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Yin R, Shan J, Xu R, Huang C. Fatigue and sleep quality in Chinese adults with connective tissue disease: A cross-sectional study. Sleep Breath 2024; 28:1449-1457. [PMID: 38265629 DOI: 10.1007/s11325-024-02993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/10/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES This study aims to evaluate fatigue and sleep quality among adults with connective tissue disease (CTD), and the interrelationship. METHODS From April 2020 to February 2021, adult CTD patients hospitalized were invited to complete sociodemographic and disease-related data, Fatigue Severity Scale (FSS), and Pittsburgh Sleep Quality Index (PSQI), as well as laboratory detection through computer query. Statistical analysis was performed using SPSS 22.0. RESULTS A total of 363 patients with CTD were included in the study. Of which, 313 patients were accompanied by single CTD (systemic lupus erythematosus (SLE) = 109, Sjogren's syndrome (SS) = 51, rheumatoid arthritis (RA) = 44, idiopathic inflammatory myopathies (IIM) = 36, Vasculitis = 17, systemic sclerosis (SSc) = 14, other = 42, respectively), and 50 patients had CTD ≥ 2. Compared with CTD = 1, patients with CTD ≥ 2 had longer disease duration, higher erythrocyte sedimentation rate, and higher IgG level (all P < 0.05). The prevalence of poor sleep quality in 363 CTD patients was 61.2%, among which, 59.1% for CTD = 1 and 74.0% for CTD ≥ 2, with significant difference (P = 0.045). Additionally, 75.5% experienced fatigue, and 75.4% for CTD = 1, 76.0% for CTD ≥ 2 (P = 0.927). Fatigue and sleep quality interacted in CTD patients (r = 0.236, P < 0.01; χ2 = 11.302, P = 0.001). Interestingly, no significant differences were found in the prevalence of fatigue and poor sleep quality among CTD subgroups, as well as the FSS score, the seven components of sleep quality and total PSQI score (P > 0.05). CONCLUSIONS More than 3/5 CTD patients experience fatigue and poor sleep quality, and not different among CTD subgroups. Targeted interventions are needed to reduce fatigue, improve sleep quality, and ultimately improve the prognosis of patients with CTD.
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Affiliation(s)
- Rulan Yin
- Department of Nursing, The First Affiliated Hospital of Soochow University, 188Th Shizi Street, Suzhou, Jiangsu, China.
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
| | - Jun Shan
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
- Medical School of Nantong University, Nantong, China
| | - Rong Xu
- Department of Rheumatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Changyin Huang
- Department of Outpatient Surgery, The First Affiliated Hospital of Soochow University, 188Th Shizi Street, Suzhou, Jiangsu, China.
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Floyd L, Dhaygude A, Mitra S, Rowland C. Developing a disease-specific patient reported outcome measure to enhance understanding of the lived experiences of ANCA associated vasculitis: A protocol paper. PLoS One 2024; 19:e0298796. [PMID: 38451929 PMCID: PMC10919579 DOI: 10.1371/journal.pone.0298796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a chronic, relapsing-remitting condition associated with increased morbidity. Previous research has shown patients with AAV report high levels of fatigue, pain, depression and anxiety. Over recent years successful work has been carried out to improve clinical outcomes, resulting in reduced mortality and end stage kidney disease (ESKD). Despite this, little work has been done to better understand the role of the patient within this condition. The prevalence of AAV is increasing and to date, there is a shortage of specific tools that assess and measure key features relating to patient reported outcomes (PROs). This protocol details how we can better understand the lived experiences of those with AAV through the development of a disease specific, patient reported outcome measure (PROM), to be used in clinic practice. This will allow us to recognise and validate PROs and the impact the disease and its treatment has on patients' health related quality of life (HRQoL). In addition, we aim to identify potential differences in PRO's between demographics, organ involvement and treatment subgroups in AAV as well as outcomes relating to the patient experience. Patients from a single centre in the UK will be recruited to take part in the exploratory qualitative study which will include focus groups and semi-structured interviews. The inclusion criteria comprise anyone with a diagnosis of AAV and willing to participate, including those who have active or relapsing disease, those are economically active, unemployed, retired and patients receiving renal replacement therapy. The aim of the project is to identify key issues patients experience in relation to their disease and its management and how these can be better assessed in a new PROM developed for use in the clinic setting. This will enable better delivery of individualised care and inform shared decision making, while also serving as a platform for future research looking at PROs in other glomerulonephritides.
