title: Serial measurements of antineutrophil cytoplasmic autoantibodies in patients with systemic vasculitis.
abstract: OBJECTIVE
  To assess the value of serial determinations of antineutrophil cytoplasmic autoantibodies (ANCA) for monitoring disease activity in patients with systemic vasculitis.
  
  
  METHODS
  Forty-three patients with histologically proven vasculitis (21 with Wegener's granulomatosis, 17 with microscopic polyangiitis, and 5 with renal-limited vasculitis) were studied for a median follow-up of 22 months. Disease activity was prospectively assessed and quantified by the Birmingham Vasculitis Activity Score. A total of 347 sera were analyzed for ANCA determination.
  
  
  RESULTS
  Relapses occurred in 23 (54%) of 43 patients. Diagnostic category (Wegener's granulomatosis vs micropolyangiitis and renal-limited vasculitis), severity of initial symptoms (mean vasculitis activity score, mean number of organs involved), and ANCA pattern [cytoplasmic-ANCA (c-ANCA) vs perinuclear-ANCA (p-ANCA)] did not significantly differ between relapsers and nonrelapsers. Lung involvement was more frequent at onset among relapsers [16 of 23 (70%) vs 6 of 20 (30%); P = 0.02]. Relapses were slightly, but not significantly, more frequent in patients with Wegener's granulomatosis or a c-ANCA pattern. The percentage of relapsers was greater in patients with persistently positive ANCA than in patients with negative or decreasing ANCA titers (86% vs 20%, P = 0.0001). However, the predictive value of an increase in ANCA titers for the occurrence of a subsequent relapse was only 28% (4 of 14) for c-ANCA, 12% (2 of 17) for anti-proteinase 3-ANCA, and 43% (6 of 14) for anti-myeloperoxidase-ANCA. An increase in ANCA occurred before or during relapse in 33% (10 of 30) of cases for c-ANCA/anti-proteinase 3 antibodies, and 73% (11 of 15) of cases for anti-myeloperoxidase antibodies.
  
  
  CONCLUSIONS
  The persistence of ANCA positivity is strongly associated with relapses. However, an increase in ANCA titers has a poor value for the early prediction of a subsequent relapse and should not be used as a sole parameter for therapeutic intervention. In addition, our results suggest that serial anti-myeloperoxidase determination may be useful as a prognostic marker in patients who are p-ANCA positive.
authors.affiliation: Department of Nephrology, Internal Medicine, Centre Hospitalier de Valenciennes, France.
authors.forename: X
authors.initials: X
authors.lastname: Kyndt
authors.forename: D
authors.initials: D
authors.lastname: Reumaux
authors.forename: F
authors.initials: F
authors.lastname: Bridoux
authors.forename: B
authors.initials: B
authors.lastname: Tribout
authors.forename: P
authors.initials: P
authors.lastname: Bataille
authors.forename: E
authors.initials: E
authors.lastname: Hachulla
authors.forename: P Y
authors.initials: PY
authors.lastname: Hatron
authors.forename: P
authors.initials: P
authors.lastname: Duthilleul
authors.forename: P
authors.initials: P
authors.lastname: Vanhille
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001167:Arteritis / Q000276:immunology; D010450:Endopeptidases / Q000276:immunology; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009195:Peroxidase / Q000276:immunology; D011237:Predictive Value of Tests; D012008:Recurrence; D014657:Vasculitis / Q000201:enzymology / Q000276:immunology*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D009195:Peroxidase; D010450:Endopeptidases