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Zeitschrift für Rheumatologie

, Volume 76, Issue 2, pp 143–148 | Cite as

Paradigmenwechsel in der ANCA-Diagnostik

Neue internationale Konsensusempfehlungen
  • E. Csernok
  • N. Kempiners
  • B. Hellmich
Leitthema

Zusammenfassung

Hintergrund

Als Standard zum Nachweis von antineutrophilen zytoplasmatischen Antikörpern (ANCA) galt bis dato die indirekte Immunfluoreszenz (IIF), gefolgt von einem antigenspezifischen Assay gegen Proteinase 3 (PR3) bzw. Myeloperoxidase (MPO). Die Entwicklung sensitiverer und hochspezifischer PR3-ANCA- und MPO-ANCA-Immunoassays zur Diagnostik der ANCA-assoziierten Vaskulitiden (AAV) stellt die aktuell für die ANCA-Detektion empfohlene 2‑stufige diagnostische Strategie infrage.

Ziel

Es erfolgen die Darstellung und Diskussion der neuen internationalen Konsensusempfehlungen zur ANCA-Diagnostik bei AAV.

Methoden

Dieser Beitrag beschreibt die neuen Leitlinien zur ANCA-Immundiagnostik, die auf Basis der Ergebnisse einer aktuellen großen multizentrischen Studie der European Vasculitis Society (EUVAS) erstellt wurden. Der Entwurf des Autorenkomitees wurde von jedem Mitwirkenden überarbeitet und anschließend an 12 Experten auf 4 Kontinenten verschickt. Nach weiteren Korrekturen wurde das endgültige Dokument an diese Personen zur Ratifizierung zurückgereicht und zur Veröffentlichung eingereicht.

Ergebnisse/Schlussfolgerung

Die aktuellen Studienergebnisse bestätigen, dass die diagnostische Wertigkeit der antigenspezifischen Immunoassays der IIF überlegen ist. Die aktuellen Konsensusempfehlungen befürworten die primäre Verwendung des PR3- und MPO-ANCA-Immunoassay zur diagnostischen Evaluation von Patienten mit AAV ohne die Notwendigkeit einer simultanen Durchführung einer IIF.

Schlüsselwörter

ANCA Vaskulitiden Antigenspezifische Immunoassays Konsensusemfehlungen 

Paradigm shift in ANCA diagnostics

New international consensus recommendations

Abstract

Background

Up to now indirect immunofluorescence (IIF) followed by an antigen-specific assay specific for proteinase 3 (PR3) or myeloperoxidase (MPO) has been the standard method for the detection of antineutrophil cytoplasmic antibodies (ANCA). The development of more sensitive and highly specific PR3-ANCA and MPO-ANCA immunoassays for the diagnosis of ANCA-associated vasculitis (AAV) has raised doubts about the two-stage diagnostic strategy currently recommended for ANCA detection.

Objective

Presentation and discussion of the new international consensus recommendations on ANCA testing in AAV.

Methods

This article presents the new guidelines for ANCA testing that have been developed based on the results of a recent large multicenter study by the European Vasculitis Society (EUVAS). The draft of the author committee was revised by each contributor and subsequently distributed to 12 experts on 4 continents. After further revision the final document was returned for ratification and submitted for publication.

Results/conclusion

The current study results confirm the superiority of the diagnostic value of antigen-specific immunoassays compared to IIF. The current consensus recommendations support the primary use of PR3-ANCA and MPO-ANCA immunoassays for diagnostic evaluation of patients with AAV without the categorical need for additional IIF.

Keywords

ANCA Vasculitis Antigen specific Immunoassays Consensus recommendation 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Im Zusammenhang mit den im vorliegenden Manuskript behandelten Themen geben die Autoren folgende mögliche Interessenkonflikte an: E. Csernok: Honorar für Vortragleistungen von Inova, Medipan, Orgentec, Phadia; B. Hellmich: Honorar für Vortragsleistung von Orgentec. N. Kempiners gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Referenzlabor für Vaskulitis-Immundiagnostik, Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Kreiskliniken Esslingen gGmbH, Klinik KirchheimAkademisches Lehrkrankenhaus der Universität TübingenKirchheim unter TeckDeutschland

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