Polyarthritis with perinuclear antineutrophil cytoplasmic antibody inaugurating microscopic polyangiitis. Report of a case.
Microscopic polyangiitis, a condition recently differentiated from macroscopic periarteritis nodosa, is characterized by small vessel damage, pauciimmune necrotizing glomerulonephritis and presence of perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA). Arthralgia is a common symptom often present early in the disease, and other joint manifestations have also been reported. We report a case with polyarthritis as the first manifestation. Perinuclear ANCA was found in a moderate titer. A renal biopsy done six months after the onset of joint symptoms to investigate rapidly progressive renal failure established the diagnosis. The p-ANCA exhibited antimyeloperoxidase specificity. In the discussion we review the diagnosis of microscopic polyangiitis and of concomitant polyarthritis and p-ANCA production. ANCA is present in some patients with rheumatoid arthritis or systemic lupus erythematosus. It is important to determine the specificity of the ANCA since presence of p-ANCA with antimyeloperoxidase specificity in a patient with polyarthritis is highly suggestive of systemic vasculitis.
Pizzuti
P
P
Department of Medicine, René-Dubos Hospital, Pontoise, France.
Kemiche
F
F
Pertuiset
E
E
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis / Q000096:biosynthesis*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D003937:Diagnosis, Differential; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D014657:Vasculitis / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy
D019268:Antibodies, Antineutrophil Cytoplasmic