MEDICAL TESTS

• (Last update 07/02/10)
• General 
  • Activity level
    • A study of Wegener's granulomatosis patients has shown that five disease assessment methods yield comparable results.
    • The five tested were:  BVAS for Wegener's granulomatosis (BVAS/WG), BVAS2003, a physician global assessment (PGA), the Disease Extent Index (DEI), and the Five Factor Score (FFS).
    • A patient with an autoimmune vasculitis should ask the treating physician for one or more of the assessment measures.
  • Disease Extent Index
    • Click Here to view a table used to estimate the extent of vasculitis.
• Specific tests
  • Most AVs have no specific tests to identify the type of AV without ambiguity.
    • Some tests exist to help narrow the diagnosis of some AVs.
    • Considerable research is being done to develop specific tests for specific AVs, and to better measure AV activity level.
  • AVs are tentatively diagnosed by symptoms, by blood and urine tests, by clinical exam, by imaging tests, and by detailed medical history and by experienced judgment.
    • A positive biopsy may be required for diagnosis, but not all physicians will insist on a positive biopsy.
    • Because of the use of different methods of measurement, it is sometimes not possible to directly compare one patient's test results with an other's
  • For some AVs, it's important to test IgE, IgG, and IgM levels.
  • A 2006 survey found overwhelming consensus from an experienced body of pediatric rheumatologists on the need to study childhood-onset vasculitis independently from adult disease.
  • There is new,FDA approved technology that can measure eosinophilic inflammation in the airway.  This simple, inexpensive test can predict an exacerbation. Not many physicians know about it because it is so new. It is called exhaled nitric oxide test and a California company called Apieron manufactures this device.
  • Vasculitis patients should be evaluated not only with electrocardiography but also with echocardiography or cardiac MRI.  
  • In the absence of complaints and major ECG abnormalities, cardiac involvement could still be detected in nearly 40% of some patients, indicating that the absence of complaints or a normal ECG does not exclude cardiac involvement.  
  • If a patient is to be put on azathioprine (Imuran), the patient should be tested for low TPMT activity.  TPMT genotyping is a one-time test. It's results will not change over time and are not affected by variables such as medications or blood transfusions. This makes it the preferred test if the patient had a recent blood transfusion or is already on thiopurine drug therapy. However, not all the alleles that cause TPMT enzyme deficits have been identified and thus the test results sometimes inaccurately predict normal TPMT enzyme activity.
  • A June 2009 study titled, “Exercise-induced Vasculitis Associated with Auto-Immune Disease” noted that Exercise-induced vasculitis (EIV) is an under reported and frequently misdiagnosed condition that occurs on the lower extremities shortly after exercise.  Clinicians should recognize EIV and consider the possibility  that this disorder may be the presenting sign of subclinical connective-tissue diseases.?
• Testing resources
  • Click here to view a file on medical tests used to diagnose and judge the severity of autoimmune vasculitides.
    • [Also includes information on record keeping of medical test results]
  • Click here to view a file listing medical tests used for baseline testing.
    • Every AV patient should have baseline tests ordered as soon as diagnosed so that future test results can be compared..
  • Click here to view a table of conversion factors that allows one to convert U.S.A. conventional units to standard international units.
  • Click here to view information from the American Association of Autoimmune Diseases.
  • Click here to view an excellent web page with an index and chart of a panel of autoimmune tests with some norms and interpretations, then scroll down past the list of tests to the table entries.
• Genetic tests
  • A number of researchers are investigating genetics related to vasculitis.
    • To date no specific genetic markers can unambiguously determine if a person is liable to develop an autoimmune vasculitis.
    • In 2007, research discovered on chromosome 17, a gene, NALP, known to control part of the immune system that serves to alert the body to viral and bacterial attacks.  If the sensor for NALP overreacts, it could trigger an incorrect response of the immune system.  This may help discover a medication to control over-reaction.
    • Immature dendritic cells promote cellular interaction.  IL-6 is prominent in Kawasaki's disease.
    • The suppressor function on the gene RUNX3 is lost in ANCA-related diseases.
    • The NKG2D T cells have been shown to help sustain inflammation.
• Diagnostic tests
  • Abnormal.  All initial laboratory tests that are abnormal should perhaps be repeated to assure the original results to be correct.
    • Infection is the great imitator of vasculitis so must be looked for and ruled out.
  • Blood chemistry tests and cell counts
    • Blood tests that are usually ordered for suspected AVs are the Erythrocyte Sedimentation Rate (ESR or SED), and the C Reactive Protein test.
      • Recent work suggests IL-6 and fibrinogen levels may indicate AV activity.
      • Inflammation due to trauma, infection, or allergy may raise those non-specific test results.
      • ANCA (anti-neutrophilic cytotoxic antibodies) can be useful in diagnosing some AVs.
        • Click here to view an excellent discussion on ANCA testing and interpretation, "LABORATORY STANDARD IN THE DIAGNOSIS AND THERAPY MONITORING OF AUTOIMMUNE DISEASE: VASCULITIS".
        • Click here to read an authoritative article on testing and reporting ANCA results.
        • See Antibody below.
        • Different labs may give differing results on the key AV tests, ANCA (both c and p) and anti-PR-3/anti-MPO.
        • False positives and negatives can and do occur due to mishandling or misinterpretation or even due to effects of medications.
        • The first positive should be retested for affirmation.
        • It is best that all the ANCA tests be done at the same lab.
        • It is important to know at what level of dilution the ANCA result is considered to positive.
          • A survey done some years ago of labs doing the ANCA test showed widely differing results from the same sample supplied to all the surveyed labs.
          • An effort to standardize these tests was underway in Europe in the '90s by the EUVAS group (and may have already succeeded).
        • Recent work (2004) shows that there are varying epitopes of ANCA which are not all detected easily by the usual test methods.
          • The so-called "Capture ELISA Anti-PR-3 Test" can be more sensitive in detecting the less usual epitopes.
          • In particular, the Capture ELISA using the MoAb 12.8 antibody was found to have a 96% sensitivity in one study.
          • Other ANCA antigens than anti-PR3 and anti-MPO are azurocidin, bactericidal permeability- increasing protein (BPI-ANCA), cathepsin G, elastase, lactoferrin, human leukocyte elastase (HLE), and lysozyme.
          • A 2003 study concluded that the anti-PR-3 epitope changes during the disease progress, thus perhaps affecting the ELISA test result and perhaps introducing ambiguity into the ELISA test results.
          • A 2006 Japanese 2000-2004 retrospective study indicated a much higher ratio of anti-MPO to anti-PR3 antibodies in cases of primary renal vasculitis than European or U.S. patients.

