Incidence of thromboembolic events in patients with a systemic form of vasculitis and cutaneous vasculitis

Ana Šimac, Željka Kardum, Jasminka Milas Ahić, Ana Marija Masle, Kristina Kovačević Stranski, Višnja Prus

Objectives: Vasculitis is a rare disease characterized by inflammation and necrosis of blood vessels. Inflammationinduced thrombosis is a hallmark of several autoimmune diseases, such as systemic lupus erythematosus (SLE ), rheumatoid arthritis (RA ), Sjögren’s syndrome (SS), and systemic vasculitis. In this study, we aimed to investigate the frequency of thromboembolic (TE) events in the systemic form of vasculitis and cutaneous vasculitis and to determine the possible risk factors for developing thromboembolic events. Methods: In this single-centre retrospective study, the patients diagnosed with systemic vasculitis and cutaneous leukocytoclastic vasculitis were included. Medical records of the patients that were treated at the Division of Rheumatology, Clinical Immunology, and Allergology University Hospital Centre Osijek in the period of 30 months (from November 2016. to June 2019.) were analysed. Results: Out of a total of 46 patients who were included in the study, 30 were diagnosed with systemic vasculitis, and 16 with cutaneous vasculitis. Statistically significant differences in relation to gender were found between the two groups (systemic vasculitis vs cutaneous vasculitis: the female gender 76.67% vs 43.75%; p=0.026), but there was no difference between the groups in relation to the age of disease onset. Thromboembolic events were found to be more frequent in the systemic form of the disease (p=0.0321). In the systemic vasculitis group, TE events were found in patients who suffered from involvement of multiple organ systems and in younger patients. Conclusion: Our research found that patients with systemic vasculitis, who are younger, with high disease activity, and who suffered from the involvement of multiple organ system, have an increased risk for developing TE events. In those patients, special attention should be paid to searching for additional TE risk factors, such as genetics, for the purpose of preventing unwanted events and applying TE prophylaxis on time.

Uvod: Vaskulitis je rijetka bolest karakterizirana upalom i nekrozom krvnih žila. Upalom inducirana tromboza smatra se svojstvom nekoliko autoimunosnih bolesti poput sistemskog eritemskog lupusa (SLE ), reumatoidnog artritisa (RA ), Sjögrenova sindroma (SS) te sistemskih vaskulitisa. U ovom istraživanju nastojali smo utvrditi učestalost tromboembolijskih (TE) događaja kod sistemskog oblika vaskulitisa i vaskulitisa ograničenog na kožu te procijeniti koji su mogući rizični čimbenici za razvoj tromboembolijskih (TE) događaja. Ispitanici i metode: U ovoj retrospektivnoj studiji sudjelovali su bolesnici s dijagnozom sistemskog vaskulitisa i vaskulitisa ograničenog na kožu liječenih u Zavodu za reumatologiju, kliničku imunologiju i alergologiju Kliničkoga bolničkog centra Osijek u razdoblju od 30 mjeseci (od studenog 2016. do lipnja 2019. godine). Klinički podatci prikupljeni su pretraživanjem medicinske dokumentacije. Rezultati: U studiju je uključeno ukupno 46 bolesnika, 30 s dijagnozom sistemskog vaskulitisa i 16 s vaskulitisom ograničenim na kožu. Među dvjema skupinama bilo je statistički značajne razlike po spolu (sistemski vaskulitis vs vaskulitis ograničen na kožu – ženski spol 76,67% vs 43,75%; p=0,026), no među grupama nije bilo razlike u dobi pojave bolesti. Tromboembolijski događaji bili su češći u bolesnika sa sistemskim oblikom vaskulitisa (p=0,0321). Pri analizi bolesnika sa sistemskim vaskulitisom kao rizični čimbenici za razvoj TE događaja utvrđeni su zahvaćanje više organskih sustava bolešću te mlađa životna dob. Zaključak: U našem istraživanju pokazali smo da bolesnici sa sistemskim vaskulitisom, mlađe životne dobi, uz visoku aktivnost bolesti i zahvaćanje više organskih sustava imaju povećan rizik za nastanak tromoebolijskih događaja te bi se kod takvih bolesnika trebala posvetiti posebna pozornost u otkrivanju dodatnih rizičnih čimbenika kao što je genetska predispozicija u svrhu sprječavanja neželjenih događaja te primjenu pravovremene TE profilakse.