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HomeAnswersRheumatologyblood vessel disordersWhat could be the severe joint pain with inflammation followed by bleeding from nose after a while?

What does elevated ANCA-MPO and ANCA-Pr3 levels signify?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At February 29, 2020
Reviewed AtApril 23, 2024

Patient's Query

Hello doctor,

I am a 47-year-old female. I started to have severe joint pains and inflammation around three weeks back. Then one day as I was giving a presentation, my team members noticed that I was bleeding profusely from my nose. The in-house nurse was called and I was found with high pressure of 210/120 mmHg and was subsequently hospitalized for a day. After extensive blood tests, I was found that my ANCA-MPO (p-ANCA) is 202.55 U/ml and ANCA-Pr3 (c-ANCA) is 40.74 U/ml. What does this mean? I was prescribed Imuran 50 mg once a day.

Hi,

Welcome to icliniq.com.

I have gone through your query. I need to clear up a few doubts before giving you the final answer. I understand you had some problem which started three weeks back with joint pains followed by high blood pressure causing a nosebleed. I would like to investigate why you had a sudden blood pressure rise. Is it due to inflammation in the kidneys or some other reason if previously things were normal? Do you have any history of fever, recurrent nose blocks, or hearing loss? Were the other blood tests done like CRP (C-reactive protein), urine routine, chest x-ray, and ESR (erythrocyte sedimentation rate)? As per the results, these are the markers for vasculitis. So we need to be sure these are the ones that are causing your joint pains or high blood pressure. Because the management will change if there is renal involvement and Imuran alone would not be enough.

Thank you.

Investigations to be done

1. CRP. 2. ESR. 3. Urine routine. 4. X-ray chest PA (postero-anterior) view. 5. CBC (complete blood count), LFT (liver function test) and serum creatinine.

Patient's Query

Thank you doctor,

I am attaching all the latest test reports. She does not have any history of fever, recurrent nose blocks, hearing loss or hypertension. A chest x-ray was taken and was certified as clear.

Hi,

Welcome back to icliniq.com.

I have gone through the reports. (attachment removed to protect patient identity). As of now, there seems to be significant inflammation in the blood with high CRP and ESR with markers for autoimmunity, C ANCA (antineutrophil cytoplasmic antibodies), P ANCA (antineutrophil cytoplasmic antibodies) and ANA (antinuclear antibody) are positive. I could not find anything in the urine routine.

Implications of the tests:

With joint pains and high C ANCA and P ANCA, it probably looks start of vasculitis. Since it began three months back, we will have to monitor it for the evolution of symptoms and if any organ involvement. The most common organs are usually the lungs and kidneys. Since blood pressure did rise, I would suggest getting a urine routine done daily for three days to look for RBC (red blood cells) and casts. Imuran may not be the best choice to stop inflammation at this stage. She will need a short course of steroids as the blood shows high inflammation. Imuran's effect will take four to six weeks and till then you do not want to leave the inflammation uncontrolled. Do repeat CBC, CRP, and urine routine every four weeks to observe for disease monitoring, and for any evolution of new symptoms. After three months I would suggest repeating the ANCA test again to be sure if there are just falsely positive or if they are persisting to be high as management may differ. As of now, no major organ involvement is there.

I hope this helps.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Naval Mendiratta
Dr. Naval Mendiratta

Rheumatology

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