LETTER
Testing with Antineutrophil Cytoplasmic Antibody To Diagnose Wegener Granulomatosis
Gary S. Hoffman, MD
1 October 1996 | Volume 125 Issue 7 | Page 622
TO THE EDITOR:
Rao and colleagues [1] provide an important critical analysis of the role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis. They correctly emphasize the dangers of a positive test result in the setting of low pretest probability of this disorder. Their discussion includes a comparison of data from the National Institutes of Health (NIH) cohort [2] and that of Cohen Tervaert and colleagues [3]. This comparison requires clarification. It is stated that, in the NIH series, c-ANCA titers temporally correlated with changes in disease activity in only 24% of patients. This is not entirely correct. The 24% refers to the frequency with which an increase in c-ANCA titer preceded a relapse in patients who were previously in remission or who had mild, smoldering disease. This observation emphasizes that, in our experience, an increase in c-ANCA titer in relatively well and stable patients is often not followed by clinical exacerbation. Thus, we found changing titers in this subset not to be a reliable prognostic marker. When we compared c-ANCA titer changes with disease activity, we found that 64% of patients had a concurrent change in c-ANCA titers and improvement or worsening of disease. Like Rao and colleagues, we urge caution for those who would substitute changes in c-ANCA titer for careful clinical evaluation.
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Author and Article Information
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Cleveland Clinic Foundation, Cleveland, OH 44195
1. Rao JK, Weinberger M, Oddone EZ, Allen NB, Landsman P, Feussner JR. The role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis. A literature review and meta-analysis. Ann Intern Med. 1995; 123:925-32.
2. Kerr GS, Fleisher TA, Hallahan CW, Leavitt RY, Fauci AS, Hoffman GS. Limited prognostic value of changes in antineutrophil cytoplasmic antibody titer in patients with Wegener's granulomatosis. Arthritis Rheum. 1993; 36:365-71.
3. Cohen Tervaert JW, van der Woude FJ, Fauci AS, Ambrus JL, Velosa J, Keane WF, et al. Association between active Wegener's granulomatosis and anticytoplasmic antibodies. Arch Intern Med. 1989; 149:2461-5.[Abstract]
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