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Dr. Kararizou replies

To the Editor:

We thank Drs. Aries and Gross for their comments on our article¹.

They emphasize the importance of antineutrophil cytoplasmic antibody (ANCA) testing as a serological marker associated with vasculitis and consequently as a differentiating factor of nonsystemic versus systemic vasculitis.

We acknowledge the importance of their comment, as nonsystemic and Wegener's vasculitis both affect the small epineurial blood vessels^2-5. As noted in our article, the cellular composition of the inflammatory infiltrates appears to be similar in both nonsystemic vasculitic neuropathy and in the systemic form (especially in Wegener's) and so, in the case where granuloma formation is absent, this can be confusing^2-5.

As our study is a retrospective one, spanning a period of 20 years, ANCA testing was not available at the time some of our patients were examined. Thus we can only report the results concerning 17 out of 22 patients, which were negative for perinuclear and cytoplasmic ANCA.

We are now completing a study in a large group on systemic vasculitic polyneuropathy; the study comprises patients with positive ANCA, many of them having prominent or exclusively sensory symptoms.

EVANGELIA KARARIZOU, MD, Department of Neuropathology, Aeginition Hospital, Athens, Greece.

REFERENCES

1. Kararizou E, Davaki P, Karandreas N, Davou R, Vassilopoulos D. Nonsystemic vasculitic neuropathy: a clinicopathological study of 22 cases. J Rheumatol 2005;32:853-8.

2. Midroni G, Cohen SM, Bilbao JM. Endoneurial vasculitis and tubuloreticular inclusions in peripheral nerve biopsy. Clin Neuropathol 2000;19:70-6.

3. Lacomis D, Giuliani M, Stehen V, Powell H. Small fiber neuropathy and vasculitis. Arthritis Rheum 1997;40:1173-7.

4. Dyck PJ, Benstead TJ, Conn DL, Stevens JC, Windebank AJ, Low PA. Nonsystemic vasculitic neuropathy. Brain 1987;110:843-4.

5. Midroni G, Bilbao JM. Vasculitic neuropathy. In: Midroni G, Bilbao JM, editors. Biopsy diagnosis of peripheral neuropathy. Boston; Oxford; Melbourne: Butterworth-Heinemann 1995: 241-62.