Persistence of antineutrophil cytoplasmic antibodies (ANCA) in asymptomatic patients with systemic polyarteritis nodosa or Churg-Strauss syndrome: follow-up of 53 patients

Clin Exp Rheumatol. Mar-Apr 1995;13(2):193-8.

Abstract

Objective: We retrospectively analyzed the significance of persistent ANCA positivity after clinical remission in 53 consecutive patients with histologically and/or angiographically proven polyarteritis nodosa (PAN), or Churg-Strauss syndrome (CSS) followed between 1981 and 1993.

Methods: ANCA were detected using an immunofluorescence assay and ELISA: Each patient met the American College of Rheumatology 1990 criteria for PAN or CSS. Clinical and biological evaluations were always essential factors in the decision to intensify therapy.

Results: ANCA were initially present in 15 patients (28.3%): 3/26 (11.5%) with HBV-related PAN, 6/18 (33.3%) with PAN of unknown etiology and 6/9 (66.7%) with CSS. Five patients remained ANCA-positive after clinical remission: 3 with PAN (one of them relapsed) and 2 with CSS who both relapsed. Among the 12 patients who died during follow-up, only 1 (8.3%) was initially ANCA-positive. Fifteen of the 41 survivors (29.2%) were ANCA-positive.

Conclusion: Persistence of ANCA positivity in PAN and CSS may be a marker of an underlying disease process, but does not adequately reflect disease activity and, thus, in no case should be the only indication for therapeutic intensification.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antibodies, Antineutrophil Cytoplasmic
  • Autoantibodies / blood*
  • Biomarkers / blood
  • Churg-Strauss Syndrome / immunology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Polyarteritis Nodosa / immunology*
  • Prognosis
  • Recurrence
  • Time Factors

Substances

  • Antibodies, Antineutrophil Cytoplasmic
  • Autoantibodies
  • Biomarkers