ANCA-P (Anti-Neutrophil Cytoplasmic Antibodies, Perinuclear Type)

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ANCA-P are autoantibodies directed against proteins in neutrophil granules that localize in a perinuclear pattern on immunofluorescence. They are most often associated with small-vessel vasculitides, especially Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA).

Function and Pathogenesis

• Immune misdirection: ANCA-P bind to neutrophil antigens (notably myeloperoxidase), activating neutrophils and the complement cascade.
• Vessel injury: Activated neutrophils adhere to endothelium, degranulate, and release reactive oxygen species—damaging small blood vessels in organs like kidneys, lungs, and sinuses.

Clinical Presentation

Common symptoms of ANCA-P–associated vasculitis include:

• Constitutional: Fever, fatigue, weight loss
• Musculoskeletal: Arthralgia, myalgia
• Cutaneous: Palpable purpura, ulcerations
• Renal: Rapidly progressive glomerulonephritis (hematuria, proteinuria)
• Pulmonary: Cough, hemoptysis, nodules
• ENT: Sinusitis, nasal crusting, epistaxis

Diagnosis

1. Blood test:
   • Indirect immunofluorescence (IIF): Perinuclear staining pattern
   • ELISA: Specific anti-myeloperoxidase (MPO-ANCA) titers
2. Supporting evaluation:
   • Urinalysis (renal involvement)
   • Chest imaging (CT scan for nodules or hemorrhage)
   • Tissue biopsy (definitive—shows necrotizing vasculitis/granulomas)

Disease Monitoring

• Titer trends: Rising ANCA-P levels often correlate with flares.
• Clinical correlation: Always interpret titers alongside symptoms and organ function tests.

Management

• Induction therapy: High-dose corticosteroids + cyclophosphamide or rituximab
• Maintenance therapy: Lower-dose immunosuppressants (azathioprine, methotrexate)
• Supportive care: Blood pressure control, renal replacement if needed

Diet & Lifestyle

• No specific foods alter ANCA-P levels.
• A balanced diet rich in antioxidants, adequate protein, and micronutrients supports overall immunity and healing.

Frequently Asked Questions

1. What is ANCA-P?
   Autoantibodies against neutrophil cytoplasmic antigens that stain in a perinuclear pattern, associated with certain vasculitides.
2. How is ANCA-P tested?
   Via blood: initial IIF for pattern, then ELISA for MPO-ANCA specificity.
3. Which diseases are linked to ANCA-P?
   Primarily Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA).
4. Can ANCA-P levels change over time?
   Yes. Levels often rise during active disease and fall with effective treatment.
5. Is there a cure for ANCA-P–related conditions?
   No definitive cure exists; however, immunosuppressive therapy can induce and maintain remission, preventing organ damage.

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