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Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study

BACKGROUND: The clinical characteristics of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) positive granulomatosis with polyangiitis (GPA) remain unclear, as does the difference between MPO-ANCA positive GPA and proteinase 3 (PR3)-ANCA positive GPA, especially with regard to the deta...

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Autores principales: Ikeda, Satoshi, Arita, Machiko, Misaki, Kenta, Kashiwagi, Yumiko, Ito, Yuhei, Yamada, Hirotaka, Hotta, Machiko, Nishiyama, Akihiro, Ito, Akihiro, Noyama, Maki, Koyama, Takashi, Notohara, Kenji, Ishida, Tadashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520074/
https://www.ncbi.nlm.nih.gov/pubmed/26223225
http://dx.doi.org/10.1186/s12890-015-0068-1
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author Ikeda, Satoshi
Arita, Machiko
Misaki, Kenta
Kashiwagi, Yumiko
Ito, Yuhei
Yamada, Hirotaka
Hotta, Machiko
Nishiyama, Akihiro
Ito, Akihiro
Noyama, Maki
Koyama, Takashi
Notohara, Kenji
Ishida, Tadashi
author_facet Ikeda, Satoshi
Arita, Machiko
Misaki, Kenta
Kashiwagi, Yumiko
Ito, Yuhei
Yamada, Hirotaka
Hotta, Machiko
Nishiyama, Akihiro
Ito, Akihiro
Noyama, Maki
Koyama, Takashi
Notohara, Kenji
Ishida, Tadashi
author_sort Ikeda, Satoshi
collection PubMed
description BACKGROUND: The clinical characteristics of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) positive granulomatosis with polyangiitis (GPA) remain unclear, as does the difference between MPO-ANCA positive GPA and proteinase 3 (PR3)-ANCA positive GPA, especially with regard to the details of respiratory tract involvement. We investigated the differences in clinical, radiological, and histopathological features between PR3-ANCA positive GPA and MPO-ANCA positive GPA. METHODS: We retrospectively reviewed 16 patients who were newly diagnosed with GPA between December 2000 and July 2014. One patient, who was positive for both PR3-ANCA and MPO-ANCA, was excluded. Our review was based on the European Medicine Agency (EMA) algorithm. RESULTS: Fifty-six percent of GPA patients were positive for PR3-ANCA, 38 % for MPO-ANCA, and the remaining 6 % for both. The MPO-ANCA positive group included a greater number of females (67 %). There were no statistically significant differences in laboratory data, symptoms and signs, Birmingham Vasculitis Activity Score, or CT findings between the two groups. As for upper respiratory tract involvement, the most common manifestation was paranasal sinusitis, whereas lung nodules were most common as the lower respiratory tract involvement in both groups. Although the combination therapy with prednisone and cyclophosphamide was the most common initial treatment in both groups, the relapse rate in MPO-ANCA positive cases was lower than that of PR3-ANCA positive cases (17 % and 56 %, respectively). CONCLUSION: A high prevalence of MPO-ANCA positive GPA was noted. No significant differences in clinico-radiological findings were observed except for the prevalence of relapse between the PR3-ANCA positive cases and MPO-ANCA positive cases, suggesting that the type of ANCA may be of little help in the diagnosis of GPA. Examination for granulomatous findings in the respiratory tract is important, even in MPO-ANCA positive cases. There is a need to accumulate more cases and conduct a further investigation in the future.
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spelling pubmed-45200742015-07-31 Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study Ikeda, Satoshi Arita, Machiko Misaki, Kenta Kashiwagi, Yumiko Ito, Yuhei Yamada, Hirotaka Hotta, Machiko Nishiyama, Akihiro Ito, Akihiro Noyama, Maki Koyama, Takashi Notohara, Kenji Ishida, Tadashi BMC Pulm Med Research Article BACKGROUND: The clinical characteristics of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) positive granulomatosis with polyangiitis (GPA) remain unclear, as does the difference between MPO-ANCA positive GPA and proteinase 3 (PR3)-ANCA positive GPA, especially with regard to the details of respiratory tract involvement. We investigated the differences in clinical, radiological, and histopathological features between PR3-ANCA positive GPA and MPO-ANCA positive GPA. METHODS: We retrospectively reviewed 16 patients who were newly diagnosed with GPA between December 2000 and July 2014. One patient, who was positive for both PR3-ANCA and MPO-ANCA, was excluded. Our review was based on the European Medicine Agency (EMA) algorithm. RESULTS: Fifty-six percent of GPA patients were positive for PR3-ANCA, 38 % for MPO-ANCA, and the remaining 6 % for both. The MPO-ANCA positive group included a greater number of females (67 %). There were no statistically significant differences in laboratory data, symptoms and signs, Birmingham Vasculitis Activity Score, or CT findings between the two groups. As for upper respiratory tract involvement, the most common manifestation was paranasal sinusitis, whereas lung nodules were most common as the lower respiratory tract involvement in both groups. Although the combination therapy with prednisone and cyclophosphamide was the most common initial treatment in both groups, the relapse rate in MPO-ANCA positive cases was lower than that of PR3-ANCA positive cases (17 % and 56 %, respectively). CONCLUSION: A high prevalence of MPO-ANCA positive GPA was noted. No significant differences in clinico-radiological findings were observed except for the prevalence of relapse between the PR3-ANCA positive cases and MPO-ANCA positive cases, suggesting that the type of ANCA may be of little help in the diagnosis of GPA. Examination for granulomatous findings in the respiratory tract is important, even in MPO-ANCA positive cases. There is a need to accumulate more cases and conduct a further investigation in the future. BioMed Central 2015-07-30 /pmc/articles/PMC4520074/ /pubmed/26223225 http://dx.doi.org/10.1186/s12890-015-0068-1 Text en © Ikeda et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ikeda, Satoshi
Arita, Machiko
Misaki, Kenta
Kashiwagi, Yumiko
Ito, Yuhei
Yamada, Hirotaka
Hotta, Machiko
Nishiyama, Akihiro
Ito, Akihiro
Noyama, Maki
Koyama, Takashi
Notohara, Kenji
Ishida, Tadashi
Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study
title Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study
title_full Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study
title_fullStr Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study
title_full_unstemmed Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study
title_short Comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between PR3-ANCA positive and MPO-ANCA positive cases: a retrospective cohort study
title_sort comparative investigation of respiratory tract involvement in granulomatosis with polyangiitis between pr3-anca positive and mpo-anca positive cases: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520074/
https://www.ncbi.nlm.nih.gov/pubmed/26223225
http://dx.doi.org/10.1186/s12890-015-0068-1
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