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. 1995 Oct;71(840):605–612. doi: 10.1136/pgmj.71.840.605

An audit of ANCA in routine clinical practice.

J D Edgar 1, S A McMillan 1, I N Bruce 1, S K Conlan 1
PMCID: PMC2398263  PMID: 8545289

Abstract

We have reviewed the medical records of 301/327 consecutive patients in whom anti-neutrophil cytoplasmic antibodies (ANCA) were detected by the Regional Immunology Laboratory in Northern Ireland between January 1988 and October 1991 (45 months). We have collected data for each patient regarding age, sex, smoking habit, area of residence, and details of any other autoantibody activity. Clinical diagnosis was established, with the number of organ systems involved and the evidence for that involvement (symptomatic, biochemical, radiological, and histological). Diagnoses were divided into four groups according to their recognised vasculitic features and these were related to the pattern of immunofluorescence and maximum ANCA titre detected. The most frequent diagnosis was rheumatoid arthritis (18.2% of patients) and the connective tissue disorders as a whole accounted for 27.9% of patients. ANCA were also detected in a wide range of clinical conditions which are not associated with vasculitis and these patients were an important source of 'false-positives'. The positive predictive value (PPV) of ANCA of all patterns and titres for vasculitic conditions was 27%, however, the detection of a classical ANCA pattern at high titre (> or = 1:640) was associated with an increased PPV of 75%. The coexistence of an antinuclear antibody (ANA) reduces the PPV of both classical and perinuclear ANCA, although perinuclear ANCA with antimyeloperoxidase specificity had an improved PPV. We conclude that ANCA testing should not be used as the only screening investigation for vasculitis but should be included in a rational investigative scheme. The interpretation of a positive ANCA result must take into account the presence of other autoantibodies and the full range of non-vasculitic conditions when the clinical situation is not typical of vasculitis.

