HER ANTİ NÖTROFİL SİTOPLAZMİK ANTİKOR (ANCA) POZİTİFLİĞİ ROMATOLOJİK HASTALIKLA İLİŞKİLİ MİDİR?

Öz

Amaç: Anti-nötrofil sitoplazmik antikor (ANCA) saptanan hastalarda romatolojik hastalık saptanma oranını ve ANCA ilişkili vaskülit (AİV) dışında ANCA pozitifliğine yol açan diğer durumları belirlemeyi amaçladık. Gereç ve Yöntemler: İstanbul Medeniyet Üniversitesi, Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi Romatoloji polikliniğinde Ocak 2023-Kasım 2024 tarihleri arasında ANCA pozitifliği nedeniyle değerlendirilen 18-90 yaş aralığındaki 76 erişkin geriye dönük değerlendirildi. Hastaların demografik verileri, ANCA titresi ve paterni, diğer laboratuvar parametreleri, romatolojik olarak değerlendirilmesi neticesindeki nihai tanıları kaydedildi. Romatolojik hastalık tanısı alan hastalar grup 1, almayanlar ise grup 2 olarak sınıflandırıldı. Bulgular: 76 hasta retrospektif olarak değerlendirildi. Hastaların 51’i (%67) kadın, 25’i (%33) erkek idi. Hastaların ortanca yaşı 60,5’ti (min-max:24-84). 40 (%52,6) hastada p- ANCA, 10 (%13,2) hastada c-ANCA saptanırken, 21’inde (%22,6) MPO ANCA, 33’ünde (%43,6) PR3 ANCA pozitifti. 39’u (%51,3) romatolojik hastalık tanısı aldı, bunların 23’ü (%30,3) AİV idi. İki enfektif endokardit, birer hastada akciğer kanseri, tüberküloz, ülseratif kolit ve kronik ürtiker saptandı. Grup 1’de PR3 ANCA titresi, sedimentasyon ve CRP değerleri Grup 2’ye göre anlamlı olarak daha yüksekti (sırasıyla p<0,0001, p=0,017 ve p=0,005). Sonuç: ANCA testi AİV için spesifik olmayıp diğer inflamatuar hastalıklarda, enfektif patolojilerde tespit edebilir. O nedenle ANCA bir tarama testi olmayıp vaskülit şüphesi olan olgularda istenmeli ve klinik bulgular eşliğinde değerlendirilmelidir.

Anahtar Kelimeler

• Antinötrofil sitoplazmik antikor
• c-ANCA
• p-ANCA
• anti-nötrofil sitoplazmik antikor-ilişkili vaskülit

Destekleyen Kurum

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Etik Beyan

Medipol Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan 02.09.2024 tarihinde E-10840098-202.3.02-5272 no’lu karar ile alınmıştır.

Teşekkür

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Is Every Anti-Neutrophil Cytoplasmic Antibody (ANCA) Positivity Associated With Rheumatologic Disease?

Öz

Objective: We aimed to determine the rate of rheumatological disease detection in patients with anti-neutrophil cytoplasmic antibody (ANCA) and other conditions that lead to ANCA positivity other than ANCA-associated vasculitis (AIV). Material and Methods: A retrospective evaluation was made of 76 adults aged 18-90 years who were evaluated for ANCA positivity at the Rheumatology Clinic of İstanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital between January 2023 and November 2024. Demographic parameters, ANCA titer and pattern, other laboratory values, and final diagnoses as a result of rheumatological evaluation of the patients were recorded. Patients diagnosed with rheumatological diseases were classified as group 1, and patients without were classified as group 2. Results: Seventy-six patients were evaluated retrospectively. Fifty-one (67%) patients were female and 25 (33%) were male. The median age of the patients was 60.5 (min-max:24-84). p- ANCA was detected in 40 patients (52.6%), c-ANCA was detected in 10 (13.2%), MPO ANCA was positive in 21 (22.6%), and PR3 ANCA was positive in 33 (43.6%). 39 (51.3%) were diagnosed with rheumatologic disease, 23 of which were AIV. Infective endocarditis was detected in two patients, and lung cancer, tuberculosis, ulcerative colitis, and chronic urticaria were detected in one patient each. PR3 ANCA titer, sedimentation and CRP values were significantly higher in Group 1 than in Group 2 (p<0.0001, p=0.017 and p=0.005, respectively). Conclusion: ANCA test is not specific for AAV and can detect other inflammatory diseases and infectious pathologies. Therefore, ANCA is not a screening test and should be requested in cases of suspected vasculitis and evaluated with clinical findings.

Anahtar Kelimeler

• Antineutrophil cytoplasmic antibodies
• c-ANCA
• p-ANCA
• anti-neutrophil cytoplasmic antibody-associated vasculitis

Kaynakça

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