FIGURE 5 - ANCA IN DIAGNOSING SMALL VESSEL AV

• Urine analysis by both chemistry and microscopic.
  • Early changes in urinary function are critical to evaluating vasculitis patients.
  • In order to identify such changes, the specimen for microscopic examination has to be as fresh as possible and examined by an expert in microscopic analysis immediately after the sample is taken.
    • If you send the specimen to a lab, the red cells will have formed solids and casts will have disintegrated.
• Imaging tests such as x-ray, MRI, CT scan, and PET scan
  • Imaging tests are common for persons with nasal and sinus inflammation, for those with breathing problems, with ear and eye inflammations, and for other areas where symptoms are evident.
  • Color Doppler ultrasonography, computerized tomography angiography, and magnetic resonance imaging/angiography are able to delineate both the vessel wall and the lumen. They may show vessel wall alterations when the lumen is still unaffected on angiography
    • A CT virtual bronchoscopy can help identify lung abnormalities, stenoses and larynx problems.
      • X-rays sometimes miss important abnormalities or results in images that are misinterpreted..
    • MRIs show soft tissues better than CT scans and so can be more useful when, for example, imaging sinuses.
    • CT angiograms (imaging of blood vessels) may help identify vasculitis in the brain (Primary CNS vasculitis) showing beading & other abnormalities.
      • Contrast fluid may be used if tolerated by the patient.
    • A magnetic resonance image (MRI) is often appropriate should central nervous system symptoms be present,.
      • Digital subtraction angiography (DSA) may be useful in identifying stenosis or other abnormalities caused by vasculitis.
    • There may be a place for 18 FDG PET/CT scan in detecting vessel stenosis. PET scans can be useful in granulomatous diseases and large vessel  vasculitides to identify areas of inflammation or infection.
    • Similarly, there may be a place for fluid-attenuated inversion recovery-magnetic resonance imaging (FLAIR-MRI) in suspected cerebral vasculitis.
    • Susceptibility weighted imaging (SWI) is a magnetic resonance (MR) technique that is exquisitely sensitive to paramagnetic substances, such as deoxygenated blood, blood products, iron, and calcium.
    • Magnetic resonance imaging, including ADC maps, diffusion and gradient echo sequences, is the investigation of choice to detect and monitor cerebral involvement. Certain MRI techniques and 18-fluorodeoxyglucose positron emission tomography allow the visualization of vessel wall inflammation when the lumen is still unaffected on angiography.

• Biopsies of the suspected granuloma and/or blood vessels or other affected tissues.
  • A positive biopsy for an AV in combination with symptoms, medical history, examination and other test results is usually considered conclusive.
  • Biopsies may be required of tissues where there is persistent inflammation problems in any of the body's organs or tissues:
  • Frequency of organ involvement is varied among the AVs.
  • G/I involvement may require 25 to 50 tissue samples to detect vasculitis.
• Blood flow in extremities may be measured to detect vascular stenosis or other damage.
• Kidney function
  • Urine tests will look for signs of kidney damage and abnormalities.
  • Urine creatinine level if elevated can be indicative of deficient kidney function.
    • The "gold standard" is the 24 hour creatinine clearance test.
  • A new (2006) non-invasive test for kidney disease, developed by clinicians at Hammersmith Hospitals NHS Trust and Imperial College London, may provide a simple, safe, cheap and reliable method of detecting kidney disease.
    • This new test may be useful only for anti-GBM disease (Goodpasture's).
    • This new test can accurately measure response to treatment, allowing clinicians to tailor treatments to individual patients.
      • The test can tell if a treatment is working, and shows before it is too late, if it's necessary to change the medication, without the need to proceed to a biopsy.
      • The test identifies the amount of a cytokine molecule called monocyte chemoattractant protein (MCP-1) present in the urine. MCP-1 is produced by the body as a response to inflammation, and attracts white blood cells to the area to combat pathogens.
      • This new test may not yield useful results for AVs without kidney involvement.
• AATD (Alpha-1 Anti-Trypsin Deficiency)
  • All new or suspected vasculitis patients especially those with lung involvement should be screened for alpha-1 anti-trypsin deficiency (AATD).
  • Anyone with early emphysema or emphysema out of proportion to smoking history or unexplained liver disease should be screened for alpha-1 anti-trypsin deficiency (AATD).
  • Click here to view a web page about alpha-1 anti-trypsin deficiency.
  • Alpha1-antitrypsin deficiency is not sufficient to induce ANCA positive vasculitides, and may only act as a second hit amplifying factor.
• Hepatitis
  • Since identification of the hepatitis C virus (HCV) in 1989, it has become clear that the chronic infection can be accompanied by a variety of systemic autoreactive phenomena, most notably vasculitis [Feb. 2007 article].
  • All known or suspected autoimmune vasculitis patients should be tested for hepatitis C.
    • This virus replicates very rapidly, turning over billions of times each day and chronically stimulating the immune system.
    • In approximately half of patients, this chronic immune stimulation leads to the development of autoreactivity and the appearance of rheumatoid factor (RF) in serum.
  • Correlation of Hepatitis C with vasculitis implies the possibility that various  undesirable antibodies may result from hepatitis C infection.
  • Vasculitis patients should be screened for hepatitis A, B, and C.
• Endothelial cells
  • A Feb. 2006 study noted that markedly increased numbers of circulating endothelial cells (CECs) discriminate active vasculitis from limited granulomatous disease and remission.
  • A more recent study found the level of CECs did not track the disease activity.    
    • In one study, a cut off value of 20 cells/ml for a positive result yielded 64% specificity and 95% sensitivity for active systemic vasculitis; the positive predictive value was 63% and the negative predictive value 95%.
    • These findings add further proof to the concept of CECs as a marker of ANCA associated small vessel vasculitis.
    • The usefulness of CEC tests remains unresolved.
• Cryoglobulins (proteins that clump when cooled)
  • Some patients also are found to have cryoglobulins, and a subset develop autoimmune conditions such as cryoglobulinemic vasculitis with symptoms of purpura, glomerulonephritis, peripheral neuropathy, and polyarthritis. B-cell lymphomas also can occur.
• Other tests as are appropriate.
• A 2009 article by Zangani et al indicates that NF-1-beta mediated bioluminescence is a very sensitive and early indicator of inflammation and disease, perhaps allowing precise identification of incipient disease sites before symptoms appear, and also perhaps providing an evaluation of disease activity level.
• A 1990 study suggested CD4(+)CD25(+) effector memory T-cells expressing CD134 and GITR seem to play a role in disease mechanisms, as suggested by their close association with disease activity and their participation in inflammatory process.  Further research may make use of this finding in laboratory tests.
• Possibly the new Pentraxin 3 test or the ankle/brachial pressure test as a measure of cardiovascular risk. A 2002 study showed PTX3 represents a novel acute-phase reactant produced at sites of active vasculitis.  A test for PTX3 might be useful in determining disease activity level.
• Anti-idiotype antibodies (anti-ids) have a potential role in the immunomodulation of various autoimmune disorders...   High prevalence of anti-ids in remission cases and low prevalence in active cases with absence of anti-ids in relapse cases as well as an inverse correlation of ANCA and anti-ids indicate its beneficial effect on the disease process.
• Screening for anti-GBM antibodies should be undertaken in patients with clinical signs of systemic vasculitis.

• After diagnosis
  • One time tests
    • Every WG or AV patient should have baseline tests ordered so that future tests will have a comparison.
      • Click here to view a file listing medical tests used for baseline testing and for diagnosing and treating AVs.
        • All AV patients should have a baseline bone scan (presuming the patient is or will  be taking Prednisone.
        • Similarly, imaging tests (MRI/CT scan/x-ray, PET scan), hearing tests, EKGs, and 24-hour urine creatinine clearance tests should be ordered if not already done during diagnosis.
  • Scheduled Tests
    • Tracking AV
      • For the remainder of the patient's life, disease activity must be checked for periodically.
      • Tracking tests may differ according to the organs or tissues affected previously.
      • Period checks of kidney function should be done even for patients in whom kidneys weren't previously affected.
      • A November 2007 study said, "Decreases in PR3-ANCA levels are not associated with shorter time to remission, and increases are not associated with relapse. These findings suggest that ANCA levels cannot be used to guide immunosuppressive therapy"�.
    • Frequency
      • Ask your physicians how often various tests should be scheduled.
      • These tests should be done frequently, perhaps every other week for AV patients whose disease still active or after treatment changes have been made.
        • CRP, ESR, urine creatinine
        • While on immunosuppressives, liver functions should be tested periodically during treatment
        • ANCA, anti-PR3, anti-MPO (if applicable)
        • After remission, the frequency of these can be lessened.
      • Imaging test if lungs/nasal/sinus/central nervous system are involved or suspected
      • Bone density test
        • If on Prednisone or similar, a bone scan should be scheduled perhaps annually.
      • Colon exam as indicated by symptoms.
      • The patient should ask about the necessity and frequency recommended for dipstick urine tests for blood and protein.
      • The patient should inquire if there are other tests that should be done periodically.
    • Dipsticks
      • Patients with kidney damage may well benefit from use of urine dipsticks even if they normally have blood or protein in their urine, as increases may be detected.
      • Dipsticks should test urine for protein (albumin-specific) and blood.                                     
        • It's a good idea to test for glucose in addition to blood and protein as Prednisone and similar can cause diabetes.
      • Getting a prescription from their physician for dipsticks might permit health insurance reimbursement.
      • If your pharmacy doesn't have the desired type, they may be special ordered through a wholesale distributor or on-line if legal.
      • Report to your physician any change in results from previously reported dipstick test results.
      • Dipstick sensitivity degrades over time.  Ask your pharmacist and physician about when to discard unused dipsticks.
      • For current information on dipsticks, search Google or other search engines to find the type desired.
      • Features of various dipsticks vary in the number of tests with the more tests being the more expensive.
        • Some that seem to have blood/leukocytes and protein, but don't test for many other factors are: 

