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Most proteinase3- and myeloperoxidase-antineutrophil cytoplasmic antibodies enzyme-linked immunosorbent assays perform less well in treated small-vessel vasculitis than in active disease

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Savige J, Trevisin M, Hayman M, Pollock W. Most proteinase 3- and myeloperoxidase-antineutrophil cytoplasmic antibodies enzyme-linked immunosorbent assays perform less well in treated small-vessel vasculitis than in active disease. APMIS 2009; 177: 60–2.

Antineutrophil cytoplasmic antibodies (ANCA) levels have been thought to follow disease activity, with levels being high at presentation, declining with treatment and increasing just before relapse. However, we have shown that ANCA often persist for many years in patients with clinically inactive Wegener's granulomatosis. ANCA assays are less sensitive for treated disease than for active disease, and the levels in treated patients produce different results in different assay systems. ANCA often persist for years without relapse, and the risk of relapse probably depend on levels that are critical for any individual patient. The capture enzyme-linked immunosorbent assays may be more sensitive in detecting early relapse. Relapse is more common when ANCA levels are high but, although elevated, ANCA levels are lower in relapse than at presentation. Standardized ANCA levels for the definitions of remission and relapse may not be possible, and the optimal ANCA testing protocol for treated disease remains unclear.
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Keywords: Antineutrophil cytoplasmic antibodies; Wegener granulomatosis; microscopic polyangiitis; myeloperoxidase; proteinase 3

Document Type: Research Article

Affiliations: 1: Department of Medicine (Northern Health), The Northern Hospital, The University of Melbourne, Epping VIC 3076, Australia; and 2: Canterbury Health Laboratories, Canterbury District Health Board, Christchurch, New Zealand

Publication date: 01 June 2009

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