[Vasculitis 1998: new aspects in diagnosis and therapy].
The Chapel Hill conference established the most actual classification of systemic vasculitides. Disease activity and organ damage were standardized by means of a new scoring system (BVAS; VDI). Bacterial infection is frequent during the active phase of vasculitis. The measurement of serum procalcitonin helps to differentiate between disease activity and infection. In a recent study the European vasculitis group (EC-BCR project) found that the presence of C-ANCA/PR 3-ANCA or P-ANCA/MPO-ANCA is as reliable as histological proof of vasculitis. In rare cases ANCA is positive in diseases other than vasculitis, which has to be kept in mind for diagnosis and therapy. The association between ANCA and IgA nephropathy is exciting. The occurrence of IgA-GN in patients with Wegener's granulomatosis is usually a secondary event whereas in patients with rapidly progressive IgA-GN microscopic polyangiitis follows. Many observations support the view that ANCA-positive vasculitides are T-cell mediated diseases. Our investigations demonstrate that neutrophils express class II antigens during active disease and are able to trigger T-cell activation via infectious stimuli. With regard to therapy of ANCA-positive vasculitides several strategies are currently being examined in different European countries (EUVAS) with the aim to limit cyclophosphamide to the active stage of the disease.
Andrassy
K
K
Sektion Nephrologie der Medizinische Klinik, Universität Heidelberg, Deutschland.
Hänsch
G
G
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D001324:Autoantigens / Q000276:immunology; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002986:Clinical Trials as Topic; D003520:Cyclophosphamide / Q000008:administration & dosage; D005060:Europe; D005922:Glomerulonephritis, IGA / Q000276:immunology; D006023:Glycoproteins / Q000097:blood*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D011498:Protein Precursors / Q000097:blood*; D013601:T-Lymphocytes / Q000276:immunology; D014652:Vascular Diseases / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D001324:Autoantigens; C000606589:CALCA protein, human; D006023:Glycoproteins; D007166:Immunosuppressive Agents; D011498:Protein Precursors; D003520:Cyclophosphamide; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide