[ANCA vasculitis preceded by isolated joint manifestations. Report of two cases and literature review]

Abstract

Introduction: Joint manifestations of ANCA (antineutrophil cytoplasmic antibody) associated vasculitis (AAV) are extremely common in the progression of systemic damages. However, the joint involvement is rarely isolated. The diagnosis and the treatment are difficult in this particular situation and few data are available on the topic.

Case report: We have observed two cases of joint manifestation revealing AAV we are going to describe here. The evolution toward a more severe disease raises the question of the treatment managing. The place of the ANCA research in relation to other immune tests is also discussed.

Conclusion: Isolated joint manifestations of ANCA vasculitis are rare but can lead to a delay in diagnosis. ANCA vasculitis should be considered in seronegative symmetrical polyarthritis by looking for ANCA in a second line biological test. Methotrexate is the first treatment option to be considered. In case of insufficient response or failure, rituximab seems an interesting option in this context.

Keywords: ANCA-associated vasculitis; Methotrexate; Rheumatic inflammatory disease; Rhumatisme inflammatoire; Rituximab; Vascularites associées aux ANCA.