Changes in proteinase 3 anti-neutrophil cytoplasm autoantibody levels in early systemic granulomatosis with polyangiitis (Wegener's) may reflect treatment rather than disease activity

N. Rasmussen*, A. Salmela, A. Ekstrand, K. de Groot, G. Gregorini, J. W. Cohen Tervaert, W. L. Gross, A. Wiik, D. R. W. Jayne

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Web of Science)

Abstract

Objective. To investigate the nature of the relationship between proteinase 3 anti-neutrophil cytoplasm autoantibody (PR3-ANCA) and relapse in patients with early systemic granulomatosis with polyangiitis (Wegener's) (GPA).Methods. Clinical data from 16 relapsing and 12 non-relapsing patients with early systemic GPA from a randomised clinical trial were correlated to monthly PR3-ANCA values over 18 months. Each sample was examined using 9 different enzyme-linked immunosorbent assays (ELISAs) to ensure reliability of ANCA results. PR3-ANCA peaks were identified by the highest sum of logarithmic transformation values from all assays in samples after remission.Results. A PR3-ANCA peak was identified in all relapsing and non-relapsing patients and coincided with relapse in all 14 evaluable relapsing patients. The monthly increment before the peak, however, was similar in relapsing and non-relapsing patients in all assays. Increments from remission to peak were higher in relapsing patients in 219 assays. PR3-ANCA values at entry and peak PR3-ANCA values were higher in relapsing patients in 319 and 219 assays, respectively. However, large overlaps of PR3-ANCA values prevented a distinction between relapsing and non-relapsing patients. The median time to reach peak values was 14 months in relapsing and 12 months in non-relapsing patients with scheduled termination of treatment at 12 months.Conclusion. The predictive value for relapses of PR3-ANCA determinations confirm and extend previous reports. Although all relapses were related to PR3-ANCA increases, reduction or withdrawal of immunosuppression without relapse was also related to increases and may explain the lack of predictive value of sequential PR3-ANCA determinations.
Original languageEnglish
Pages (from-to)S38-S44
JournalClinical and Experimental Rheumatology
Volume31
Issue number1
Publication statusPublished - 2013

Keywords

  • antineutrophil cytoplasmic autoantibodies
  • Wegener's granulomatosis
  • granulomatosis with polyangiitis (Wegener's)
  • disease activity
  • ELISA

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