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Arthritis und Rheuma 2019; 39(01): 20-26
DOI: 10.1055/a-0817-5141
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Labordiagnostik bei Kollagenosen und Vaskulitiden

Laboratory diagnostics of connective tissue diseases and vasculitides
Elena Csernok
1   Abteilung für Innere Medizin, Rheumatologie, Kreiskliniken Esslingen GmbH, Klinik Kirchheim, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim unter Teck
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Publication History

Publication Date:
13 March 2019 (online)

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Zusammenfassung

Der Hauptanteil der immunologischen labormedizinischen Untersuchungen bei Kollagenosen und Vaskulitiden besteht -neben entzündungsdiagnostischen, hämatologischen, urinanalytischen, klinisch-chemischen, zytologischen und histologischen Untersuchungen - vor allem in der Bestimmung krankheitsassoziierter Autoantikörper. Grundstein der Labordiagnostik ist dabei der Nachweis von Antinukleären Antikörpern (ANA) bzw. Anti-Neutrophilen Cytoplasmatischen Antikörpern (ANCA). Der Nachweis dieser Autoantikörper unterstützt Diagnose-Sicherung oder -Ausschluss, Sub-Spezifizierung der Erkrankungs-Entitäten, Prognose und die Verlaufsbeobachtung. Der vorliegende Artikel über die Labordiagnostik dieser Erkrankungen hat deshalb die Beschreibung von Autoantikörpern und ihrer diagnostischen Bedeutung bei Kollagenosen und Vaskulitiden zum Schwerpunkt.

Summary

Basic laboratory tests consisting of a complete blood and urine analysis, and inflammatory, hematological, chemical, cytological and histological investigations mainly contribute to the diagnostics of connective tissue diseases and vasculitides. The most commonly used immunological tests are screening for antinuclear antibodies (ANA) and/or antineutrophil cytoplasmic antibodies (ANCA). Detection of these autoantibodies supports confirmation or exclusion of diagnosis, sub-typing of disease entities, prognosis and follow-up. This article will focus on the ANA/ANCA specificity and discuss the role of these autoantibodies in the diagnostic work-up of patients with connective tissues diseases and vasculitides.

Schlüsselwörter:

