From the Research
A patient with chronic granulomatous mastitis does not necessarily require an autoimmune workup, as the clinical utility of autoantibodies in these patients has been questioned by recent studies. The decision to perform an autoimmune workup should be individualized based on clinical presentation, particularly if there are features suggesting an underlying autoimmune condition.
- The workup may include antinuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and specific antibodies like anti-neutrophil cytoplasmic antibodies (ANCA) 1.
- These tests can help identify conditions such as lupus, rheumatoid arthritis, or other autoimmune disorders that might be associated with granulomatous mastitis.
- Additionally, screening for sarcoidosis with serum angiotensin-converting enzyme (ACE) levels and chest imaging may be appropriate.
- The rationale for autoimmune testing stems from the understanding that some cases of granulomatous mastitis represent a localized autoimmune reaction or may be part of a systemic autoimmune process.
- However, many cases are idiopathic or related to other factors such as infection or reaction to foreign material.
- Treatment typically focuses on the mastitis itself with anti-inflammatory medications, steroids (such as prednisone 0.5-1 mg/kg/day with gradual taper over weeks to months), immunomodulators like methotrexate (10-25 mg weekly) or azathioprine, and sometimes surgical management, regardless of autoimmune status 2, 3.
- A recent study found that the positivity of autoantibodies such as RF, ANA, and anti-CCP was not statistically significant between patients with idiopathic granulomatous mastitis and healthy women, suggesting that these tests may not be useful in diagnosing or managing the condition 1.