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Affiliation(s)
- Lauren Floyd
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Ajay Dhaygude
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Sandip Mitra
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academy of Health Sciences Centre (MAHSC), Manchester University Hospitals & University of Manchester, Manchester, United Kingdom
| | - Christine Rowland
- Manchester Centre for Health Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Panagiotopoulos A, Thomas K, Argyriou E, Chalkia A, Kapsala N, Koutsianas C, Mavrea E, Petras D, Boumpas DT, Vassilopoulos D. Health-related quality of life in patients with ANCA vasculitides compared to rheumatoid arthritis: a cross-sectional comparative study. Rheumatology (Oxford) 2024; 63:399-406. [PMID: 37171857 PMCID: PMC10836997 DOI: 10.1093/rheumatology/kead214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES There are limited data regarding health-related quality of life (HRQoL) in patients with ANCA-associated vasculitides (AAVs). We aimed to evaluate the HRQoL in patients with AAVs and compare it to another chronic inflammatory disease like RA and to healthy controls (HC). METHODS This was a multicentre, cross-sectional study of patients with AAVs and RA recruited from three tertiary rheumatology clinics. HRQoL was assessed with the Short Form 36 Health Survey, which included the physical and mental component summary scores (PCS and MCS). Data from 1007 HC served as historical controls. RESULTS Sixty-six patients with AAVs and 71 with RA were included. Both AAV and RA patients had significantly lower PCS and MCS scores compared with HC (P < 0.05). HRQoL in AAV patients was worse in patients with microscopic polyangiitis compared with granulomatosis with polyangiitis (physical components) and those with high (VDI ≥ 3) vs low (VDI < 3) damage scores while it did not differ between those with active (BVASv3 ≥ 1) vs. inactive (BVASv3 < 1) disease. In contrast, in RA patients, HRQoL correlated both with disease activity (assessed by the DAS28-ESR) and functional impairment/damage (assessed by the HAQ). Although overall patients with RA had similar HRQoL compared with those with AAVs, those with active RA had worse HRQoL compared with those with active AAV. CONCLUSIONS In patients with AAVs, HRQoL correlated more with organ damage and less with disease activity whereas in RA patients, it correlated with both. These data emphasize the need for AAV therapies aiming at preventing organ damage and thus improving HRQoL.
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Affiliation(s)
- Alexandros Panagiotopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | | | - Aglaia Chalkia
- Nephrology Department, General Hospital of Athens Hippokration, Athens, Greece
| | - Noemin Kapsala
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | - Christos Koutsianas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Evgenia Mavrea
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Petras
- Nephrology Department, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios T Boumpas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
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Granath A, Pettersson S, Gunnarsson I, Welin E, Dahlberg K. How is the patient perspective captured in ANCA-associated vasculitis research? An integrative review. Rheumatol Adv Pract 2023; 7:rkad092. [PMID: 37954916 PMCID: PMC10637867 DOI: 10.1093/rap/rkad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Objective The aim was to describe how the patient perspective is captured in clinical research on ANCA-associated vasculitis (AAV). Methods This integrative review included 2149 publications found in four different databases and manual searches. After screening, 156 articles remained. All articles were sorted and categorized, and 77 original articles were analysed further. Results The patient perspective was captured with patient-reported outcome measures (PROMs), single-item questionnaires, project-specific questionnaires and interviews. The most common aspects measured were health-related quality of life, anxiety and depression, and fatigue, and the least common were lifestyle habits, relationships and self-management. Conclusion The patient perspective was captured predominantly with generic PROMs and occasionally with a qualitative approach. AVV is a lifelong disease, and the results from this review show that not all aspects of importance to patients are covered with the PROMs used in research. Future studies should include the areas that are the most important for patients.
