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Impact of glucocorticoids on muscle biopsy findings in antineutrophil cytoplasmic antibody-associated vasculitis

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Abstract

Several studies have examined the utility of quadriceps femoris muscle biopsies for diagnosing antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We aimed to investigate the effects of glucocorticoid therapy on the muscle biopsy findings of patients with AAV. Data from patients with AAV who underwent a biopsy of the bilateral vastus lateralis of the quadriceps femoris at Tokyo Metropolitan Tama Medical Center between January 2015 and December 2023 were retrospectively analyzed. In total, 126 patients with suspected small vessel vasculitis (SVV) or medium vessel vasculitis (MVV) underwent a muscle biopsy at the study center. Of these, the present study included 71 patients with a final diagnosis of AAV who received a muscle biopsy of the bilateral vastus lateralis at disease onset and began glucocorticoid therapy at the study center. Of the 71 patients, 41 (57.7%) had a positive muscle biopsy finding as defined by the presence of inflammatory infiltrates with fibrinoid necrosis in the vessels. Fifty-six and 15 patients underwent a biopsy before and after starting glucocorticoid therapy, respectively. Of the former, 33 (58.9%) had a positive finding compared to eight (53.3%) of the latter (Pearson's chi-square test: p = 0.697). Among the patients with a positive biopsy result, 22 (53.7%) and 19 (46.3%) had a unilaterally and bilaterally positive finding, respectively. Glucocorticoid therapy did not significantly affect the findings of quadriceps femoris muscle biopsies. Unilateral biopsies may have a lower diagnostic sensitivity for AAV than bilateral biopsies.

Key Points

• Glucocorticoid therapy does not significantly impact the results of quadriceps femoris muscle biopsies in patients with antineutrophil cytoplas¬mic antibody (ANCA)-associated vasculitis (AAV).

• Unilateral biopsies may have a lower diagnostic sensitivity for AAV than bilateral biopsies.

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Data availability

Data are stored in Tokyo Metropolitan Tama Medical Center, and are available upon request.

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Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sector to carry out the work described in this article.

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Authors and Affiliations

  1. Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan

    Yoshitaka Ueda, Eisuke Takamasu, Kota Shimada & Naoto Yokogawa

  2. Department of Rheumatic Diseases, Tama-Nambu Chiiki Hospital, Tokyo, Japan

    Takahiro Nunokawa

  3. Department of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Haruka Okada

Authors
  1. Yoshitaka Ueda
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  2. Takahiro Nunokawa
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  6. Naoto Yokogawa
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Contributions

YU and NY contributed to the study design, collection, analysis, and interpretation of the data, and writing of the original draft. TN, ET, HO and KS contributed to the data interpretation and manuscript review and editing. All the authors approved the final version of the manuscript and confirm that they had full access to all the data, verified the data, and accept responsibility for the submission of this manuscript for publication.

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Correspondence to Yoshitaka Ueda.

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Ueda, Y., Nunokawa, T., Takamasu, E. et al. Impact of glucocorticoids on muscle biopsy findings in antineutrophil cytoplasmic antibody-associated vasculitis. Clin Rheumatol 44, 377–384 (2025). https://doi.org/10.1007/s10067-024-07277-9

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