New strategies for plasma exchange in systemic vasculitis.
The use of plasma exchange in the treatment of systemic vasculitis has been controversial and poorly defined.  Since the discovery of anti-neutrophil cytoplasm antibodies (ANCA) and the demonstration of their specificity for systemic vasculitis, there has been a reassessment of the use of plasma exchange along the same lines as its use in anti-glomerular basement membrane disease.  ANCA has also contributed to the diagnosis and classification of rapidly progressive glomerulonephritis, in which there is now firmer evidence to support the use of plasma exchange.  Current work into the immunoregulation of ANCA by idiotype/anti-idiotype interactions is leading to new approaches to therapy and plasma exchange alone appears capable of inducing prolonged remission in some patients with vasculitis, possibly through an effect on these interactions.
Department of Medicine, Addenbrooke's Hospital, Cambridge, U.K.
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Jayne
D001323:Autoantibodies / Q000097:blood; D003593:Cytoplasm / Q000276:immunology; D005921:Glomerulonephritis / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D006801:Humans; D009504:Neutrophils / Q000276:immunology; D010951:Plasma Exchange; D014657:Vasculitis / Q000276:immunology / Q000628:therapy*