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Affiliation(s)
- Annika Granath
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Centre for Innovation, Research and Education, Region Vastmanland, Vastmanland Hospital Vasteras, Sweden
| | - Susanne Pettersson
- Rheumatology Unit, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Iva Gunnarsson
- Rheumatology Unit, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Welin
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Quartuccio L, Treppo E, Urso L, Del Frate G, Mescia F, Alberici F, Vaglio A, Emmi G. Unmet needs in ANCA-associated vasculitis: Physicians' and patients' perspectives. Front Immunol 2023; 14:1112899. [PMID: 36911748 PMCID: PMC9995379 DOI: 10.3389/fimmu.2023.1112899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
In recent years, clinical research has increased significantly and therapies for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis have improved. However, there are still unanswered questions and unmet needs about AAV patients. The purpose of this review is to examine the frontiers of research related to emerging biomarkers eventually predicting relapse, and new therapeutic approaches, not to mention new quality of life assessment tools. Identifying predictors of relapse may help optimize therapeutic strategies, minimize disease recurrence, and reduce treatment-related side effects. In addition, it is important to recognize that patients may suffer long-term consequences of the disease and its treatment, which, although life-saving, is often associated with significant side effects. Our goal, therefore, is to highlight what has been achieved, the pitfalls, and what still needs to be done, comparing the views of physicians and patients.
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Affiliation(s)
- Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Elena Treppo
- Division of Rheumatology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Livio Urso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Del Frate
- Division of Rheumatology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Federica Mescia
- Nephrology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Federico Alberici
- Nephrology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy.,Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
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van Eeden C, Osman MS, Cohen Tervaert JW. Fatigue in ANCA-associated vasculitis (AAV) and systemic sclerosis (SSc): similarities with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A critical review of the literature. Expert Rev Clin Immunol 2022; 18:1049-1070. [PMID: 36045606 DOI: 10.1080/1744666x.2022.2116002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Persistent debilitating fatigue is a frequent complaint in patients with systemic autoimmune rheumatic diseases (SARDs). Fatigue is, however, frequently overlooked in the clinic, and patients who successfully achieve remission of their disease, often still have a lowered quality of life due to its persistence. How similar is this fatigue to Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), what is this fatigue associated with, and what tools/approaches (if any), have resulted in the improvement of fatigue in these patients is poorly defined. AREAS COVERED Similarities between the pathophysiology of ME/CFS, systemic sclerosis (SSc) and primary systemic vasculitides (PSV) are discussed, followed by an in-depth review of the prevalence and correlates of fatigue in these diseases. The authors reviewed literature from MEDLINE, APA PsycInfo, Embase, and CINAHL. EXPERT OPINION Persistent fatigue is a prominent feature in SARDs and may not be associated with components commonly associated with disease activity and/or progression. Immune and metabolic commonalities exist between ME/CFS, SSc, and PSVs - suggesting that common pathways inherent to the diseases and fatigue may be present. We suggest that patients with features of ME/CFS need to be identified by treating physicians, as they may require alternative approaches to therapy to improve their quality of life.
