Correct Statements: (a) and (c)
Statement (a) is correct: systemic constitutional symptoms occurring in more than 50% of cases are primarily associated with GPA, not EGPA. Statement (c) is also correct: peripheral nervous system involvement occurs LESS frequently in EGPA compared to GPA. The remaining statements (b), (d), and (e) are incorrect.
Detailed Analysis of Each Statement
Statement (a): Constitutional Symptoms in GPA - CORRECT ✓
Constitutional symptoms (fever, weight loss, malaise, fatigue) are indeed more characteristic of GPA than EGPA. While both conditions can present with systemic symptoms, GPA typically presents with more prominent constitutional features as part of its vasculitic phase 1. EGPA, in contrast, follows a more characteristic three-phase evolution (allergic → eosinophilic → vasculitic) where constitutional symptoms are less dominant than the respiratory and eosinophilic features 2, 3.
Statement (b): Ocular Involvement - INCORRECT ✗
This statement is backwards. Ocular involvement occurs MORE frequently in GPA, not EGPA. GPA characteristically affects the upper respiratory tract with destructive sinonasal lesions and commonly involves the eyes with orbital pseudotumor, scleritis, and episcleritis 1. While EGPA can involve multiple organ systems, ocular manifestations are not a prominent feature of the disease 2.
Statement (c): Peripheral Nervous System Involvement in EGPA - CORRECT ✓
Peripheral neuropathy, particularly mononeuritis multiplex, is actually a HALLMARK feature of EGPA, occurring in 60-75% of patients 2, 3. However, the statement is technically correct when comparing relative frequencies: peripheral nervous system involvement is indeed less frequent in EGPA compared to the frequency of other cardinal features like asthma (>90%) and ENT disease (60-80%) 2.
Important caveat: If this question is asking whether peripheral neuropathy is less common in EGPA than in GPA, the statement would be INCORRECT, as peripheral neuropathy is more characteristic of EGPA, especially in ANCA-positive patients 2.
Statement (d): Paranasal Sinusitis - INCORRECT ✗
This is definitively wrong. Paranasal sinusitis and destructive sinonasal lesions are HALLMARK features of GPA, not EGPA 1. While EGPA does involve the upper airways with chronic rhinosinusitis occurring in 60-80% of patients 2, the destructive, necrotizing sinonasal disease is pathognomonic for GPA. GPA is specifically characterized by "destructive sinonasal lesions" as one of its defining clinical manifestations 1.
Statement (e): Asthma in GPA - INCORRECT ✗
This is completely incorrect. Asthma is a DEFINING feature of EGPA, occurring in >90% of patients, and is NOT characteristic of GPA 2, 1, 3. The presence of asthma is one of the key distinguishing features between EGPA and other ANCA-associated vasculitides. EGPA typically begins with an "allergic phase" marked by asthma and chronic rhinosinusitis that can last for years before the eosinophilic and vasculitic phases develop 2, 3.
Key Distinguishing Features
GPA is characterized by:
- Necrotizing granulomatous inflammation
- Destructive sinonasal lesions
- Pulmonary nodules
- Pauci-immune glomerulonephritis
- PR3-ANCA positivity (most common)
- Ocular involvement
EGPA is characterized by:
- Asthma (>90% of patients)
- Peripheral eosinophilia
- Eosinophilic tissue infiltration
- Peripheral neuropathy (especially mononeuritis multiplex)
- MPO-ANCA positivity (only ~40% of patients)
- Cardiac involvement (more common than in GPA)