When it comes to diagnosing vasculitis; understanding how to interpret a negative ANCA test is important. The truth is, that tests like ANCA (antineutrophil cytoplasmic antibodies) are very helpful, but they don’t always give us all of the answers. A negative result doesn’t necessarily mean you don’t have vasculitis. That’s where having a rheumatologist look at your entire story as well as the clinical signs is necessary.
What is Vasculitis?
Vasculitis is inflammation of the blood vessels. Some symptoms are:
Joint pain and stiffness (often worse in the morning)
Skin rashes
Fevers
Weight loss or fatigue
Kidney, heart, or eye issues
Autoimmune conditions, like rheumatoid arthritis or lupus
Infections, such as infective endocarditis (a heart valve infection)
External factors, like exposure to certain drugs (e.g., cocaine cut with levamisole)
The importance of ruling out infection
It is very important to rule out infection when a patient has symptoms that are possibly vasculitis. For example, if a patient comes in with many symptoms, including inflammatory joint pain, morning stiffness, weight loss, fatigue, fevers, and a vasculitic rash. Even though these are all symptoms of an autoimmune condition, it is important to consider the possibility of infection.
This is so important is because infections can mimic vasculitis, and treating an infection with immunosuppressive medications could make things worse.
ANCA Tests: Helpful, But Not Everything
If you have symptoms of vasculitis, your doctor may check for ANCA antibodies. Here’s what you need to know:
A negative ANCA doesn’t rule out vasculitis. You may still have it, even if the test is negative.
A positive ANCA can have other causes. For example:
Infections: like endocarditis.
Drug exposure: Cocaine or its cutting agent, levamisole, can cause ANCA to be positive.
Other conditions: Rheumatoid arthritis and lupus can also trigger a positive ANCA result.
How Doctors Approach Vasculitis
To determine if a patient may have Vasculitis, your rheumatologist may ask:
What symptoms do you have? Joint pain, fevers, weight loss, skin rashes, night sweats?
Which organs are involved? Are the kidneys, lungs, heart, or eyes affected?
What type of vasculitis could this be?
Small vessels: These often affect the kidneys or lungs.
Medium vessels: These may cause rashes or nerve issues.
Large vessels: these can lead to headaches, scalp pain, or vision loss (like in giant cell arteritis).
Diagnosing vasculitis isn’t as simple as running one test. It can require a careful evaluation by a rheumatologist. It can take time and patience, but your rheumatologist can guide you toward the correct diagnosis and treatment.
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