Treatment of Anca positive Vasculitis

Treatment of Anca positive Vasculitis

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Treatment of ANCA Positive Vasculitis/

Wegner Granulomatosis (W.G) & Microscopic Polyngitis (MPA)

Introduction

The vasculitis associated with cytoplasmic antibodies (ANCA) includes microscopic polyangiitis, Wegener's granulomatosis, the Churg-Strauss disease and forms of vasculitis confined to the kidney. In the classification of Chapel Hill, these diseases are included as small-vessel vasculitis, though sometimes it can affect vessels of medium size 1. Its popularity is extremely low and is estimated at 2.4 cases per million inhabitants in the case of Churg-Strauss disease, 3.6 cases per million in microscopic polyangiitis and 10 cases of Wegener's granulomatosis (Buhaescu, 2005, 85).

From the diagnosis point of view, it is considered essential for the performance of tissues to allow histological diagnosis and determination of ANCA by immunofluorescence and ELISA. The diagnostic sensitivity and specificity of these antibodies for these diseases is high, relating mainly p-ANCA with MPO specificity with microscopic polyangiitis and c-ANCA with PR3 specificity with Wegener's granulomatosis (De Groot, 2001, 2018).

Summary

Wegener's granulomatosis, microscopic polyangiitis, vasculitis limited to the kidney and Churg-Strauss syndrome are ANCA positive vasculitis within the small-vessel vasculitis. The treatment of these entities has been standardized over the last decade, mainly due to the contribution of clinical trials sponsored by the group EUVAS. Briefly, the treatment of generalized forms includes the induction period of remission and then maintaining it. The treatment of induction of remission is different depending on the severity of the disease. Thus, for the forms that begin with creatinine <500 mmol / l, the treatment of choice is bowling cyclophosphamide and prednisone. For the most critical or pulmonary hemorrhage, the treatment of choice includes the oral cyclophosphamide and prednisone with plasmapheresis. In both cases, it will make appropriate adjustments in immunosuppressive function of age and renal function in order to minimize side effects.

From the clinical point of view, all these entities enrolled in the kidney with pauciinmune necrotizing glomerulonephritis with extracapillary proliferation, being too frequent occurrence of lung in pulmonary hemorrhage. Because it is systemic vasculitis, connection can be seen in almost all organs, a fact that occurs at different rates depending on the subtype of vasculitis.

The two main determinants of poor prognosis are advanced age and unusually poor renal function at the time of diagnosis. Starting block for analysis of treatment of small-vessel vasculitis, it is necessary to look at different concepts, such as clinical tools for assessing the vasculitic activity and serological markers of activity that will help distinguish between active vasculitis and inactive (Paulsen, & Helle, 1996, 2052).

Consequently, there is the need for a safe and easy to understand in regard to the clinical assessment. Thus, was born the ostensible BVAS (Birmingham Vasculitis Activity Score). This method numerically symptom scores of 9 organ systems can achieve a maximum score of 63 points. It is considered that a patient is in remission when the symptoms score in the BVAS no more than 5 points. Given the low incidence and prevalence of the disease, this rate is of vital importance to ...