c-ANCA as a marker of Wegener's disease

• Published in: The Lancet (British edition) 1996-01, Vol.347 (8994), p.115-118
• Main Authors: Unsworth, D.J., Tomson, C.R.V., Lock, R.J., Wallington, T.B., Feest, T.G., Franssen, C.F.M., Cohen Tervaert, J.W., Stegeman, C.A., Kallenberg, C.G.M., Niles, JohnL, McCluskey, RobertT, Clark, HeatherE, Bosch, Xavier, Urbano-Márquez, Alvaro, Malnick, StephenD.H., Bass, DanielD, Sthoeger, ZevM, Rao, JayaK, Weinberger, Morris, Allen, NancyB, Feussner, JohnR
• Format: Article
• Language: English
• Subjects: Aged; Antibodies, Antineutrophil Cytoplasmic; Antigens; Antineutrophil cytoplasmic antibodies; Autoantibodies - blood; Biomarkers; Biomarkers - blood; Diagnosis, Differential; Gangrene; Granulomatosis with Polyangiitis - immunology; Health services; Humans; Immunoglobulins; Immunology; Inflammatory diseases; Kidney Papillary Necrosis - blood; Laboratories; Lung cancer; Lupus; Male; Middle Aged; Neutrophils; Patients; Predictive Value of Tests; R&D; Research & development; Rheumatoid arthritis; Rheumatology; Sensitivity and Specificity
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(96)90240-8

[...]heating of sera may induce a c-ANCA pattern which is not produced by anti-PR,. · Unfortunately, Rao and colleagues did not test their sera by an antigen-specific test, such as ELISA, for the presence of anti-PR, antibodies.Rao and colleagues seem to have overlooked antimyeloperoxidase-antibody-associated necrotising small vessel vasculitis, including cases with biopsy-proven Wegener's granulomatosis.Since 1985, we and others have studied prospectively the associations between ANCA, both with respect to fluorescence patterns and antigenic specificities, and the primary vasculitides, including Wegener's.4 On the basis of those analyses of hundreds of patients with vasculitides and other inflammatory disorders the presence of anti-PR, antibodies has high sensitivity, as well as specificity, for a diagnosis of Wegener's granulomatosis.According to the criteria followed by the authors, a patient having both lung cancer and renal calculi can be clinically diagnosed with Wegener's granulomatosis.[...]we performed the study prospectively in patients with suspected vasculitis because this clinical spectrum represents the way that many participating clinicians use ANCA: to evaluate patients for whom Wegener's granulomatosis is a possible, but not certain, diagnosis.