Association between age at disease onset of anti-neutrophil cytoplasmic antibody-associated vasculitis and clinical presentation and short-term outcomes

Objectives: ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- A nd older-onset patients are still incompletely understood. Methods: We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: <65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results: A total of 1338 patients with AAV were included: 66% had disease onset at <65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion: Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients

X-ray, 31P CP/MAS, and single-crystal NMR studies, and 31P DFT GIAO calculations of inclusion complexes of bis[6-O,6-O'-(1,2:3,4- diisopropylidene-alpha-D-galactopyranosyl)thiophosphoryl] disulfide: the importance of C-H...S=P contacts in the solid state.

Bis[6-O,6-O′-(1,2:3,4-diisopropylidene-α-D-galactopyranosyl)thiophosphoryl] disulfide shows a strong tendency to form inclusion compounds. The crystal and molecular structure of eight different solvates was established by X-ray analysis. The results indicate three different types of disulfide arrangements in the crystal lattice. By means of 31P CP/MAS NMR experiments the principal values δ11, δ22, and δ33 of the 31P chemical shift tensor were obtained for each form. The orientation of its principal axes with respect to a molecular frame was investigated by means of 31P CP and single-crystal NMR for the complex with propan-2-ol. The principal axis 1 of both chemically equivalent phosphorus atoms is nearly parallel to the P[BOND]S bond and the principal axis 3 is very close to the P[DOUBLE BOND]S bond. DFT GIAO calculations of the model compound (EtO)2(S)P1SSP2(S)(OEt)2 allowed assignment of the experimental chemical shift curves to the magnetically nonequivalent atoms P1 and P2. The maximum difference between calculated angles (∢ i[BOND]P[BOND]X)calcd and experimental angles (∢ i[BOND]P[BOND]X)exptl is 8.3° and the rms distance 3.8° (i=principal axes 1, 2, 3; X=S, -S-, -O1-, -O2-). The influence of C[BOND]H⋅⋅⋅S weak hydrogen bonding on phosphorus shielding was tested theoretically (31P DFT GIAO) employing the dimethoxythiophosphoryl disulfide⋅CH4 complex as a model compound. The sensitivity of 31P δii parameters to intermolecular forces is demonstrated

X-ray, 31P CP/MAS, and single-crystal NMR studies, and 31P DFT GIAO calculations of inclusion complexes of bis[6-O,6-O-(1,2:3,4- diisopropylidene-α-D-galactopyranosyl)thiophosphoryl] disulfide: the importance of C-H...S=P contacts in the solid state

Bis[6-O,6-O-(1,2:3,4-diisopropylidene-alpha-D-galactopyranosyl) thiophosphoryl] disulfide shows a strong tendency to form inclusion compounds. The crystal and molecular structure of eight different solvates was established by X-ray analysis. The results indicate three different types of disulfide arrangements in the crystal lattice. By means of 31P CP/MAS NMR experiments the principal values δ 11, δ 22, and δ 33 of the 31P chemical shift tensor were obtained for each form. The orientation of its principal axes with respect to a molecular frame was investigated by means of 31P CP and single-crystal NMR for the complex with propan-2-ol. The principal axis 1 of both chemically equivalent phosphorus atoms is nearly parallel to the P-S bond and the principal axis 3 is very close to the P=S bond. DFT GIAO calculations of the model compound (EtO)2(S)P1SSP2(S)-(OEt)2 allowed assignment of the experimental chemical shift curves to the magnetically nonequivalent atoms P1 and P2. The maximum difference between calculated angles [symbol: see text] i-P-X)calcd and experimental angles [symbol: see text] i-P-X)exptl is 8.3 degrees and the rms distance 3.8 degrees (i = principal axes 1, 2, 3; X = S, -S-, -O1-, -O2-). The influence of C-H...S weak hydrogen bonding on phosphorus shielding was tested theoretically (31P DFT GIAO) employing the dimethoxythiophosphoryl disulfide.CH4 complex as a model compound. The sensitivity of 31P delta ii parameters to intermolecular forces is demonstrated