Clinical applications of antineutrophil cytoplasmic antibody testing.

Abstract

PURPOSE OF REVIEW:

Antineutrophil cytoplasmic antibodies are closely associated with Wegener granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome and have contributed to new pathogenetic concepts and improved nomenclature of systemic vasculitides (antineutrophil cytoplasmic antibody-associated vasculitides). However, the application of antineutrophil cytoplasmic antibody testing as a clinical diagnostic tool is still regarded as controversial. This review summarizes the most recent developments in the field, identifies areas of uncertainty, and gives practical guidelines.

RECENT FINDINGS:

The problems of antineutrophil cytoplasmic antibody testing include the diversity of antineutrophil cytoplasmic antibody target antigens, assay standardization and performance, the application of antineutrophil cytoplasmic antibody testing in a clinical setting with a low pretest probability, and, finally, the widespread assumption that antineutrophil cytoplasmic antibody titers alone may closely reflect disease activity and therefore may be used to guide therapy.

SUMMARY:

Recent findings demonstrate that the combined use of indirect immunofluorescence tests and solid phase assays to detect antineutrophil cytoplasmic antibody directed against myeloperoxidase and proteinase 3 can minimize the occurrence of false-positive antineutrophil cytoplasmic antibody results. Furthermore, the yield of antineutrophil cytoplasmic antibody testing can be improved by the use of a well-standardized test, adherence to published guidelines, and restricting the use of the tests to clinical situations with a rather high pretest probability for antineutrophil cytoplasmic antibody-associated vasculitides. However, treatment decisions should be based on the clinical presentation of the patient and histologic findings and not on the results of antineutrophil cytoplasmic antibody testing alone.

• Authors: Wilhelm H Schmitt, Fokko J van der Woude
• Journal: Current opinion in rheumatology (Curr Opin Rheumatol) Vol. 16 Issue 1 Pg. 9-17 (Jan 2004) ISSN: 1040-8711 [Print] United States
• PMID: 14673383 (Publication Type: Journal Article, Review)

Chemical References

• Antibodies, Antineutrophil Cytoplasmic

Topics

• Antibodies, Antineutrophil Cytoplasmic (analysis, immunology)
• Disease-Free Survival
• Enzyme-Linked Immunosorbent Assay
• Fluorescent Antibody Technique, Indirect
• Granulomatosis with Polyangiitis (immunology)
• Humans
• Predictive Value of Tests
• Sensitivity and Specificity
• Vasculitis (immunology)