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Affiliation(s)
- Charmaine van Eeden
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed S Osman
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,School for Mental Health and Neurosciences (MHeNs), Maastricht University, Maastricht, Netherlands
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Berti A, Boleto G, Merkel PA, Tómasson G, Monti S, Quinn KA, Hassett LC, Carmona L, Ramiro S. Psychometric properties of outcome measurement instruments for ANCA-associated vasculitis: a systematic literature review. Rheumatology (Oxford) 2022; 61:4603-4618. [PMID: 35293985 PMCID: PMC9707311 DOI: 10.1093/rheumatology/keac175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/29/2021] [Accepted: 01/14/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To systematically review the psychometric properties of outcome measurement instruments used in ANCA-associated vasculitis (AAV). METHODS Medline, EMBASE, Cochrane, Scopus and Web of Science were searched from inception to 14 July 2020 for validation studies of instruments used in AAV. Following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) and OMERACT frameworks, different psychometric properties (validity, reliability, responsiveness and feasibility) were summarized. Risk of bias was assessed according to the COSMIN checklist. RESULTS From 2505 articles identified, 32 met the predefined selection criteria, providing information on 22 instruments assessing disease activity (n = 7), damage (n = 2), activity and damage (n = 1), health-related quality of life (HRQoL; n = 9) and function (n = 3). Most of the instruments were tested in AAV as a group or in granulomatosis with polyangiitis only.The BVAS, any version, the Vasculitis Damage Index (VDI) and the AAV-Patient-Reported Outcome (AAV-PRO) have been more extensively validated than the other instruments. BVAS for Wegener Granulomatosis (BVAS/WG) has been shown to be valid for measuring disease activity [correlation with Physician global assessment (r = 0.90)], reliability (inter-observer intraclass correlation coefficient = 0.97), responsiveness and feasibility. For damage, VDI was shown to be moderately valid (correlations with BVAS version 3 at 6 months r = 0.14, BVAS/WG at 1 year r = 0.40 and 5 years r = 0.20), and feasible. For HRQoL, AAV-PRO demonstrated validity (correlations of the six AAV-PRO domains with EQ-5D-5L: -0.78 to -0.55; discrimination between active disease and remission, P < 0.0001 for all comparisons). The overall performance of instruments assessing function was low-to-moderate. CONCLUSION Among the 22 outcome measurement instruments used for AAV, BVAS (any version), VDI and AAV-PRO had the strongest psychometric properties.
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Affiliation(s)
- Alvise Berti
- Correspondence to: Alvise Berti, Department of Rheumatology, Santa Chiara Hospital and Department of CIBIO, University of Trento, Largo Medaglia 9, 38121 Trento, Italy. E-mail: ;
| | - Gonçalo Boleto
- Rheumatology, Université de Paris, Hôpital Cochin, Paris, France
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, Rheumatology Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Gunnar Tómasson
- Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland
| | - Sara Monti
- Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Kaitlin A Quinn
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD
| | | | - Loreto Carmona
- Rheumatology, Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center (LUMC), Leiden,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
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Harper L, Hewitt CA, Litchfield I, Morgan MD, Chanouzas D, Caulfield HK, Coughlan L, Dean C, Fletcher K, Cramp F, Greenfield S, Ives NJ, Jowett S, Kodabuckus S, Tearne S, Sehmi S, Edwardson C, Dawkins NP, Daley AJ. Management of fatigue with physical activity and behavioural change support in vasculitis: a feasibility study. Rheumatology (Oxford) 2021; 60:4130-4140. [PMID: 33369680 DOI: 10.1093/rheumatology/keaa890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/11/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Patients with ANCA-associated vasculitis (AAV) experience high levels of fatigue, despite disease remission. This study assessed the feasibility and acceptability of a definitive randomized controlled trial of a behavioural-based physical activity intervention to support fatigue self-management in AAV patients. METHODS AAV patients in disease remission with fatigue (Multidimensional Fatigue Inventory-20 general fatigue domain ≥14) were randomly allocated to intervention or standard care in this single-centre open-label randomized controlled feasibility study. The intervention lasted 12 weeks and comprised eight face-to-face physical activity sessions with a facilitator and 12 weekly telephone calls. Participants were encouraged to monitor their physical activity using a tracker device (Fitbit). Standard care involved sign-posting to fatigue websites. The primary outcome was feasibility of a phase III trial assessed against three stop/go traffic light criteria, (recruitment, intervention adherence and study withdrawal). A qualitative study assessed participant views about the intervention. RESULTS A total of 248 patients were screened and 134 were eligible to participate (54%). Stop/go criteria were amber for recruitment; 43/134 (32%, 95% CI: 24, 40) eligible participants randomized, amber for adherence; 73% of participants attended all eight physical activity sessions, but only 11/22 (50%, 95% CI: 29, 71%) completed the intervention as per the intended schedule, and green for study withdrawal; 2/43 participants withdrew before 24 weeks (5%, 95% CI: 0, 11). Qualitative results suggested the intervention was acceptable. CONCLUSION This study suggests a behavioural-based physical activity intervention targeting fatigue self-management was acceptable to patients with AAV, although recruitment and protocol adherence will need modification prior to a definitive trial. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN11929227.
