Impact of Various ANA Results and ANCA Serotypes on the Outcome of Patients with ANCA-Associated Vasculitis

Abstract

Aim: We aimed to demostrate how antinuclear antibody (ANA) and ANCA serotypes affect ANCA-associated vasculitis (AAV) patients' results. Material method: This retrospective cohort analysis analyzed 10,726 Turkish tertiary hospital serum samples over 4.5 years. ANCA indirect immunofluorescence test (IIF) and ANCA Enzyme-Linked Immunosorbent Assay (ELISA) testing were requested by all patients. Results: Among 10,726 patients, there were 920 patients with positive ANCA IIF and/or ANCA ELISA test. Of the 920 patients, 18 of the 98 patients with AAV were concomitant connective tissue patients, so 80 AAV patients were included in the study. Organ involvement in these very rare patients was pulmonary (63.75%), ear-nose-throat (43.75%), renal (38.75%), joint (38.75%), skin (20%), neurological (20%), ocular (17.5%), gastrointestinal (11.25%), and cardiac (2.5%) systems. Proteinuria (51.25%), renal biopsy (48.75%), hematuria (37.5%), hypertension (56.25%), chronic renal failure (36.25%), diabetes (21.25%), coronary artery disease (10%), and asthma (8.75%) were present. ANA was found in 42.5% of 80 patients. Renal involvement and coronary artery disease were more common in ANA-positive patients (p =.0,14 and p=0.50). ANA-negative patients had higher ear, nose, and throat involvement (p=.026). PR3–ANCA individuals had higher ocular involvement (p =.020). In MPO-ANCA individuals, asthma was more common (p=.002). Conclusion: AAV patients with ANA had more renal impairment than those without. Renal biopsy is recommended to distinguish AAV from systemic lupus erythematosus. Eye morbidity is greater in PR3-ANCA. The effects of ANA and ANCA serotypes in AAV patients need more study.

Keywords

• Antinuclear antibody
• Antineutrophil cytoplasmic antibody
• vasculitis
• organ involvement

ANCA İlişkili Vaskülitli Hastaların Sonuçlarına Çeşitli ANA Sonuçlarının ve ANCA Serotiplerinin Etkisi

Öz

Amaç: Bu çalışmada, antinükleer antikor (ANA) ve antinötrofil sitoplazmik antikor (ANCA) serotiplerinin ANCA ile ilişkili vaskülit (AAV) hastalarının sonuçlarını nasıl etkilediğini göstermeyi amaçladık. Gereç ve yöntem: Bu retrospektif kohort analizi, 4,5 yıl boyunca üçüncü basamak bir hastanede 10.726 serum örneğini analiz etmiştir. Tüm hastalardan ANCA indirekt immünofloresan testi (IIF) ve Enzim-Linked İmmünosorbent Assay (ELISA) istenmiştir. Bulgular: 10.726 hasta arasında, ANCA IIF ve/veya ANCA ELISA testi pozitif olan 920 hasta vardı. 920 hastanın 98'i AAV hastasıydı ve bunların 18'i eşlik eden bağ dokusu hastasıydı, bu nedenle 80 AAV hastası çalışmaya dahil edildi. Çok nadir görülen bu hastaların organ tutulumu pulmoner (%63,75), kulak-burun-boğaz (%43,75), renal (%38,75), eklem (%38,75), deri (%20), nörolojik (%20), oküler (%17,5), gastrointestinal (11,25%) ve kardiyak (2,5%) olmuştur . Proteinüri (%51,25), böbrek biyopsisi (%48,75), hematüri (%37,5), hipertansiyon (%56,25), kronik böbrek yetmezliği (%36,25), diyabet (%21,25), koroner arter hastalığı (%10) ve astım (%8,75) mevcuttu. ANA, 80 hastanın %42,5'inde saptandı. ANA pozitif hastalarda böbrek tutulumu ve koroner arter hastalığı daha yaygındı (p = 0,14 ve p = 0,50). ANA negatif hastalarda kulak, burun ve boğaz tutulumu daha yüksekti (p = 0,026). PR3-ANCA'lı bireylerde göz tutulumu daha yüksekti (p = 0,020). MPO-ANCA bireylerde astım daha yaygındı (p=.002). Sonuç: ANA'lı AAV hastalarında, ANA'sız hastalara göre böbrek yetmezliği daha yaygındı. AAV'yi sistemik lupus eritematozusdan ayırt etmek için böbrek biyopsisi önerilir. Göz morbiditesi PR3-ANCA'da daha yüksektir. AAV hastalarında ANA ve ANCA serotiplerinin etkileri daha fazla araştırılmalıdır.

Anahtar Kelimeler

• Antinükleer antikor
• Antinötrofil sitoplazmik antikor
• vaskülit
• organ tutulumu.

Kaynakça

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