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Research ArticleAccepted Articles

The Natural History of DADA2 Vasculitis in a Large Cohort and Factors Associated with Disease-Related Damage

Dynne-Noya Kind Engelstein, David Levartovsky, Isaiah D. Wexler, Paulina Navon Elkan, Shai Padeh, Amir Bieber, Philip J. Hashkes, Liora Harel, Eduard Ling, Ofra Goldzweig, Irit Tirosh, Shaye Kivity, Yonatan Butbul Aviel, Marina Eskin-Schwartz, Itzhak Rosner, Michal Feldon, Pnina Langevitz, Alexandra Balbir-Gurman, Yackov Berkun and Reeval Segel
The Journal of Rheumatology January 2026, jrheum.2025-0297; DOI: https://doi.org/10.3899/jrheum.2025-0297
Dynne-Noya Kind Engelstein
D.N. Kind-Engelstein, MD, The Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
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David Levartovsky
D. Levartovsky, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
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Isaiah D. Wexler
I.D. Wexler, MD, PhD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
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Paulina Navon Elkan
P. Navon-Elkan, MD, Pediatric Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Shai Padeh
S. Padeh, MD, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
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Amir Bieber
A. Bieber, MD, The Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Philip J. Hashkes
P.J. Hashkes, MD, MSc, The Faculty of Medicine, The Hebrew University of Jerusalem, Israel; Pediatric Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Liora Harel
L. Harel, MD, Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
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Eduard Ling
E. Ling, MD, Rheumatology Clinic, Clalit Health Services, Southern District; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Ofra Goldzweig
O. Goldzweig, MD, Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
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Irit Tirosh
I. Tirosh, MD, Pediatric Rheumatology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
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Shaye Kivity
S. Kivity, MD, Department of Rheumatology, Meir Medical Center, Kfar Saba, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
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Yonatan Butbul Aviel
Y. Butbul-Aviel, MD, Department of Pediatrics B, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel; The Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Marina Eskin-Schwartz
M. Eskin-Schwartz, MD, PhD, Genetics Institute at Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Itzhak Rosner
I. Rosner, MD, Bnai Zion Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Michal Feldon
M. Feldon, MD, Department of Pediatrics, Shamir Medical Center, Zriffin, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
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Pnina Langevitz
P. Langevitz, MD, Rheumatic Diseases Unit, Center for Autoimmune diseases, Sheba Medical Center, Ramat Gan, Israel.
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Alexandra Balbir-Gurman
A. Balbir-Gurman, MD, Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel; The Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Yackov Berkun
Y. Berkun, MD, The Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
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Reeval Segel
R. Segel, MD, The Faculty of Medicine, The Hebrew University of Jerusalem, Israel; Pediatric Genetics Unit, Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel; The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel.
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Abstract

Objective To describe the clinical and laboratory findings, disease course and treatment effectiveness of a large, genetically homogenous group of patients with deficiency of adenosine deaminase 2 (DADA2), and to identify factors associated with disease-related damage.

Methods We conducted a retrospective cohort study that included 45 patients with DADA2 vasculitis with long-term follow-up. Information was collected from patients' charts including demographic information, clinical presentations, laboratory findings, and treatment. The extent of disease related damage was determined based on the vasculitis damage index (VDI).

Results In this large homogenous cohort, we found that a young age at disease onset and periodic illness that included recurrent episodes of fever, myalgia and abdominal pain are associated with disease-related damage. Patients with severe DADA2 disease responded favorably to TNFα inhibitors.

Conclusion Early age of onset and the periodic nature of the disease warrant prompt initiation of TNFα inhibitor treatment to prevent later complications and severe progression.

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The Journal of Rheumatology: 53 (3)
The Journal of Rheumatology
Vol. 53, Issue 3
1 Mar 2026
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Accepted manuscript
The Natural History of DADA2 Vasculitis in a Large Cohort and Factors Associated with Disease-Related Damage
Dynne-Noya Kind Engelstein, David Levartovsky, Isaiah D. Wexler, Paulina Navon Elkan, Shai Padeh, Amir Bieber, Philip J. Hashkes, Liora Harel, Eduard Ling, Ofra Goldzweig, Irit Tirosh, Shaye Kivity, Yonatan Butbul Aviel, Marina Eskin-Schwartz, Itzhak Rosner, Michal Feldon, Pnina Langevitz, Alexandra Balbir-Gurman, Yackov Berkun, Reeval Segel
The Journal of Rheumatology Jan 2026, jrheum.2025-0297; DOI: 10.3899/jrheum.2025-0297

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Accepted manuscript
The Natural History of DADA2 Vasculitis in a Large Cohort and Factors Associated with Disease-Related Damage
Dynne-Noya Kind Engelstein, David Levartovsky, Isaiah D. Wexler, Paulina Navon Elkan, Shai Padeh, Amir Bieber, Philip J. Hashkes, Liora Harel, Eduard Ling, Ofra Goldzweig, Irit Tirosh, Shaye Kivity, Yonatan Butbul Aviel, Marina Eskin-Schwartz, Itzhak Rosner, Michal Feldon, Pnina Langevitz, Alexandra Balbir-Gurman, Yackov Berkun, Reeval Segel
The Journal of Rheumatology Jan 2026, jrheum.2025-0297; DOI: 10.3899/jrheum.2025-0297
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