Diagnosing ANCA-associated vasculitis in ANCA positive patients: A retrospective analysis on the role of clinical symptoms and the ANCA titre

被引:54
作者
Houben, Eline [1 ]
Bax, Willem A. [1 ]
van Dam, Bastiaan [1 ]
Slieker, Walentina A. T. [2 ]
Verhave, Gideon [1 ]
Frerichs, Fenneke C. P. [1 ]
van Eijk, Izhar C. [3 ]
Boersma, Wim G. [4 ]
de Kuyper, Guido T. M. [5 ]
Penne, Erik L. [1 ]
机构
[1] Northwest Clin, Dept Internal Med, Alkmaar, Netherlands
[2] Northwest Clin, Lab Clin Chem Hematol & Immunol, Alkmaar, Netherlands
[3] Northwest Clin, Dept Rheumatol, Alkmaar, Netherlands
[4] Northwest Clin, Dept Pulmonol, Alkmaar, Netherlands
[5] Northwest Clin, Dept Otolaryngol, Alkmaar, Netherlands
关键词
anti-neutrophil cytoplasmic antibody; anti-neutrophil cytoplasmic antibody-associated vasculitis; diagnosis; ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; WEGENERS-GRANULOMATOSIS; RENAL INVOLVEMENT; MICROSCOPIC POLYANGIITIS; SYSTEMIC VASCULITIS; REMISSION-INDUCTION; CLASSIFICATION; GLOMERULONEPHRITIS; EPIDEMIOLOGY; AUTOANTIBODY;
D O I
10.1097/MD.0000000000005096
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Currently no validated diagnostic system for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is available. Therefore, diagnosing AAV is often challenging. We aimed to identify factors that lead to a clinical diagnosis AAV in ANCA positive patients in a teaching hospital in The Netherlands.In this study, all patients that tested positive for ANCA proteinase 3 (PR3) and/or myeloperoxidase (MPO) between 2005 and 2015 were analysed. Patients with a clinical diagnosis of AAV were compared with patients without a clinical diagnosis of AAV. Clinical symptoms and laboratory variables at presentation, including the ANCA titre, were collected for both patients with and without AAV. Clinical and laboratory variables related with AAV were investigated, using multivariable logistic regression.Two hundred thirty seven consecutive patients with a positive ANCA were included, of whom 119 were clinically diagnosed with AAV. Of the 118 ANCA positive patients without AAV, 87 patients had an alternative diagnosis, including inflammatory bowel disease (n=24), other rheumatic diseases (n=23), infection (n=11), malignancy (n=4), and other diagnoses (n=25). In a multivariable regression model, a high ANCA titre (odds ratio [OR] 14.16, 95% confidence interval [CI] 6.93-28.94) and a high number of affected organ systems (OR 7.67, 95% CI 3.69-15.94) were associated with AAV.MPO and PR3 ANCA can be positive in a variety of diseases that mimic AAV. A higher ANCA titre and multiple affected organ systems may help to discriminate between AAV and other systemic illnesses in anti-PR3 and anti-MPO positive patients. A diagnostic scoring system incorporating these factors should be considered.
引用
收藏
页数:7
相关论文
共 39 条
[1]   Neonatal microscopic polyangiitis secondary to transfer of maternal myeloperoxidase-antineutrophil cytoplasmic antibody resulting in neonatal pulmonary hemorrhage and renal involvement [J].
Bansal, PJ ;
Tobin, MC .
ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY, 2004, 93 (04) :398-401
[2]   Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): Clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort [J].
Comarmond, Cloe ;
Pagnoux, Christian ;
Khellaf, Mehdi ;
Cordier, Jean-Francois ;
Hamidou, Mohamed ;
Viallard, Jean-Francois ;
Maurier, Francois ;
Jouneau, Stephane ;
Bienvenu, Boris ;
Puechal, Xavier ;
Aumaitre, Olivier ;
Le Guenno, Guillaume ;
Le Quellec, Alain ;
Cevallos, Ramiro ;
Fain, Olivier ;
Godeau, Bertrand ;
Seror, Raphaele ;
Dunogue, Bertrand ;
Mahr, Alfred ;
Guilpain, Philippe ;
Cohen, Pascal ;
Aouba, Achille ;
Mouthon, Luc ;
Guillevin, Loic .
ARTHRITIS AND RHEUMATISM, 2013, 65 (01) :270-281
[3]  
DeBandt M, 1996, BRIT J RHEUMATOL, V35, P38
[4]   Damage occurs early in systemic vasculitis and is an index of outcome [J].
Exley, AR ;
Carruthers, DM ;
Luqmani, RA ;
Kitas, GD ;
Gordon, C ;
Janssen, BA ;
Savage, COS ;
Bacon, PA .
QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS, 1997, 90 (06) :391-399
[5]  
FRIES JF, 1990, ARTHRITIS RHEUM, V33, P1135
[6]   Diagnostic Approach to ANCA-associated Vasculitides [J].
Gaffo, Angelo L. .
RHEUMATIC DISEASE CLINICS OF NORTH AMERICA, 2010, 36 (03) :491-+
[7]   Review article: Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis [J].
Gao, Ying ;
Zhao, Ming-Hui .
NEPHROLOGY, 2009, 14 (01) :33-41
[8]   Limited versus severe Wegener's granulomatosis - Baseline data on patients in the Wegener's granulomatosis etanercept trial [J].
Hopkins, J ;
Stone, JH ;
Uhlfelder, ML ;
Moore, AM ;
Hoffman, GS ;
Holbrook, JT ;
Meinert, CL ;
Dodge, J ;
Donithan, J ;
Min, N ;
Murrow, L ;
Smith, J ;
Tibbs, AK ;
Van Natta, M ;
Spiera, R ;
Berman, R ;
Enuha, S ;
Merkel, PA ;
Gelbard, R ;
Nuite, M ;
Schiller, A ;
Blumenthal, D ;
Bork, D ;
Clark, T ;
Crook, SL ;
Calabrese, LH ;
Farkas, S ;
Sridharan, S ;
Strom, K ;
Wilke, W ;
St Clair, EW ;
Allen, NB ;
Rodin, K ;
Scarlett, E ;
Hellmann, DB ;
Pinachos, L ;
Regan, MJ ;
Specks, U ;
Bradt, K ;
Carlson, K ;
Fisher, S ;
Hammel, B ;
Mieras, K ;
Ytterberg, S ;
Davis, JC ;
Fitzpatrick, M ;
Fye, K ;
Lund, S ;
McCune, J ;
Coomer, BJ .
ARTHRITIS AND RHEUMATISM, 2003, 48 (08) :2299-2309
[9]   Randomized trial of plasma exchange or high-dosage Methylprednisolone as adjunctive therapy for severe renal vasculitis [J].
Jayne, David R. W. ;
Gaskin, Gill ;
Rasmussen, Niels ;
Abramowicz, Daniel ;
Ferrario, Franco ;
Guillevin, Loic ;
Mirapeix, Eduardo ;
Savage, Caroline O. S. ;
Sinico, Renato A. ;
Stegeman, Coen A. ;
Westman, Kerstin W. ;
van der Woude, Fokko J. ;
van Wijngaarden, Robert A. F. de Lind ;
Pusey, Charles D. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2007, 18 (07) :2180-2188
[10]  
Jennette J. C., 1995, Annals Academy of Medicine Singapore, V24, P248