Labordiagnostik - Kollagenosen - Vaskulitiden

Keywords

Laboratory diagnostics - connective tissue diseases - vasculitides
 

  • Literatur

  • 1 Sack U, Conrad K, Csernok E. et al. Autoantikörpernachweis mittels indirekter Immunfluoreszenz an HEp-2-Zellen.. Dtsch Med Wochenschr 2009; 134: 1278-1282.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Meroni PL, Schur PH. ANA screening: an old test with new recommendations.. Ann Rheum Dis 2010; 69: 1420-1422.
    CrossrefPubMedGoogle Scholar
  • 3 Chan EKL, Damoiseaux J, Carballo OG. et al. Report of the First International Consensus on Standardized Nomenclature of Antinuclear Antibody HEp-2 Cell Patterns (ICAP) 2014-2015.. Front Immunol 2015; 6: 412.
    CrossrefPubMedGoogle Scholar
  • 4 Damoiseaux J, von Mühlen CA, Garcia-De La Torre I. et al. 2016.. International consensus on ANA patterns (ICAP): the bumpy road towards a consensus on reporting ANA results. Autoimmun Highlights 2016; 7: 1-8.
    Google Scholar
  • 5 Maguire GA, Ginawi A, Lee J. et al. Clinical utility of ANA measured by ELISA compared with ANA measured by immunofluorescence.. Rheumatology (Oxford) 2009; 48: 1013-1014.
    CrossrefPubMedGoogle Scholar
  • 6 Fritzler MJ. The antinuclear antibody test: Last or lasting gasp?. Arthritis Rheum 2011; 63: 19-22.
    CrossrefPubMedGoogle Scholar
  • 7 Mariz HA, Sato EI, Barbosa SH. et al. Pattern on the antinuclear anti-body-HEp-2 test is a critical parameter for discriminating antinuclear antibody-positive healthy individuals and patients with autoimmune rheumatic diseases.. Arthritis Rheum 2011; 63: 191-200.
    CrossrefPubMedGoogle Scholar
  • 8 Font J, Cervera R, Ramos-Casals M. et al. Clusters of clinical and immu-nologic features in systemic lupus erythematosus: analysis of 600 patients from a single center.. Semin Arthritis Rheum 2004; 33: 217-230.
    CrossrefPubMedGoogle Scholar
  • 9 Hoffman IEA, Peene I, Meheus L. et al. Specific antinuclear antibodies are associated with clinical features in systemic lupus erythematosus.. Ann Rheum Dis 2004; 63: 1155-1158.
    CrossrefPubMedGoogle Scholar
  • 10 Tan EM, Cohen AS, Fries JF. et al. The 1982 revised criteria for the classification of systemic lupus erythematosus.. Arthritis Rheum 1982; 25: 1271-1277.
    CrossrefPubMedGoogle Scholar
  • 11 Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.. Arthritis Rheum 1997; 40: 1725.
    CrossrefPubMedGoogle Scholar
  • 12 Petri M, Orbai AM, Alarcon GS. et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.. Arthritis Rheum 2012; 64: 2677-2686.
    CrossrefPubMedGoogle Scholar
  • 13 Vitali C, Bombardieri S, Jonsson R. et al. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group.. Ann Rheum Dis 2002; 61: 554-558.
    CrossrefPubMedGoogle Scholar
  • 14 van den Hoogen F, Khanna D, Fransen J. et al. 2013; classification criteria for systemic sclerosis: an American College of Rheumatology/ European League against Rheumatism collaborative initiative.. Arthritis Rheum 2013; 65: 2737-2747.
    CrossrefPubMedGoogle Scholar
  • 15 Witte T. Pathogenese and Diagnostik des Sjögren-Syndroms.. Z Rheumatol 2010; 69: 50-56.
    CrossrefPubMedGoogle Scholar
  • 16 Mierau R, Moinzadeh P, Riemekasten G. et al. Frequency of disease-associated and other nuclear autoantibodies in patients of the German network for systemic scleroderma: correlation with characteristic clinical features.. Arthritis Res Ther 2011; 13: R172.
    CrossrefPubMedGoogle Scholar
  • 17 Barsotti S, Bruni C, Cometi L. et al. One year in review 2017: Idiopathic inflammatory myopathies.. Clin Exp Rheumatol 2017; 35 (Suppl. 06) 875-884.
    PubMedGoogle Scholar
  • 18 Cappelli S, Bellando-Randone S, Martinovic D. et al. “To be or not to be”, ten years after: evidence for mixed connective tissue disease as a distinct entity.. Semin Arthritis Rheum 2012; 41: 589-598.
    CrossrefPubMedGoogle Scholar
  • 19 Fries JF, Hunder GG, Bloch DA. et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis.. Summary. Arthritis Rheum 1990; 33: 1135-1136.
    PubMedGoogle Scholar
  • 20 Jennette JC, Falk RJ, Andrassy K. et al. Nomenclature of systemic vasculitides.. Proposal of an international consensus conference. Arthritis Rheum 1994; 37: 187-192.
    PubMedGoogle Scholar
  • 21 Jennette JC, Falk RJ, Bacon PA. et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides.. Arthritis Rheum 2013; 65: 1-11.
    CrossrefPubMedGoogle Scholar
  • 22 Lyons PA, Rayner TF, Trivedi S. et al. Genetically distinct subsets within ANCA-associated vasculitis.. N Engl J Med 2012; 367: 214-223.
    CrossrefPubMedGoogle Scholar
  • 23 Davies DJ, Moran JE, Niall JF. et al. Segmental necrotising glomerulonephritis with antineutrophil antibody: possible arbovirus aetiology?. Brit Med J 1982; 285: 606.
    CrossrefPubMedGoogle Scholar
  • 24 van der Woude FJ, Rasmussen N, Lobatto S. et al. Autoantibodies against neutrophils and monocytes: tool for diagnosis and marker of disease activity in Wegener’s granulomatosis.. Lancet 1985; 1: 425-429.
    PubMedGoogle Scholar
  • 25 Csernok E, Lamprecht P, Gross WL. Diagnostic significance of ANCA in vasculitis.. Nat Clin Pract Rheumatol 2006; 2: 174-175.
    PubMedGoogle Scholar
  • 26 Damoiseaux J, Csernok E, Rasmussen N. et al. Detection of antineutro-phil cytoplasmic antibodies (ANCAs): a multicentre European Vasculitis Study Group (EUVAS) evaluation of the value of indirect immunofluorescence (IIF) versus antigen-specific immunoassays.. Ann Rheum Dis 2017; 76: 647-653.
    CrossrefPubMedGoogle Scholar
  • 27 Csernok E, Damoiseaux J, Rasmussen N. et al. Evaluation of automated multi-parametric indirect immunofluorescence assays to detect anti-neutrophil cytoplasmic antibodies (ANCA) in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA).. Autoimmun Rev 2016; 15: 736-741.
    CrossrefPubMedGoogle Scholar
  • 28 Bossuyt X, Cohen Tervaert JW, Arimura Y. et al. Revised 2017 international consensus on testing of ANCA in small vessel vasculitis.. Nat Rev Rheumatol 2017; 13: 683-692.
    CrossrefPubMedGoogle Scholar
  • 29 Tomasson G, Grayson PC, Mahr AD. et al. Value of ANCA measurements during remission to predict a relapse of ANCA-associated vasculitis -- a meta-analysis.. Rheumatology (Oxford) 2012; 51: 100-109.
    CrossrefPubMedGoogle Scholar
  • 30 Kemna MJ, Damoiseaux J, Austen J. et al. ANCA as a predictor of relapse: useful in patients with renal involvement but not in patients with nonrenal disease.. J Am Soc Nephrol 2015; 26: 537-542.
    CrossrefPubMedGoogle Scholar
  • 31 Cornec D, Cornec-Le Gall E, Fervenza FC, Specks U. ANCA-associated vasculitis - clinical utility of using ANCA specificity to classify patients.. Nat Rev Rheumatol 2016; 12: 570-579.
    CrossrefPubMedGoogle Scholar
  • 32 Holle JU, Csernok E, Gross WL. Non-ANCA-associated vasculitides.. In: Shoenfeld Y, Meroni PL. eds. The General Practice Guide to Autoimmune Diseases.. Lengerich: Papst Science Publishers; 2012: 103-116.
    Google Scholar
  • 33 Bosch X, Lopez-Soto A, Mirapeix E. et al. Antineutrophil cytoplasmic au-toantibody-associated alveolar capillaritis in patients presenting with pulmonary hemorrhage.. Arch Pathol Lab Med 1994; 118: 517-522.
    PubMedGoogle Scholar
  • 34 Ferri C, Mascia MT. Cryoglobulinemic vasculitis.. Curr Opin Rheumatol 2006; 18: 54-63.
    CrossrefPubMedGoogle Scholar