Hypertrophic pachymeningitis in ANCA-associated vasculitis: a cross-sectional and multi-institutional study in Japan (J-CANVAS)

Yasuhiro Shimojima, Dai Kishida, Takanori Ichikawa, Takashi Kida, Nobuyuki Yajima, Satoshi Omura, Daiki Nakagomi, Yoshiyuki Abe, Masatoshi Kadoya, Naoho Takizawa, Atsushi Nomura, Yuji Kukida, Naoya Kondo, Yasuhiko Yamano, Takuya Yanagida, Koji Endo, Shintaro Hirata, Kiyoshi Matsui, Tohru Takeuchi, Kunihiro IchinoseMasaru Kato, Ryo Yanai, Yusuke Matsuo, Ryo Nishioka, Ryota Okazaki, Tomoaki Takata, Takafumi Ito, Mayuko Moriyama, Ayuko Takatani, Yoshia Miyawaki, Toshiko Ito-Ihara, Takashi Kawaguchi, Yutaka Kawahito, Yoshiki Sekijima

Research output: Contribution to journalArticlepeer-review


Background: This study investigated the characteristics of hypertrophic pachymeningitis (HP) in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), using information from a multicenter study in Japan. Methods: We analyzed the clinical information of 663 Asian patients with AAV (total AAV), including 558 patients with newly diagnosed AAV and 105 with relapsed AAV. Clinical findings were compared between patients with and without HP. To elucidate the relevant manifestations for HP development, multivariable logistic regression analyses were additionally performed. Results: Of the patients with AAV (mean age, 70.2 ± 13.5 years), HP was noted in 30 (4.52%), including 20 (3.58%) with newly diagnosed AAV and 10 (9.52%) with relapsed AAV. Granulomatosis with polyangiitis (GPA) was classified in 50% of patients with HP. A higher prevalence of GPA was significantly observed in patients with HP than in those without HP in total AAV and newly diagnosed AAV (p < 0.001). In newly diagnosed AAV, serum proteinase 3 (PR3)-ANCA positivity was significantly higher in patients with HP than in those without HP (p = 0.030). Patients with HP significantly had ear, nose, and throat (ENT) (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.03–2.14, p = 0.033) and mucous membrane/eye manifestations (OR 5.99, 95% CI 2.59–13.86, p < 0.0001) in total AAV. Moreover, they significantly had conductive hearing loss (OR 11.6, 95% CI 4.51–29.57, p < 0.0001) and sudden visual loss (OR 20.9, 95% CI 5.24–85.03, p < 0.0001). Conclusion: GPA was predominantly observed in patients with HP. Furthermore, in newly diagnosed AAV, patients with HP showed significantly higher PR3-ANCA positivity than those without HP. The ear and eye manifestations may be implicated in HP development.

Original languageEnglish
Article number204
JournalArthritis Research and Therapy
Issue number1
Publication statusPublished - Dec 2022
Externally publishedYes


  • ANCA-associated vasculitis
  • Antineutrophil cytoplasmic antibody
  • Conductive hearing loss
  • Ear, nose, and throat
  • Granulomatosis with polyangiitis
  • Hypertrophic pachymeningitis
  • Mucous membranes/eyes
  • Sudden visual loss

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology


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