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ANCA will less commonly form against alternative antigens that may also result in a p-ANCA pattern. These include lactoferrin, elastase, and cathepsin G. [citation needed] When the condition is a vasculitis, the target is usually MPO. [1] However, the proportion of p-ANCA sera with anti-MPO antibodies has been reported to be as low as 12%. [2]
The signs and symptoms of microscopic polyangiitis may resemble those of granulomatosis with polyangiitis (GPA) (another form of small-vessel vasculitis) but typically lacks the significant upper respiratory tract involvement (e.g., sinusitis) frequently seen in people affected by GPA. [citation needed]
The definite diagnosis of vasculitis is established after a biopsy of involved organ or tissue, such as skin, sinuses, lung, nerve, brain, and kidney. The biopsy elucidates the pattern of blood vessel inflammation. Some types of vasculitis display leukocytoclasis, which is vascular damage caused by nuclear debris from infiltrating neutrophils. [37]
Atypical ANCA is associated with drug-induced systemic vasculitis, inflammatory bowel disease and rheumatoid arthritis. [3] [7] The ANCA-positive rate is much higher in patients with type 1 diabetes mellitus than in healthy individuals. [8] Levamisole, which is a common adulterant of cocaine, can cause an ANCA positive vasculitis. [9]
Small vessel vasculitis (SVV) is separated into immune complex SVV and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). [4] Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a necrotizing vasculitis linked to MPO-ANCA or PR3-ANCA that primarily affects small vessels and has few or no immune deposits.
In the setting of systemic vasculitis as described above, proliferative nephritis is associated with antineutrophil cytoplasmic antibodies (ANCA). [3] Because of this, an ANCA test should always follow a negative immunofluorescence result to have the highest accuracy for confirming pauci-immune vasculitis-driven proliferative nephritis.
The signs and symptoms of GPA are highly varied and reflect which organs are supplied by the affected blood vessels. Typical signs and symptoms include nosebleeds, stuffy nose and crustiness of nasal secretions, and inflammation of the uveal layer of the eye. [3] Damage to the heart, lungs and kidneys can be fatal. The cause of GPA is unknown.
Churg-Strauss syndrome is very similar to both granulomatosis with polyangiitis and microscopic polyangiitis. It too is caused by p-ANCA antibodies and it causes similar symptoms such as sinusitis, lung damage, and kidney damage, but it also causes gastrointestinal, skin, nerve, and heart damage like some medium-vessel vasculitis diseases.