• All the above test for blood/protein and glucose.
  • The tests for blood may not be albumin specific, so these might not be suitable.
  • Above dipstick data is not to be construed to be as recommendations
• Costs may vary from source to source.  Prices shown are for an on-line pharmacy in Aug. 2007.  Shipping probably not included.
• A more exacting test for blood in urine is a laboratory test that centrifuges the urine to separate out the cells and casts.
• Antibody tests
  • General
    • IgE, IgG, and IgM tests may be appropriate.
    • Research continues to expand the test procedures available for formerly untested antibodies.
      • Genetic testing has not developed to the point of being able to identify autoimmune vasculitis.
  • ANCA - A test for anti neutrophil cytoplasmic antibodies was the first blood test developed that helped narrow the field of possibilities of AVs.
    • Click here to see how and why ANCA should be tested.
    • The result of an ANCA test is positive or negative or atypical.
      • ANCA tests are indirect immunofluorescence (IIF) tests requiring a skilled technician to perform the test, exam the results using a microscope and various levels of titration, and to interpret the results.
    • ANCA levels don't necessarily correctly indicate disease activity level.
    • ANCA test results are expressed as a ratio such as 1:256 or 1:1024 (or 1/256, 1/1024)  These might be incorrectly abbreviated to 256 or 1024.
    • Interpretation
      • ANCA alone is rarely enough to diagnose an autoimmune vasculitis. 
      • Classification of associated small vessel vasculitides based on antineutrophil cytoplasm autoantibody specificity has been complicated by the finding that different ethnic groups may have very different clinical features relative to antigen specificity.

* No quantitation in the literature

Note 1 - Figures from http://www.aruplab.com/guides/ug/tests/0050523.jsp - National Standards Lab
Note 2 - Approximation of the proportion of patients positive for ANCA based on references cited by Kallenberg et al (9) and others
Note 3 - Figures from a paper by Stegleman et al.  Clinically, skin vasculitis and arthralgias predominated and renal vasculitis was rare. 

• • Non AV ANCA
    • ANCA test results can be positive due to conditions other than autoimmune diseases.
    • Amebiasis, subacute and bacterial endocarditis have been shown to cause transient positive ANCAs.
    • ANCA can be observed in other pathologies: rhumatismal autoimmune diseases, inflammatory gut diseases, after drugs (hydralazine, minocycline, propylthiouracil), after silical exposition, infections (cystic fibrosis, endocarditis, HIV infection).
    • A false positive pANCA can result from ANA responding to the IIF test.
    • A 2005 paper noted that the presence of myeloperoxidase antineutrophil cytoplasmic antibodies( MPO-ANCA), IgM anticardiolipin antibody, and antihistone antibodies in combination was found to be characteristic of drug-induced vasculitic syndromes caused by the antithyroid drugs propylthiouracil and methimazol.
      • Clinically, skin vasculitis and arthralgias predominated and renal vasculitis was rare.
  • • A significant level of antibodies to Bacteria Permeability Increasing (BPI protein) can give a false positive ANCA result.
      • In 2003 , a single case of WG in remission had significant pulmonary infection.
      • Testing revealed that the patient had developed a positive ANCA, but not to PR3 nor to MPO, but to BPI.
      • It is thought the BPI-ANCA interfered with antibiotic action, thereby allowing the infection.  Treatment with cyclophosphamide and Infliximab (Remicade) resulted in a negative BPI-ANCA.
    • Alpha-1 antitrypsin deficiency (AATD) can also skew ANCA test results
      • Alpha1-antitrypsin deficiency is not sufficient to induce ANCA positive vasculitides, and may only act as a second hit amplifying factor.
    • A rare benign heart tumor, atrial myxoma may result in a positive cANCA.
    • A Feb. 2008 study of patients in tropical areas showed that ANCA positivity was found in 19%, 32% and 30% of malaria, tuberculosis and leprosy patients

TABLE 3 - ANCA - ANTIGEN TARGETS & AI DISEASES

WG-Wegener's granulomatosis; MPA-microscopic polyangiitis; CSS-Churg-Strauss syndrome; UC-ulcerative colitis; CD-Crohn's disease; PSC-primary sclerosing cholangitis; SLE-systemic lupus erythematosus; RA-rheumatoid arthritis; AIH-autoimmune hepatitis; HLE--human leukocyte elastase; BPI-bactericidal/permeability-increasing protein; HMG1/2-high mobility group of non-histone chromosomal proteins 1 and 2

