Open AccessEvaluation of antineutrophil cytoplasmic antibody seroconversion induced by minocycline, sulfasalazine, or penicillamine
Author(s) -
Choi Hyon K.,
Slot Marjan C.,
Pan Guoli,
Weissbach Charyl A.,
Niles John L.,
Merkel Peter A.
Publication year - 2000
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/1529-0131(200011)43:11<2488::aid-anr16>3.0.co;2-x
Subject(s) - medicine , sulfasalazine , anti neutrophil cytoplasmic antibody , gastroenterology , minocycline , rheumatoid arthritis , seroconversion , panca , vasculitis , placebo , ulcerative colitis , immunology , antibody , pathology , antibiotics , alternative medicine , disease , microbiology and biotechnology , biology
Objective Case reports have suggested that minocycline, sulfasalazine, and penicillamine are associated with antineutrophil cytoplasmic antibody (ANCA)–positive vasculitis. This study evaluated ANCA seroconversion due to these agents in serum samples prospectively collected in randomized, double‐blind, controlled trials. Methods The sources of study sera were 3 clinical trials: 1) a 48‐week trial of minocycline for early rheumatoid arthritis, with 64 patients receiving minocycline compared with 68 receiving placebo; 2) a 37‐week trial of sulfasalazine for rheumatoid arthritis, with 51 receiving sulfasalazine compared with 38 receiving placebo; and 3) a 104‐week trial of penicillamine for early systemic sclerosis, with 15 undergoing high‐dose penicillamine treatment versus 12 receiving low‐dose penicillamine. ANCA were measured in the baseline and study‐end serum samples by indirect immunofluorescence (IIF) for perinuclear ANCA (pANCA) and cytoplasmic ANCA (cANCA) patterns, and by antigen‐specific enzyme‐linked immunosorbent assay (ELISA) for antibodies to myeloperoxidase (anti‐MPO) and proteinase 3 (anti‐PR3). Laboratory personnel were blinded to the group identity of the samples. ANCA results were interpreted using an ANCA scoring system that combines the results of IIF and ELISA testing. Results No patient in any of the active study drug groups demonstrated ANCA seroconversion according to the final interpretation of the combined IIF and ELISA results. Twelve of the 248 patients (5%) were positive for anti‐MPO with pANCA at baseline. No subject was positive for anti‐PR3 with cANCA. There were no findings suggestive of vasculitis in any of these patients. Conclusion From our study results, there was no suggestion of ANCA seroconversion induced by minocycline, sulfasalazine, or penicillamine. However, these findings do not rule out the possibility of rare, sporadic cases of either ANCA seroconversion or true drug‐induced vasculitis with these drugs.