Clinical significance of myeloperoxidase-anti-neutrophil cytoplasmic antibody in idiopathic interstitial pneumonias

Hozumi, Hironao; Oyama, Yoshiyuki; Yasui, Hideki; Suzuki, Yuzo; Kono, Masato; Karayama, Masato; Furuhashi, Kazuki; Enomoto, Noriyuki; Fujisawa, Tomoyuki; Inui, Naoki; Nakamura, Yutaro; Suda, Takafumi

doi:10.1371/journal.pone.0199659

Cited by 51 publications

(50 citation statements)

References 21 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interstitial lung disease (ILD) is increasingly observed in association with MPO-ANCA antibodies with or without other manifestations of AAV 139140141. Whereas treatment of ILD in patients with other AAV manifestations follows the typical approaches described earlier, the management of ILD and a positive ANCA test without other AAV manifestations is uncertain.…”

Section: Treatment Challenges Associated With Specific Manifestationsmentioning

confidence: 99%

Management of ANCA associated vasculitis

Wallace

Miloslavsky

2020

BMJ

View full text Add to dashboard Cite

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a small to medium vessel vasculitis associated with excess morbidity and mortality. This review explores how management of AAV has evolved over the past two decades with pivotal randomized controlled trials shaping the management of induction and maintenance of remission. Contemporary AAV care is characterized by approaches that minimize the cumulative exposure to cyclophosphamide and glucocorticoids, increasingly use rituximab for remission induction and maintenance, and consider therapies with less toxicity (for example, methotrexate, mycophenolate mofetil) for manifestations of AAV that do not threaten organ function or survival. Simultaneously, improvements in outcomes, such as renal and overall survival, have been observed. Additional trials and observational studies evaluating the comparative effectiveness of agents for AAV in various patient subgroups are needed. Prospective studies are necessary to assess the effect of psychosocial interventions on patient reported outcomes in AAV. Despite the expanding array of treatments for AAV, little guidance on how to personalize AAV care is available to physicians.

show abstract

Section: Treatment Challenges Associated With Specific Manifestationsmentioning

confidence: 99%

Management of ANCA associated vasculitis

Wallace

Miloslavsky

2020

BMJ

View full text Add to dashboard Cite

show abstract

“…The association of IP and ANCA does not seem to be fortuitous . Hironao Hozumi et al found that MPO‐ANCA positivity was associated with subsequent MPA development in patients initially diagnosed with IIP, especially those with UIP pattern on HRCT. If patients with IP are found to have positive MPO‐ANCA, there may be two possibilities, on the one hand, MPO‐ANCA may play a part in the development of IP, on the other hand, fibrotic process may induce production of the MPO‐ANCA .…”

Section: Discussionmentioning

confidence: 99%

Clinical features and prognosis of microscopic polyangiitis with usual interstitial pneumonia compared with idiopathic pulmonary fibrosis

Zhao

Dai

Liu

et al. 2019

Clinical Respiratory J

View full text Add to dashboard Cite

Introduction Pulmonary involvement in microscopic polyangiitis (MPA) is common, little is known about the clinical features of MPA with interstitial pneumonia (MPA‐IP). Objectives This study aimed to explore the prevalence of microscopic polyangiitis associated usual interstitial pneumonia (UIP)(MPA‐UIP) and compare its clinical features and prognosis with those of MPA‐non‐UIP and idiopathic pulmonary fibrosis (IPF). Methods A total of 73 patients with MPA‐IP were identified and divided into MPA‐UIP patients and MPA‐non‐UIP patients. The clinical characteristics and survival of MPA‐UIP patients were analysed and compared with those of MPA‐non‐UIP patients and 68 patients with IPF. Results The results showed that 34/73 (47%) MPA‐IP patients were classified as MPA‐UIP patients. Compared with MPA‐non‐UIP patients, MPA‐UIP patients tend to have longer duration of symptoms prior to diagnosis and usually have pulmonary involvement as the initial presentation. However, they were less likely to have proteinuria and/or hematuria. Compared with IPF patients, MPA‐UIP patients usually had multisystem damage, positive anti‐neutrophil cytoplasmic autoantibodies and elevated levels of nonspecific inflammatory markers. MPA‐UIP death was concentrated mainly in the first 3 months after diagnosis and resulted in a higher early mortality compared with IPF. Conclusion UIP is the most frequent type of MPA‐IP. These patients tend to have longer duration of symptoms prior to diagnosis and usually have pulmonary involvement as the first presentation. However, they are less likely to have proteinuria and/or hematuria. MPA patients with UIP can be differentiated from IPF patients through comprehensive analysis of clinical and laboratory findings.

show abstract

“…The first assumption is that MPO may play a role in pulmonary fibrosis and the second that pulmonary fibrosis may induce the production of the antibody. [9][10][11] Extra pulmonary manifestations in IPF requires ANCA testing in order to rule out the possibility of a co-existing vasculitis. IPF with positive anti-MPO antibodies is associated with the risk of MPA development and certainly worst prognosis.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary fibrosis and microscopic polyangiitis in a 75-year-old woman

Koutsoviti¹,

Elezoglou²,

Katsimpari³

et al. 2019

MJR

View full text Add to dashboard Cite

We present a case of a 75-year-old woman who admitted in the internal medicine department for a recent onset of persisting moderate daily fever and fatigue that started 30 days prior to her hospitalization. Her past medical history is remarkable for mild pulmonary fibrosis, megaloblastic anaemia, and hypergammaglobulinaemia of no obvious causes. On presentation, she was febrile (38ºC) and had high ESR and CRP levels, but most of her laboratory tests were within normal levels and had no signs of arthritis or rash. She was hospitalized for suspected lower urinary tract infection and started on antibiotics. During hospitalization, her renal function deteriorated together with microscopic haematuria, proteinuria and granular urine casts in urine analysis and her inflammation markers raised further. A renal biopsy revealed glomerulonephritis with pauci-immune crescents, and serology tests were positive for anti-MPO p-ANCA, both suggesting a diagnosis of microscopic polyangiitis (MPA). While high-dose methylprednisolone pulses and cyclophosphamide were introduced intravenously, there was no remission, but respiratory failure occurred that led to patient's intubation and transfer to the ICU. She died a few days later due to septic shock. Asymptomatic pulmonary fibrosis can precede microscopic polyangiitis for several years and is associated with a poor prognosis.

show abstract

Clinical significance of myeloperoxidase-anti-neutrophil cytoplasmic antibody in idiopathic interstitial pneumonias

Cited by 51 publications

References 21 publications

Management of ANCA associated vasculitis

Management of ANCA associated vasculitis

Clinical features and prognosis of microscopic polyangiitis with usual interstitial pneumonia compared with idiopathic pulmonary fibrosis

Pulmonary fibrosis and microscopic polyangiitis in a 75-year-old woman

Contact Info

Product

Resources

About