title: Limited prognostic value of changes in antineutrophil cytoplasmic antibody titer in patients with Wegener's granulomatosis.
abstract: OBJECTIVE
  To assess the correlation and prognostic value of antineutrophil cytoplasmic antibody (cANCA) titers with disease activity in patients with Wegener's granulomatosis (WG).
  
  
  METHODS
  One hundred six patients with WG had serum ANCA determinations; 72 had serial titers obtained routinely at 1-3-month intervals. One hundred twelve subjects (19 of whom were healthy donors) served as controls. All serum samples were tested for cANCA by an indirect immunofluorescence technique. A prospective analysis of disease activity and cANCA values was performed. Disease activity was assessed according to clinical, laboratory, radiographic, and histopathologic findings.
  
  
  RESULTS
  Positivity for cANCA was a sensitive (88%) marker of active WG. However, changes in serial titers temporally correlated with a change in disease status in only 64% of patients. Furthermore, an increase in the cANCA titer preceded clinical exacerbation of disease in only 24% of patients who had been in remission or had low-grade, smoldering disease.
  
  
  CONCLUSIONS
  A rise in cANCA titer alone should not be considered adequate evidence of an impending clinical exacerbation, and therefore does not justify initiating or increasing immunosuppressive therapy.
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892.
authors.forename: G S
authors.initials: GS
authors.lastname: Kerr
authors.forename: T A
authors.initials: TA
authors.lastname: Fleisher
authors.forename: C W
authors.initials: CW
authors.lastname: Hallahan
authors.forename: R Y
authors.initials: RY
authors.lastname: Leavitt
authors.forename: A S
authors.initials: AS
authors.lastname: Fauci
authors.forename: G S
authors.initials: GS
authors.lastname: Hoffman
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000032:analysis*; D015415:Biomarkers; D003520:Cyclophosphamide / Q000627:therapeutic use; D005189:False Positive Reactions; D005455:Fluorescent Antibody Technique; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D011237:Predictive Value of Tests; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D015415:Biomarkers; D007074:Immunoglobulin G; D003520:Cyclophosphamide; D011241:Prednisone