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Selected References

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  1. Coremans I. E., Hagen E. C., van der Voort E. A., van der Woude F. J., Daha M. R., Breedveld F. C. Autoantibodies to neutrophil cytoplasmic enzymes in Felty's syndrome. Clin Exp Rheumatol. 1993 May-Jun;11(3):255–262. [PubMed] [Google Scholar]
  2. Davenport A., Lock R. J., Wallington T. B., Feest T. G. Clinical significance of anti-neutrophil cytoplasm antibodies detected by a standardized indirect immunofluorescence assay. Q J Med. 1994 May;87(5):291–299. [PubMed] [Google Scholar]
  3. Davies D. J., Moran J. E., Niall J. F., Ryan G. B. Segmental necrotising glomerulonephritis with antineutrophil antibody: possible arbovirus aetiology? 1982 Aug 28-Sep 4Br Med J (Clin Res Ed) 285(6342):606–606. doi: 10.1136/bmj.285.6342.606. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Edgar J. D., Bell A. L., Conlan S. K., McMillan S. A. Antineutrophil cytoplasmic antibodies in rheumatoid arthritis. Br J Rheumatol. 1992 Dec;31(12):859–860. doi: 10.1093/rheumatology/31.12.859. [DOI] [PubMed] [Google Scholar]
  5. Edgar J. D., Rooney D. P., McNamee P., McNeill T. A. An association between ANCA positive renal disease and malignancy. Clin Nephrol. 1993 Jul;40(1):22–25. [PubMed] [Google Scholar]
  6. Efthimiou J., Spickett G., Lane D., Thompson A. Antineutrophil cytoplasmic antibodies, cystic fibrosis, and infection. Lancet. 1991 Apr 27;337(8748):1037–1038. doi: 10.1016/0140-6736(91)92694-w. [DOI] [PubMed] [Google Scholar]
  7. Ewert B. H., Jennette J. C., Falk R. J. The pathogenic role of antineutrophil cytoplasmic autoantibodies. Am J Kidney Dis. 1991 Aug;18(2):188–195. doi: 10.1016/s0272-6386(12)80879-1. [DOI] [PubMed] [Google Scholar]
  8. Falk R. J., Terrell R. S., Charles L. A., Jennette J. C. Anti-neutrophil cytoplasmic autoantibodies induce neutrophils to degranulate and produce oxygen radicals in vitro. Proc Natl Acad Sci U S A. 1990 Jun;87(11):4115–4119. doi: 10.1073/pnas.87.11.4115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gross W. L., Csernok E., Schmitt W. H. Antineutrophil cytoplasmic autoantibodies: immunobiological aspects. Klin Wochenschr. 1991 Sep 3;69(13):558–566. doi: 10.1007/BF01649318. [DOI] [PubMed] [Google Scholar]
  10. Gross W. L., Hauschild S., Mistry N. The clinical relevance of ANCA in vasculitis. Clin Exp Immunol. 1993 Sep;93 (Suppl 1):7–11. doi: 10.1111/j.1365-2249.1993.tb06215.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gross W. L., Schmitt W. H., Csernok E. ANCA and associated diseases: immunodiagnostic and pathogenetic aspects. Clin Exp Immunol. 1993 Jan;91(1):1–12. doi: 10.1111/j.1365-2249.1993.tb03345.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jennette J. C., Falk R. J. Antineutrophil cytoplasmic autoantibodies and associated diseases: a review. Am J Kidney Dis. 1990 Jun;15(6):517–529. doi: 10.1016/s0272-6386(12)80521-x. [DOI] [PubMed] [Google Scholar]
  13. Juby A., Johnston C., Davis P., Russell A. S. Antinuclear and antineutrophil cytoplasmic antibodies (ANCA) in the sera of patients with Felty's syndrome. Br J Rheumatol. 1992 Mar;31(3):185–188. doi: 10.1093/rheumatology/31.3.185. [DOI] [PubMed] [Google Scholar]
  14. Lawrence M., Griew K., Derry J., Anderson J., Humphreys J. Auditing audits: use and development of the Oxfordshire Medical Audit Advisory Group rating system. BMJ. 1994 Aug 20;309(6953):513–516. doi: 10.1136/bmj.309.6953.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ramírez G., Khamashta M. A., Hughes G. R. The ANCA test: its clinical relevance. Ann Rheum Dis. 1990 Oct;49(10):741–742. doi: 10.1136/ard.49.10.741. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rump J. A., Schölmerich J., Gross V., Roth M., Helfesrieder R., Rautmann A., Lüdemann J., Gross W. L., Peter H. H. A new type of perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) in active ulcerative colitis but not in Crohn's disease. Immunobiology. 1990 Nov;181(4-5):406–413. doi: 10.1016/S0171-2985(11)80509-7. [DOI] [PubMed] [Google Scholar]
  17. Saxon A., Shanahan F., Landers C., Ganz T., Targan S. A distinct subset of antineutrophil cytoplasmic antibodies is associated with inflammatory bowel disease. J Allergy Clin Immunol. 1990 Aug;86(2):202–210. doi: 10.1016/s0091-6749(05)80067-3. [DOI] [PubMed] [Google Scholar]
  18. Schmitt W. H., Csernok E., Gross W. L. ANCA and infection. Lancet. 1991 Jun 8;337(8754):1416–1417. doi: 10.1016/0140-6736(91)93102-f. [DOI] [PubMed] [Google Scholar]
  19. Tervaert J. W., Huitema M. G., Hené R. J., Sluiter W. J., The T. H., van der Hem G. K., Kallenberg C. G. Prevention of relapses in Wegener's granulomatosis by treatment based on antineutrophil cytoplasmic antibody titre. Lancet. 1990 Sep 22;336(8717):709–711. doi: 10.1016/0140-6736(90)92205-v. [DOI] [PubMed] [Google Scholar]
  20. van der Woude F. J., Rasmussen N., Lobatto S., Wiik A., Permin H., van Es L. A., van der Giessen M., van der Hem G. K., The T. H. Autoantibodies against neutrophils and monocytes: tool for diagnosis and marker of disease activity in Wegener's granulomatosis. Lancet. 1985 Feb 23;1(8426):425–429. doi: 10.1016/s0140-6736(85)91147-x. [DOI] [PubMed] [Google Scholar]

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