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Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement

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Abstract

Objective

Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile.

Methods

We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays.

Results

Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80–0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18–3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1 pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5 pg/ml; p = 0.076).

Conclusion

Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement.

Key Points

• Joint involvement in adult IgAV is a frequent manifestation.

• Joint involvement is associated with more frequent gastrointestinal manifestations.

• Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV.

• IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.

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Acknowledgements

We gratefully acknowledge E. Maillard, K. Labroquère, and M. Andrieu from the Cochin Immunobiology facility and the “Fondation du Rein” which supported this work. We also acknowledgethe French Vasculitis Study Group (FVSG) and the HSPrognosis group.

Funding

This work was supported by grants from the “Fondation du Rein.” A. A. Audemard-Verger was supported by a PhD fellowship from the “Ligue contre le Cancer” and from INSERM.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France

    Alice Delapierre, Pauline Baudart & Christian Marcelli

  2. Université Paris Descartes, Paris, France

    Benjamin Terrier & Loïc Guillevin

  3. Department of Internal Medicine, Hôpital Cochin, Paris, France

    Benjamin Terrier & Loïc Guillevin

  4. National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France

    Benjamin Terrier & Loïc Guillevin

  5. Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Evangéline Pillebout

  6. Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie Et Transplantation Rénale, CHU de La Conception, AP-HM, Marseille, France

    Noémie Jourde-Chiche

  7. Department of Internal Medicine, Hôpital Saint Louis, APHP, Paris, France

    Bertrand Lioger

  8. Department of Internal Medicine, CHU, Nice, France

    Nihal Martis

  9. Department of Internal Medicine, CHU, Toulouse, France

    Guillaume Moulis

  10. Department of Internal Medicine, CHU, Bordeaux, France

    Etienne Rivière

  11. Department of Internal Medicine and Nephrology, Valenciennes, CH, France

    Noémie Le Gouellec

  12. Department of Internal Medicine, CHU, La Réunion, France

    Loïc Raffray

  13. Department of Internal Medicine, CHU, Angers, France

    Geoffrey Urbanski

  14. Département de Médecine Interne Et Immunologie Clinique, CHU Lille, 59000, Lille, France

    Sébastien Sanges

  15. Univ. Lille, INSERM, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France

    Sébastien Sanges

  16. Department of Internal Medicine, Hôpitaux privés, Metz, France

    Francois Maurier

  17. Department of Internal Medicine, CHU de Grenoble, Grenoble, France

    Alban Deroux

  18. Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Arsène Mekinian

  19. Center of Research On Inflammation INSERM U1149, CNRS ERL8252, Paris Diderot University, Paris, France

    Renato Monteiro

  20. Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France

    Francois Maillot & Alexandra Audemard-Verger

  21. University of Tours, Tours, France

    Francois Maillot & Alexandra Audemard-Verger

  22. Paris Descartes University, Cochin Institute, CNRS UMR8104, INSERM U1016, Paris, France

    Bruno Lucas

  23. Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France

    Achille Aouba

Authors
  1. Alice Delapierre
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  2. Benjamin Terrier
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  3. Evangéline Pillebout
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  4. Pauline Baudart
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  5. Noémie Jourde-Chiche
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  6. Bertrand Lioger
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  7. Nihal Martis
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  8. Guillaume Moulis
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  9. Etienne Rivière
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  10. Noémie Le Gouellec
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  12. Geoffrey Urbanski
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  13. Sébastien Sanges
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  14. Francois Maurier
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  15. Alban Deroux
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  16. Arsène Mekinian
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  17. Renato Monteiro
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  18. Christian Marcelli
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  19. Loïc Guillevin
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  21. Bruno Lucas
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  22. Achille Aouba
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  23. Alexandra Audemard-Verger
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Consortia

on behalf of the French Vasculitis Study Group (FVSG) and the HSPrognosis group

Corresponding author

Correspondence to Alexandra Audemard-Verger.

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Delapierre, A., Terrier, B., Pillebout, E. et al. Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement. Clin Rheumatol 41, 1483–1491 (2022). https://doi.org/10.1007/s10067-021-05937-8

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