Association of perinuclear antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies with Vienna classification subtypes of Crohn's disease

Background: The Vienna classification of Crohn's disease (CD) subdivides patients according to their age at diagnosis (A), disease location (L), and disease behavior (B). Aim: The aim of this study was to test whether perinuclear antineutrophil cytoplasmic antibodies (pANCAs) or anti-Saccharomyces cerevisiae antibodies (ASCAs) correlate to subtypes of CD according to this classification. Methods: pANCA, ASCA-immunoglobulin (Ig) A, and ASCA-IgG were detected by indirect immunofluorescence in 120 sera of patients with CD and compared with their Vienna classification. Results: Patients with diagnosis of CD at an age of 40 years or older (A2) were more frequently pANCA-positive than those whose disease started at a younger age (A1) (19% vs. 5%, p < 0.05). pANCA-positive patients almost exclusively belonged to the nonpenetrating disease groups (B I and 132); only one patient had penetrating disease (B3) (B3 vs. non-B3: p = 0.02). There was a cluster of pANCA-positive patients within the A1 B2 L3 subgroup (B2: stricturing disease; L3: ileocolonic involvement). Only 7.5% of ASCA-IgA-positive patients presented with CD that was limited to the colon (L2). ASCA-IgA and ASCA-IgG were more frequently found in patients with upper gastrointestinal disease (L4) (ASCA-IgA: 66.7% vs. 31.5% in non-L4, p < 0.05; ASCA-IgG: 44.4% vs. 27.9%, p < 0.05). Conclusion: pANCA and ASCA may be useful in predicting subtypes of CD. They therefore may be helpful in developing subtype-specific disease management strategies.