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Testing with Antineutrophil Cytoplasmic Antibody To Diagnose Wegener Granulomatosis
- Jaya K. Rao, MD; and
- Nancy B. Allen, MD
- Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202 Duke University Medical Center, Durham, NC 27710
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
