REPLY
Testing with Antineutrophil Cytoplasmic Antibody To Diagnose Wegener Granulomatosis
Jaya K. Rao, MD, and
Nancy B. Allen, MD
1 October 1996 | Volume 125 Issue 7 | Pages 622-623
IN RESPONSE:
We appreciate Dr. Hoffman's comments and clarification regarding the utility of c-ANCA titers to assess disease activity in patients with Wegener granulomatosis. As we stated in the Discussion section of our paper, previous studies that address the utility of c-ANCA as a disease-monitoring tool have provided mixed results. We mentioned the NIH study [1] primarily because these data provided a marked contrast to the temporal relation between changes in disease activity and c-ANCA titers noted by Cohen Tervaert and colleagues [2]. Furthermore, several studies have also shown that 1) some patients with active Wegener granulomatosis may have negative c-ANCA results [3, 4], 2) some patients with Wegener granulomatosis may have persistently positive c-ANCA titers during periods of remission [1, 4, 5], and 3) some patients with Wegener granulomatosis may have increases in c-ANCA titers without an increase in disease activity [1, 5].
The data mentioned by Drs. Malnick, Evron, and Sthoeger are also interesting. We reiterate our cautionary note on the use of c-ANCA results to substitute for clinical judgment in assessing the presence or absence of disease and in evaluating disease activity in patients suspected of having Wegener granulomatosis.
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Author and Article Information
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Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202
Duke University Medical Center, Durham, NC 27710
1. 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.
2. 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]
3. Davenport A, Lock RJ, Wallington TB, Feest TG. Clinical significance of antineutrophil cytoplasm antibodies detected by a standardized assay. Q J Med. 1994; 87:291-9.
4. Davenport A, Lock RJ, Wallington TB. Clinical relevance of testing for antineutrophil cytoplasm antibodies with a standard indirect immunofluorescence ANCA test in patients with upper or lower respiratory tract symptoms. Thorax. 1994; 49:213-7.
5. Jayne DR, Gaskin G, Pusey CD, Lockwood CM. ANCA and predicting relapse in systemic vasculitis. Q J Med. 1995; 88:127-33.
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