In Reply.—It is true that one of the patients in my series had limited Wegener's granulomatosis, but the other nine had or recently had had active generalized disease. Patient 9 had a very stormy course: unable to tolerate 50 mg of cyclophosphamide daily without severe leukopenia, she has achieved remission on 25 mg daily along with sulfamethoxazole and trimethoprim.
Reference 12 in my article was germaine to anticytoplasmic autoantibodies. Our experience with this test is that increased titers have paralleled activity and have increased with relapse in some patients, but not in others. A recent report1 indicates sensitivity of 84% for active Wegener's granulomatosis. In this chronic relapsing disease, a drop in anticytoplasmic autoantibodies to normal should not be regarded as a signal to stop treatment. Whatever the value of anticytoplasmic autoantibodies as a guide to therapy proves to be, it has no bearing on the choice of
HAROLD L. ISRAEL. The Treatment of Wegener's Granulomatosis With Sulfamethoxazole and Trimethoprim-Reply. Arch Intern Med. 1989;149(6):1471. doi:10.1001/archinte.1989.00390060171050
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