Controls OR (95%CI)3

Controls OR (95%CI)3.38 (1.11C10.33)5.06 (1.62C15.78)0.67 (0.07C6.20)2.21 (0.24C20.74)pp = 0.032p = 0.005p = 0.72p = 0.48 Open in a separate window 1 = number and percentage of total in each disease group. 2 = number and percentage of MRSA positive patients of tested patients. GPA = granulomatosis with polyangiitis; MPA = microscopic polyangiitis; EGPA = eosinophilic granulomatosis with polyangiitis; RA = rheumatoid arthritis; LVV = large vessel vasculitis. We found no association of MPA or EGPA with MRSA carriage compared to control. contact to domestic pets at disease onset or ever RO4987655 before. The odds ratio (OR) and 95% confidence interval [95%CI] were calculated for each item. Results Univariate analysis revealed a strong association of AAV with regular farm exposure; OR 3.44 [95%CI 1.43C8.27]. AAV was also associated with regular contact to cattle 4.30 (1.43C8.27), pigs 2.75 (1.12C6.75) and MRSA carriage 3.38 (1.11C10.3). This association was stronger in the subgroup of GPA patients. OR in this group for farm exposure was 4.97; [2.02C12.2], for cattle 6.71 [95% CI 2.19C20.7], for pigs 4.34 [1.75C10.9], and MRSA carriage 5.06 [1.62C15.8]). There was no significant association of MPA or EGPA with these parameters. Conclusion 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. Introduction Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic necrotising vasculitis predominantly affecting small vessels. AAV comprises granulomatosis with polyangiits (GPA, Wegeners), microscopic polyangiitis (MPA), RO4987655 and eosinophilic granulomatosis with polyangiitis (EGPA) [1]. The annual incidence of AAV as a group is estimated at about 10C20 patients per million [2]. The causes of AAV are poorly understood and their pathophysiological mechanisms remain uncertain [3]. In a recent genome-wide association study of patients with AAV a genetic contribution to the pathogenesis has been confirmed [4]. Beside the genetic susceptibility microbial pathogens and environmental factors have been implicated in the pathogenesis of AAV [5]. Various potential environmental risk factors have been suggested [4, 6]. Particularly, occupational exposure to different agents has been associated with the development of AAV [7, RO4987655 8]. Several case-control studies found a positive association between crystalline silica exposure and other inhaled agents with GPA and MPA [6]. RO4987655 Also differences in the geographic distribution have been reported suggesting that environmental factors may play a role in the pathogenesis of the disease [9]. In addition, an association with bacterial infection could be suggested in AAV [10]. Farming has been reported as a risk factor for the development of several autoimmune diseases [7, 11]. An association of farming and AAV has also been reported [12, 13]. However, there are inconsistent data RO4987655 about farming as a risk factor for AAV. In a recent Swedish case-control study no significantly association of farming or animal exposure with the development of AAV or GPA respectively could be detected [14]. The information about the disease and the occupation of patients in this study was obtained from registry data of inpatient care and may thus be less precise than data directly acquired using questionnaires. The aim of the present study was to investigate in a large hospital based case-control HMGCS1 study whether farming or farm exposure represent risk factors for the development of AAV in the north western part of Germany. Materials and Methods AAV patients and controls The study protocol was approved by the local independent ethics committee (Ethikkommission der ?rztekammer Westfalen-Lippe). All patients and controls provided written informed consent before participating in the study. This study was conducted in compliance with Good Clinical Practices and the Declaration of Helsinki and was approved by the local independent ethics committee. We included patients with different AAV subtypes. GPA was diagnosed according to the American College of Rheumatology (ACR) criteria and the criteria adapted from the 2012 revised Chapel Hill Consensus Conference (CHCC) [1, 15]. MPA was diagnosed according to the CHCC definition [1]. EGPA was diagnosed according to the ACR criteria and the CHCC.