Antineutrophil cytoplasmic antibodies in inflammatory bowel disease - Clinical role and review of the literature

PURPOSE: Perinuclear antineutrophil cytoplasmic antibodies have been found consistently in patients with ulcerative colitis; however, their pathogenet ic and clinical role is still uncertain. In this study we tested the preval ence of perinuclear antineutrophil cytoplasmic antibodies in a large popula tion of patients with ulcerative colitis and Crohn's disease, with particul ar attention to the possible correlation with clinical features. METHODS: P erinuclear ancineutrophil cytoplasmic antibody reactivity was investigated with indirect immunofluorescence in 279 patients with ulcerative colitis, 1 10 patients with Crohn's disease, and 252 unrelated healthy subjects. RESUL TS: Perinuclear antineutrophil cytoplasmic antibodies were found in 84 of 2 79 patients with ulcerative colitis (30 percent), 10 of 110 patients with C rohn's disease (9 percent), and 2 of 252 healthy subjects (<1 percent; P < 0.001), respectively. Perinuclear antineutrophil cytoplasmic antibodies wer e significantly more frequent in patients with ulcerative colitis with high er relapse rate (43 vs 27 percent; P < 0.002), and patients with Crohn's di sease with colitis (27 vs. 2.5 percent; P < 0.0003). Perinuclear antineutro phil cytoplasmic antibodies were also significantly less frequent in patien ts with ulcerative colitis in remission (18 vs. 34 percent; P < 0.0025). CO NCLUSIONS: In this study we confirm the relative specificity of perinuclear antineutrophil cytoplasmic antibodies, either for ulcerative colitis or fo r Crohn's disease involving the colon. Perinuclear antineutrophil cytoplasm ic antibodies were more frequently found in patients with ulcerative coliti s with a more aggressive clinical behavior; however, their presence had a l imited value in identifying homogeneous subgroups of patients in our popula tion.