Ear, Nose, Throat Issues More Common in AAV

While patients with ANCA-associated vasculitis (AAV) responded well to treatment, ear, nose, and throat symptom relapses were more common among these patients, according to the findings of a recent review study published in the Journal of Clinical Medicine.

“In AAV, organ system involvement varies among the different subtypes: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic GPA (EGPA),” the authors explained. “Nasal symptoms are present in 21.6–52.2%, sinus involvement in 30.4–33.8% and hearing loss and otitis in 10.7–18.5%. Subglottic stenosis is present in approximately 1% of AAV patients. Patients with GPA most often report ENT symptoms.”

The investigators conducted a systematic review of 31 clinical articles between 2005 and 2022 from the Medline, Embase and Cochrane libraries,. Of these, 29 studies scored low on the level of incidence. Some studies (n=11) included local treatments, while some used systemic approaches such as glucocorticoids in combination with conventional systemic DMARDs (n=8), rituximab (n=6), and mepolizumab (n=6).

“In 5 studies, hearing improvement was observed in 56–100%, with better outcomes when glucocorticoids were combined with csDMARDs compared to glucocorticoids only,” the report read.

Response rates were high in general ranging from 80% to 100%. Almost 10% to 83.3% of the patients relapsed.

Due to heterogeneity across studies meta-analysis was not performed, the researchers cautioned. “More controlled studies, specifically focusing on ENT involvement, are needed to better guide the management of ENT symptoms in AAV patients,” they said.

Reference:
Krol RM, Remmelts HHF, Klaasen R, et al. Systemic and local medical or surgical therapies for ear, nose and/or throat manifestations in ANCA-associated vasculitis: A systematic literature review. Journal of Clin Med. 2023; 12(9):3173. DOI: https://doi.org/10.3390/jcm12093173