Relation between asymptomatic proteinase 3 antibodies and future granulomatosis with polyangiitis

Stephen W. Olson, David Owshalimpur, Christina M. Yuan, Charles Arbogast, Thomas P. Baker, David Oliver, Kevin C. Abbott

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background and objectives The subclinical pathogenesis of granulomatosiswith polyangiitis (GPA) has not been completely elucidated. Proteinase 3 (PR3) antibodies are strongly associated with GPA, but have not been evaluated before disease presentation. Design, setting, participants, & measurements This was a retrospective case-control serum bank study in which PR3 antibodies and C-reactive protein (CRP) in up to three longitudinal serumsamples for 27 GPApatients before diagnosis (1 day-19 years) were comparedwith 27 controlswhose serumsampleswerematched for age, sex, and race. This study analyzed all patients with American College of Rheumatology criteria-confirmed disease identified in the Department of Defense electronic medical records between 1990 and 2008. ResultsAgreater percentage of GPApatients had at least one elevated PR3 antibody level (≥6 U/ml) as well as at least one detectable PR3 antibody level (>1U/ml) before diagnosis comparedwithmatching controls (63%[17 of 27] versus 0% [0 of 27], P<0.001; and 85% [23 of 27] versus 4% [1 of 27], P<0.001, respectively). A greater percentage of GPA patients had a>1 U/ml per year rate of increase in PR3 antibody level compared with matching controls (62% [21 of 26] versus 0% [0 of 26], P<0.001). PR3 antibody more frequently became elevated before CRP (67% [12 of 18] versus 33% [6 of 18], P=0.04). Conclusions Subclinical PR3 antibody presence, trajectory, and temporal relationship to CRP associates with the future diagnosis of GPA. This data set further elucidates the pathogenesis of GPA.

Original languageEnglish
Pages (from-to)1312-1318
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Issue number8
StatePublished - Jul 2013
Externally publishedYes


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