Abstract
BackgroundThe data from cohorts of childhood-onset granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) remain scarce and heterogeneous. We aimed to analyse the features at presentation, therapeutic approaches and the disease course of these rare diseases.MethodsElectronic searches of Medline and the Cochrane Central Register of Controlled trials database were conducted. We also checked the reference lists of the studies included and other systematic reviews, to identify additional reports. We included all cohorts, cross-sectional studies or registries reporting features at presentation or outcomes in patients with a diagnosis of childhood-onset GPA or MPA (age <18 years). The pooled prevalence of clinical manifestations at presentation, ANCA and induction therapies for GPA and MPA was calculated.ResultsWe reviewed 570 full texts and identified 14 studies on GPA and 8 on MPA. Childhood-onset GPA and MPA occurred predominantly in female subjects during adolescence. For GPA, ear-nose-throat (ENT) disease (pooled prevalence 82 % [95 % CI 78–87]), constitutional symptoms (73 % [95 % CI 55–88]), renal (65 % [95 % CI 49–79]), and lower respiratory tract (61 % [95 % CI 48–74]) manifestations were the most frequently reported at presentation. Renal disease was a hallmark of MPA (94 % [95 % CI 89–97]). ANCA were detected in >90 % of children with GPA or MPA. Combined corticosteroids and cyclophosphamide was the most frequently used first remission-inducing treatment for GPA (76 % [95 % CI 69–82]) and MPA (62 % [95 % CI 20–96]). Relapses occurred more frequently in GPA (67–100 %) than in MPA (25–50 %). The leading causes of death were the disease itself, and infections.ConclusionsChildhood-onset MPA and GPA remain severe diseases with frequent relapses and a high cumulative morbidity. Survival and disease-free survival need to be improved.Electronic supplementary materialThe online version of this article (doi:10.1186/s13023-016-0523-y) contains supplementary material, which is available to authorized users.
Highlights
The data from cohorts of childhood-onset granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) remain scarce and heterogeneous
Systemic vasculitis in children accounts for 2 to 10 % of the conditions evaluated in paediatric rheumatology clinics [1, 2]
We conducted a systematic literature review and meta-analysis: 1) to summarize the principal clinical and demographic features on presentation; 2) to describe the course of the disease and 3) to describe the therapeutic approaches reported for children with GPA and MPA
Summary
The data from cohorts of childhood-onset granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) remain scarce and heterogeneous. IgA vasculitis and Kawasaki disease are the most common [3], whereas childhood-onset antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA, Wegener’s), eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss) and microscopic polyangiitis (MPA) are more rare. Our knowledge of these diseases is based mostly on small cohort studies or, more frequently, case series or reports. We conducted a systematic literature review and meta-analysis: 1) to summarize the principal clinical and demographic features on presentation; 2) to describe the course of the disease and 3) to describe the therapeutic approaches reported for children with GPA and MPA Since the development of the first specific paediatric classification of vasculitis by the European League Against Rheumatism (EULAR) and the Paediatric Rheumatology European Society (PReS) in 2006 [4], the number of cohorts of patients with paediatric AAV, mostly GPA, reported has steadily increased [5,6,7,8,9,10,11,12].
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