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Affiliation(s)
| | | | | | | | | | - Hollie K Caulfield
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham
| | - Linda Coughlan
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Kate Fletcher
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol
| | | | - Natalie J Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research
| | | | | | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute of Applied Health Research
| | - Sukhwant Sehmi
- Birmingham Clinical Trials Unit, Institute of Applied Health Research
| | - Charlotte Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital
- NHIR Leicester Biomedical Research Centre, Leicester
| | - Nathan P Dawkins
- Diabetes Research Centre, University of Leicester, Leicester General Hospital
- NHIR Leicester Biomedical Research Centre, Leicester
| | - Amanda J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Mercuzot C, Letertre S, Daien CI, Zerkowski L, Guilpain P, Terrier B, Fesler P, Roubille C. Comorbidities and health-related quality of life in Patients with Antineutrophil Cytoplasmic Antibody (ANCA) - associated vasculitis. Autoimmun Rev 2020; 20:102708. [PMID: 33212227 DOI: 10.1016/j.autrev.2020.102708] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimization of immunosuppressive therapies has led to a marked improvement in the survival of ANCA-associated vasculitides (AAV). The main issue now appears to be the management of comorbidities and the improvement of quality of life. The objective of this review was to investigate the incidence and the impact of AAV-associated comorbidities, as well as the determinants of health-related quality of life (HRQoL). METHODS We performed a systematic literature review of articles published in Medline from 2001 to 04/28/2020. We selected relevant articles about AAV-associated comorbidities as well as HRQoL and fatigue. For each selected article, data on the incidence of comorbidity were extracted, and factors associated with the Mental component score (MCS) and the Physical component score (PCS) were identified. RESULTS Among the 10,993 references identified, 103 were retained for the final analysis. A significant increase in cardiovascular risk was evidenced, particularly for coronary artery disease and thromboembolic events, especially during the active phase of the disease. AAV was also associated with bronchiectasis, thyroid diseases and osteoporosis. A marked decrease in HRQoL and an increase in fatigue and anxiety were reported. Decrease in PCS and MCS was associated with fatigue, mood disorders, sleep disturbance, and/or unemployment. CONCLUSION The excess mortality of AAV is still a concern, partly in connection with cardiovascular and thromboembolic comorbidities. AAV patients also experiment a reduction in their HRQoL that requires integrated management. Patients with AAV need comorbidity management strategies to improve their quality of life and outcomes.
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Affiliation(s)
- Cédric Mercuzot
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Simon Letertre
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Claire I Daien
- Department of Rheumatology, Montpellier University Hospital, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Philippe Guilpain
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for Systemic Autoimmune Diseases, Montpellier University Hospital, Montpellier, France; INSERM U 1183, IRMB, Universite Montpellier, INSERM, Montpellier, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin University Hospital, Paris, France; National Referral Centre for Systemic and Autoimmune Diseases, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Fesler
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, Cedex 5, France
| | - Camille Roubille
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, Cedex 5, France.
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10
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Cheung SM, Keenan K, Senn N, Hutcheon G, Chan K, Erwig L, Schrepf A, Dospinescu P, Gray S, Waiter G, He J, Basu N. Metabolic and Structural Skeletal Muscle Health in Systemic Lupus Erythematosus-Related Fatigue: A Multimodal Magnetic Resonance Imaging Study. Arthritis Care Res (Hoboken) 2020; 71:1640-1646. [PMID: 30629805 DOI: 10.1002/acr.23833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the potential structural and metabolic role of skeletal muscle in systemic lupus erythematosus (SLE)-related fatigue. METHODS A case-control, multimodal magnetic resonance imaging (MRI) study was conducted. Cases were patients with inactive SLE who reported chronic fatigue. Controls were age- and sex-matched healthy members of the general population. Patients were clinically characterized and then underwent a 3T whole-body MRI scan. Resting and dynamic 31 P MRI spectroscopy of the calf muscles was applied, from which phosphocreatine (PCr) recovery halftime, a marker of mitochondrial dysfunction, was computed. In addition, microstructural sequences (T1-weighted anatomic images, T2 mapping, and diffusion tensor imaging) were acquired. Descriptive statistics evaluated group differences and within-case physical fatigue correlations were explored. RESULTS Of the 37 recruits (mean age 43.8 years, 89.2% female), cases (n = 19) reported higher levels of physical fatigue, pain, depression, and sleep disturbance compared to the control group (P < 0.0001). PCr was greater (P = 0.045) among cases (mean ± SD 33.0 ± 9.0 seconds) compared to controls (mean ± SD 27.1 ± 6.6 seconds). No microstructural group differences were observed. Within cases, physical fatigue did not correlate with PCr (r = -0.28, P = 0.25). CONCLUSION We report preliminary data demonstrating greater skeletal muscle mitochondrial dysfunction among fatigued patients with SLE compared to healthy controls.
