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Backgroud: Fabry disease (OMIM #301 500), the most prevalent lysosomal storage disease, is caused by enzymatic defects in alpha-galactosidase A (GLA gene; Xq22.1). Fabry disease has historically been characterized by progressive renal failure, early stroke and hypertrophic cardiomyopathy, with a diminished life expectancy. A nonclassical phenotype has been described with an almost exclusive cardiac involvement. Specific therapies with enzyme substitution or chaperone molecules are now available depending on the mutation carried. Numerous clinical and fundamental studies have been conducted without stratifying patients by phenotype or severity, despite different prognoses and possible different pathophysiologies. We aimed to identify a simple and clinically relevant way to classify and stratify patients according to their disease severity., Methods: Based on data from the French Fabry Biobank and Registry (FFABRY; n = 104; 54 males), we applied unsupervised multivariate statistics to determine clusters of patients and identify clinical criteria that would allow an effective classification of adult patients. Thanks to these criteria and empirical clinical considerations we secondly elaborate a new score that allow the severity stratification of patients., Results: We observed that the absence of acroparesthesia or cornea verticillata is sufficient to classify males as having the nonclassical phenotype. We did not identify criteria that significantly cluster female patients. The classical phenotype was associated with a higher risk of severe renal (HR = 35.1; p <10-3) and cardiac events (HR = 4.8; p = 0.008) and a trend toward a higher risk of severe neurological events (HR = 7.7; p = 0.08) compared to nonclassical males. Our simple, rapid and clinically-relevant FFABRY score gave concordant results with the validated MSSI., Conclusion: Acroparesthesia and cornea verticillata are simple clinical criteria that efficiently stratify Fabry patients, defining 3 different groups: females and males with nonclassical and classical phenotypes of significantly different severity. The FFABRY score allows severity stratification of Fabry patients., Competing Interests: WM received honoraria, congress fees and travel assistance from Shire-Takeda, Amicus and Sanofi- Genzyme. OB, DA, CM declare no conflict of interest. FLam has received travel support from Amicus Therapeutics., Shire and Sanofi-Genzyme. He received lecture fees from Actelion Pharmaceuticals. BD has received honoraria from Amicus (member of the scientific board) and Novartis (lectures) and travel fees from Genzyme-Sanofi. VLS has received travel fees and accommodations from Shire and Sanofi-Genzyme. CC has received consultant honoraria and congress fees from Biomarin and Sanofi-Genzyme and has participated in editorial activity with Takeda-Shire. CD has received travel assistance from Shire, Sanofi-Genzyme, Sobi, Orphan Europe, Nutricia, Lucane Pharma, Amicus, and Ultragenyx and honoraria from Amicus and has participated on boards with Ultragenyx and Sanofi. OB, AD, PDH declare no conflict of interest EN has received travel fees from Shire and Sanofi-Genzyme and an honorarium from Amicus. TZ has received congress fees and travel assistance from Sanofi-Genzyme. MM declare no conflict of interest FM has received honoraria from Shire and travel assistance from Sanofi-Genzyme. KHL declare no conflict of interestGB has received travel assistance from Shire, Genzyme-Sanofi and Amicus. GB has received travel assistance from Shire, Genzyme-Sanofi and Amicus. MW and FLab declare no conflict of interest AM has received travel fees and accommodations from Shire, Sanofi-Genzyme and Amicus. CL has received honoraria from Sanofi-Genzyme and travel assistance from Sanofi-Genzyme and Shire. DL has received honoraria and travel assistance from Sanofi-Genzyme and has participated on boards with Amicus. HM received honoraria and travel assistance from Sanofi-Genzyme and Amicus and has participated on boards with Amicus and Shire. OL has received travel support and lecture fees from Amicus Therapeutics, Shire, and Sanofi- Genzyme. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objective: Hypocomplementemic urticarial vasculitis (HUV) is an uncommon vasculitis of unknown etiology that is rarely described in the literature. We undertook this study to analyze the clinical spectrum and the therapeutic management of patients with HUV., Methods: We conducted a French nationwide retrospective study that included 57 patients with chronic urticaria, histologic leukocytoclastic vasculitis, and hypocomplementemia. We assessed clinical and laboratory data and evaluated the patients' cutaneous and immunologic responses to therapy. We evaluated treatment efficacy by measuring the time to treatment failure., Results: Urticarial lesions were typically more pruritic than painful and were associated with angioedema in 51% of patients, purpura in 35%, and livedo reticularis in 14%. Extracutaneous manifestations included constitutional symptoms (in 56% of patients) as well as musculoskeletal involvement (in 82%), ocular involvement (in 56%), pulmonary involvement (in 19%), gastrointestinal involvement (in 18%), and kidney involvement (in 14%). Patients with HUV typically presented with low C1q levels and normal C1 inhibitor levels, in association with anti-C1q antibodies in 55% of patients. Hydroxychloroquine or colchicine seemed to be as effective as corticosteroids as first-line therapy. In patients with relapsing and/or refractory disease, rates of cutaneous and immunologic response to therapy seemed to be higher with conventional immunosuppressive agents, in particular, azathioprine, mycophenolate mofetil, or cyclophosphamide, while a rituximab-based regimen tended to have higher efficacy. Finally, a cutaneous response to therapy was strongly associated with an immunologic response to therapy., Conclusion: HUV represents an uncommon systemic and relapsing vasculitis with various manifestations, mainly, musculoskeletal and ocular involvement associated with anti-C1q antibodies, which were found in approximately half of the patients. The best strategy for treating HUV has yet to be defined., (Copyright © 2015 by the American College of Rheumatology.)