TY - JOUR T1 - The Renaissance of Antineutrophil Cytoplasmic Antibodies as a Predictor of Relapse: <em>Ippon</em> for Japan JF - The Journal of Rheumatology JO - J Rheumatol SP - 1734 LP - 1736 DO - 10.3899/jrheum.150879 VL - 42 IS - 10 AU - JAN WILLEM COHEN TERVAERT Y1 - 2015/10/01 UR - http://www.jrheum.org/content/42/10/1734.abstract N2 - In 1985, van der Woude, et al described antineutrophil cytoplasmic antibodies (ANCA) in granulomatosis and polyangiitis (GPA, formerly Wegener’s granulomatosis) and suggested that ANCA might be a useful tool for disease activity1. Subsequently, we started a prospective study in which ANCA was measured every month in patients with GPA with both physician and patient blinded to ANCA results. During a period of 16 months, 18 of 35 patients demonstrated a rise in ANCA levels; and in 17 of 18 patients, relapse followed2. Subsequently, we started a prospective trial, where patients were randomized after an ANCA rise to receive either preemptive therapy using a 9-month course of cyclophosphamide and 3 months of corticosteroids or no therapy until clinical relapse occurred. During a period of 24 months, 20 of 58 patients had ANCA rises. Nine patients were randomized for treatment and none relapsed, whereas 9 out of 11 patients were randomized for no therapy and developed a relapse. Importantly, patients receiving no treatment at the time of ANCA rise ultimately received more cyclophosphamide and prednisolone than patients on preemptive treatment3. Later, in an open-label study, the group of Niles, et al confirmed that preemptive increases in immunosuppression following ANCA rises reduced the risk of relapse4.During the next decades, several observational studies without intervention were performed. From these studies, it was concluded that the value of repeated ANCA measurements among patients with ANCA associated vasculitis (AAV) is limited and it became more or less unethical to treat AAV patients based on ANCA levels5.In the current issue of The Journal, Yamaguchi, et al report their findings on the occurrence of ANCA rises and preemptive increases in immunosuppression following ANCA rises in their Japanese cohort of patients with AAV. In this study, … Address correspondence to Prof. Cohen Tervaert, Clinical and Experimental Immunology, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, the Netherlands. E-mail: jw.cohentervaert{at}maastrichtuniversity.nl ER -