• PR3 & MPO
  • The anti-PR3 and the anti-MPO are tests using the ELISA (Enzyme-Linked ImmunoSorbent Assay) or capture ELISA techniques.
    • Test results are reported as a single number, e.g., 24, etc., not as a ratio as is ANCA.
  • The ELISA tests are less subject to human errors in determining the level of the test results than is the ANCA test.
  • There are a number of ELISA tests:    Anchor ELISA, direct ELISA, capture ELISA, indirect immunofluorescence (IFT) and imm unoblotting.  
  • Anchor ELISA is a novel highly sensitive and specific method for the detection of PR3-ANCA in patients with WG, which may replace the need for a combined analysis with IFT and ELISA in the future.
  • One ELISA is the "sandwich" or "capture" ELISA.
    • Major advantages of this technique are that the antigen used to detect the test antigen does not need to be purified prior to use, and that these assay results are very specific.
    • One disadvantage is that not all antibodies can be used.  
    • Monoclonal antibody combinations must be qualified as "matched pair"�, meaning that they can recognize separate epitopes on the antigen so they do not hinder each other's binding.
  • A 2008 paper concluded the new test: fluoroenzymeimmunoassay (FEIA) can give results comparable to ELISA tests.
• P-ANCA/anti-MPO
  • pANCA is often positive due to anti-MPO antibodies, although there are other antibodies that can cause a positive pANCA.
  • The pANCA IIF test or the ELISA anti-MPO test, if positive may an indicator for a strong indicator for some types of autoimmune diseases e.g. microscopic polyarteritis (MPA), polyarteritis nodosa (PAN), etc.
    • Positive pANCA can be found in a small percentage of WG patients
• C-ANCA/anti-PR3
  • ELISA tests for the anti-Proteinase-3 antibody (anti-PR-3) are somewhat more specific to WG than cANCA, and perhaps more sensitive also.
    • The anti-PR-3 test may be somewhat more reliable in determining disease activity level than is the cANCA test, but not always.
    • The combined result of the ANCA/anti-PR3 tests is 90+% accurate for serious cases of WG, but only about 30% or so for light cases.
  • At least one study shows that for diagnosis of WG, both ANCA using IIF and anti-PR-3 using ELISA result in greater sensitivity than either test alone.
    • This finding is in some disagreement with a single 2003 study which showed that ELISA alone to be sufficient.
  • The general recommendation is that both the IIF and ELISA tests should be ordered for diagnoses.
• FIDIS is a new antibody test method that has yet to be commercialized and approved.
• A June 2008 study showed eotaxin-3 serum level correlated with CSS activity

THIS SITE

• Intent
  • To assist vasculitis patients in getting early diagnoses, effective treatments, and to advise of patient, organization, and scientific resources concerning vasculitis.
• Sources Used
  • The following information is derived from a variety of sources over some ten+ years and is not to be considered as medical advice, but merely the opinions or experiences or findings of the writer who is not a physician and has no medical training.
  • Much comes from Medline abstracts and medical journal articles on vasculitis.  Some is from autoimmune vasculitis patients and carers, some from newsgroups,  internet web pages, etc. that also deal with vasculitis.
  • The compiler has attempted to use only recent valid medical information regarding vasculitis, but cannot guarantee the validity nor the currency in every case
• Limitations
  • No medical decisions should be made on the basis of information on this web page or on associated linked documents and web pages unless those are from a recognized medical professional or professional medical publication.
  • Limits to this web page concerning vasculitis:
    • The author/compiler/editor of this web page and related pages has had NO medical training.
    • Only autoimmune vasculitides will be considered, not hypersensitivity vasculitis nor vasculitis as a result of an allergic reaction to medication or vaccine..
    • Most sections apply to most autoimmune vasculitides.
      • One refers specifically to Wegener’s granulomatosis.
• Terminology
  • Some abbreviations and equivalencies are:
    • Hereafter, “autoimmune vasculitis” may be abbreviated “AV” or “AVs” for plural.
    • The term “Prednisone” is sometimes used where it or a similar glucocorticoid might be prescribed to treat vasculitis.
    • “Immunosuppressives” used to  treat vasculitis are sometimes abbreviated “ISs”.
• Updates
  • This update was on June 1, 2009 and is a complete rewrite of the former web page at http://www.wegenersgranulomatosis.net that also dealt with vasculitis.
• Files & links – Vasculitis related.
  • Click here to view a web page listing all the links and files from this page.
• Tables & Figures – Vasculitis related
  • Click here to view a listing of the tables and figures in this web page.
• Disclaimer
  • ALL MEDICAL QUESTIONS, SYMPTOMS, CONCERNS AND PROBLEMS SHOULD BE DIRECTED TO APROPRIATE LICENSED MEDICAL PROFESSIONALS.
  • The writer/editor/compiler does not vouch for the accuracy, completeness, nor applicability of the information included on this site to any person, whether a vasculitis patient or otherwise. 

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