Farm Exposure as a Differential Risk Factor in ANCA-Associated Vasculitis

• Published in: PloS one 2015-09, Vol.10 (9), p.e0137196-e0137196
• Main Authors: Willeke, P, Schlüter, B, Sauerland, C, Becker, H, Reuter, S, Jacobi, A, Schotte, H
• Format: Article
• Language: English
• Subjects: Adult; Aged; Animal Husbandry; Animals; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - blood; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - etiology; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - immunology; Antibodies, Antineutrophil Cytoplasmic - blood; Antineutrophil cytoplasmic antibodies; Arthritis; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - immunology; Autoantibodies; Biopsy; Bovidae; Care and treatment; Case-Control Studies; Cattle; Causes of; Churg-Strauss Syndrome - blood; Churg-Strauss Syndrome - diagnosis; Churg-Strauss Syndrome - etiology; Churg-Strauss Syndrome - immunology; Confidence intervals; Disease; Drug resistance; Exposure; Farms; Female; Genetic aspects; Granulomatosis; Granulomatosis with Polyangiitis - blood; Granulomatosis with Polyangiitis - diagnosis; Granulomatosis with Polyangiitis - etiology; Granulomatosis with Polyangiitis - immunology; Harvesting; Hogs; Hospitals; Humans; Immunoglobulins; Immunology; Laboratories; Leukocytes (eosinophilic); Livestock; Male; Mathematical analysis; Medicine; Microscopic Polyangiitis - blood; Microscopic Polyangiitis - diagnosis; Microscopic Polyangiitis - immunology; Middle Aged; Neutrophils; Occupational Exposure - adverse effects; Odds Ratio; Pathogenesis; Patients; Pets; Physiological aspects; Questionnaires; Rheumatoid arthritis; Rheumatology; Risk Factors; Staphylococcus aureus; Staphylococcus infections; Subgroups; Surveys and Questionnaires; Swine; Vasculitis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0137196

To investigate the association of farm exposure and the development of ANCA-associated vasculitis (AAV). One hundred eighty-nine well defined patients with AAV (n = 119 with granulomatosis with polyangiitis [GPA], n = 48 with microscopic polyangiitis [MPA], n = 22 patients with eosinophilic granulomatosis with polyangiitis [EGPA]) and 190 controls (n = 119 patients with rheumatoid arthritis, n = 71 with large vessel vasculitis) were interrogated using a structured questionnaire. Factors investigated were occupation, farm exposure, contact to different livestock, participation in harvesting, residence next to a farm, MRSA status, and contact to domestic pets at disease onset or ever before. The odds ratio (OR) and 95% confidence interval [95%CI] were calculated for each item. Univariate analysis revealed a strong association of AAV with regular farm exposure; OR 3.44 [95%CI 1.43-8.27]. AAV was also associated with regular contact to cattle 4.30 (1.43-8.27), pigs 2.75 (1.12-6.75) and MRSA carriage 3.38 (1.11-10.3). This association was stronger in the subgroup of GPA patients. OR in this group for farm exposure was 4.97; [2.02-12.2], for cattle 6.71 [95% CI 2.19-20.7], for pigs 4.34 [1.75-10.9], and MRSA carriage 5.06 [1.62-15.8]). There was no significant association of MPA or EGPA with these parameters. A significant association between farm exposure or farm animal exposure and AAV especially in the subgroup of patients with GPA has been identified. This suggests that these entities are distinct and have different triggers for the immune process.