PO:36:244 | Early diagnosis in eosinophilic granulomatosis with polyangiitis: a multidisciplinary approach

Federico Giuseppe Lazzaro¹, Elena Chiaradia², Chiara Lombardi², Flavia Leone¹, Massimo Nucci², Roberta Masnata², Flora Niedda², Maria Rita Gigante¹, Pietro Rubortone¹, Silvia Laura Bosello^1|2, Maria Antonietta D'Agostino^1|2, Augusta Ortolan^1|2. | ¹Divisione di Reumatologia ed Immunologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; ²Università Cattolica del Sacro Cuore, Roma, Italy.

Background. Early diagnosis of Eosinophilic Granulomatosis with Polyangiitis (EGPA) remains one of the major unmet needs in clinical practice due to the non-specific nature of prodromal symptoms and the lack of specific biomarkers, particularly in patients who are anti-neutrophil cytoplasmic antibody (ANCA)-negative. The involvement of a multidisciplinary team may improve clinical management and the diagnostic-therapeutic process. The study objectives were: 1. To identify factors that may suggest an early diagnosis of EGPA by comparing patients referred to the rheumatologist through a multidisciplinary team, who do or do not receive an EGPA diagnosis. 2. To evaluate whether clinical features differ between EGPA patients referred through a multidisciplinary team and those referred through conventional pathways.

Materials and Methods. A retrospective study was conducted on consecutive patients between December 2023 and May 2025, categorized into three groups: 1. Patients with suspected EGPA evaluated through the multidisciplinary eosinophilic diseases pathway at our university hospital, who received a confirmed diagnosis (EGPA-MDT); 2. Patients evaluated through the same pathway who did not receive an EGPA diagnosis (nEGPA); 3. Patients referred through conventional channels who were diagnosed with EGPA (EGPA-CR). Demographic, clinical, laboratory, and instrumental data were compared. Non-parametric tests (Kruskal-Wallis, Mann-Whitney, and Chi-square) were used for statistical analysis. A p-value < 0.05 was considered statistically significant.

Results. A total of 85 patients were enrolled: 21 EGPA-MDT, 26 nEGPA, and 38 EGPA-CR. Demographic data are shown in Table 1. Compared to nEGPA patients, EGPA-MDT patients had a higher prevalence of systemic manifestations (81% vs 26.9%; p = 0.001) and more severe nasal disease (Nasal Polyp Score 4.0±2.3 vs 2.6±2.3; p = 0.05), as well as higher mean eosinophil counts (absolute mean values 4283.6±6131.6 cells/µL vs 644.4±537.4 cells/µL; p < 0.001), erythrocyte sedimentation rate (ESR, 49.3±31.1 mm/h vs 17.1±21.7 mm/h; p = 0.001), and C-reactive protein (CRP, 39.9±34.0 mg/L vs 2.0±3.5 mg/L; p < 0.001). Furthermore, EGPA-MDT patients showed greater steroid dependence (76.2% vs 15.4%; p < 0.001) and a higher rate of hospitalization at the time of first rheumatologic referral (61.9% vs 19.2%; p = 0.003) compared to nEGPA patients. When comparing clinical indices, EGPA-CR patients had higher mean BVAS scores (15.5±5.2 vs 11.6±5.6; p = 0.01) and VDI scores (4.7±1.0 vs 3.5±1.5; p = 0.006) than EGPA-MDT patients.

Conclusions. Constitutional symptoms, steroid dependence, and greater severity of sinonasal manifestations emerged as possible red flags for early EGPA diagnosis in patients within a multidisciplinary pathway. EGPA-CR patients, by contrast, displayed more severe systemic symptoms and higher disease activity, often eluding early diagnosis. Our data suggest that a multidisciplinary approach facilitates referral and early diagnosis, enabling phenotype-specific treatments that may improve the clinical course and quality of life of patients with EGPA.