| Title | Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs: comparison with idiopathic ANCA vasculitides. | | Author(s) | Bonaci-Nikolic B, Nikolic MM, Andrejevic S, Zoric S, Bukilica M | | Institution | Institute of Allergy and Clinical Immunology, Clinical Centre of Serbia, Belgrade, Serbia and Montenegro. branka_bonaci@yahoo.com | | Source | Arthritis Res Ther 2005; 7(5):R1072-81. | | MeSH | Adolescent
Adult
Aged
Antibodies, Antineutrophil Cytoplasmic
Antibody Specificity
Antithyroid Agents
Autoantigens
Autoimmune Diseases
Churg-Strauss Syndrome
Comparative Study
Cyclophosphamide
Female
Fluorescent Antibody Technique, Indirect
Follow-Up Studies
Graves Disease
Hashimoto Disease
Humans
Hyperthyroidism
Immunoprecipitation
Kidney
Lung
Male
Methimazole
Middle Aged
Nephelometry and Turbidimetry
Peroxidase
Polyarteritis Nodosa
Prednisone
Pregnancy
Pregnancy Complications
Propylthiouracil
Retrospective Studies
Serine Endopeptidases
Skin
Vasculitis
Vasculitis, Hypersensitivity
Wegener's Granulomatosis
| | Abstract | Clinical and serological profiles of idiopathic and drug-induced autoimmune diseases can be very similar. We compared data from idiopathic and antithyroid drug (ATD)-induced antineutrophil cytoplasmic antibody (ANCA)-positive patients. From 1993 to 2003, 2474 patients were tested for ANCA in the Laboratory for Allergy and Clinical Immunology in Belgrade. Out of 2474 patients, 72 (2.9%) were anti-proteinase 3 (PR3)- or anti-myeloperoxidase (MPO)-positive and their clinical and serological data were analyzed. The first group consisted of ANCA-associated idiopathic systemic vasculitis (ISV) diagnosed in 56/72 patients: 29 Wegener's granulomatosis (WG), 23 microscopic polyangiitis (MPA) and four Churg-Strauss syndrome. The second group consisted of 16/72 patients who became ANCA-positive during ATD therapy (12 receiving propylthiouracil and four receiving methimazole). We determined ANCA and antinuclear (ANA) antibodies by indirect immunofluorescence; PR3-ANCA, MPO-ANCA, anticardiolipin (aCL) and antihistone antibodies (AHA) by ELISA; and cryoglobulins by precipitation. Complement components C3 and C4, alpha-1 antitrypsin (alpha1 AT) and C reactive protein (CR-P) were measured by nephelometry. Renal lesions were present in 3/16 (18.8%) ATD-treated patients and in 42/56 (75%) ISV patients (p <0.001). Skin lesions occurred in 10/16 (62.5%) ATD-treated patients and 14/56 (25%) ISV patients (p <0.01). ATD-treated patients more frequently had MPO-ANCA, ANA, AHA, aCL, cryoglobulins and low C4 (p <0.01). ISV patients more frequently had low alpha1 AT (p = 0.059) and high CR-P (p <0.001). Of 16 ATD-treated patients, four had drug-induced ANCA vasculitis (three MPA and one WG), while 12 had lupus-like disease (LLD). Of 56 ISV patients, 13 died and eight developed terminal renal failure (TRF). There was no lethality in the ATD-treated group, but 1/16 with methimazole-induced MPA developed pulmonary-renal syndrome with progression to TRF. ANCA-positive ISV had a more severe course in comparison with ATD-induced ANCA-positive diseases. Clinically and serologically ANCA-positive ATD-treated patients can be divided into two groups: the first consisting of patients with drug-induced WG or MPA which resemble ISV and the second consisting of patients with LLD. Different serological profiles could help in the differential diagnosis and adequate therapeutic approach to ANCA-positive ATD-treated patients with symptoms of systemic disease. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 16207324 |
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