, and disease- and treatment-related complications in patients affected by these vasculitides, highlighting the differences in young versus elderly subjects.

Original languageEnglish
JournalDrugs and Aging
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Systemic Vasculitis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Antineutrophil Cytoplasmic Antibodies
Takayasu Arteritis
Giant Cell Arteritis
Granulomatosis with Polyangiitis
Vasculitis
Microscopic Polyangiitis
Phenotype
Therapeutics
Cyclophosphamide
Blood Vessels
Epidemiology
Demography
Clinical Trials
Kidney
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Pharmacology (medical)

Cite this

Aging in Primary Systemic Vasculitis : Implications for Diagnosis, Clinical Manifestations, and Management. / Berti, Alvise; Caporali, Roberto; Montecucco, Carlomaurizio; Paolazzi, Giuseppe; Monti, Sara.

In: Drugs and Aging, 01.01.2018.

Research output: Contribution to journalArticle

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