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Affiliation(s)
| | | | | | | | | | - Lars Erwig
- University of Aberdeen, Aberdeen, and GlaxoSmithKline, Stevenage, UK
| | | | | | | | | | - Jiabao He
- University of Aberdeen, Aberdeen, UK
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11
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Mooney J, Graham K, Watts RA. Impact of caring for someone with a rare rheumatic condition, views from patients and informal carers-the need for cat-like vigilance. Rheumatol Adv Pract 2019; 3:rkz003. [PMID: 31431991 PMCID: PMC6649977 DOI: 10.1093/rap/rkz003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/25/2019] [Indexed: 12/22/2022] Open
Abstract
Objective ANCA-associated vasculitis (AAV) is a rare multisystem disease. Modern therapeutic protocols have turned AAV from an acute, frequently fatal disease into a chronic disease requiring long-term immunosuppression. Patients must often manage substantial burdens related to chronic illness and treatment-related side effects, requiring help from informal carers. This study aimed to explore the experience of patients and of informal carers of patients with AAV about the impact of managing a rare rheumatic condition. Methods A qualitative approach using semi-structured interviews was used. Interviews were conducted with a purposeful sample of 18 pairs of patients with AAV and their informal carers. The interviews were used to explore the participants' experience and effects of caring. The interviews were recorded and transcribed as verbatim text and analysed using the framework technique. Results Eighteen patients (seven female; disease: 10 granulomatosis with polyangiitis; four microscopic polyangiitis; four eosinophilic granulomatosis with polyangiitis; age range 34-78 years; disease duration 1-20 years). Caregiver and patient perspectives were shared. The emerging themes were the physical and psychological impacts of the disease, the need for constant vigilance and fear of the future. Conclusion Both patients and carers faced a range of challenges in managing a rare condition, including the seriousness of the illness, dealing with the emotional toll and knowing what to expect. This study offers insight into the experiences of patients and informal carers, and health-care professionals should address individuals' fears and expectations for recovery.
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Affiliation(s)
- Janice Mooney
- School of Health and Social Care, University of Staffordshire, Stafford, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karly Graham
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
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12
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O'Malley L, Druce KL, Chanouzas D, Morgan MD, Jones R, Jayne DRW, Basu N, Harper L. The Longitudinal Course of Fatigue in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol 2019; 47:572-579. [PMID: 31263068 DOI: 10.3899/jrheum.190113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fatigue is common and burdensome in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study aimed to understand how fatigue changes over time following treatment initiation and to determine whether individuals with the poorest prognosis can be robustly identified. METHODS One hundred forty-nine patients with AAV and new-onset disease recruited to 2 clinical trials (RITUXVAS and MYCYC) were followed for 18 months. Fatigue was measured at baseline and 6-month intervals using the vitality domain of the Medical Outcomes Study Short Form-36 quality of life questionnaire and compared to a cohort of 470 controls. Group-based trajectory modeling (GBTM) determined trajectories of the symptom to which baseline characteristics and ongoing fatigue scores were compared. RESULTS Fatigue levels at diagnosis were worse in patients than controls [median (interquartile range; IQR) 30 (10-48) vs 70 (55-80); p < 0.001], with 46% of patients reporting severe fatigue. Fatigue improved after 6 months of treatment but remained worse than in controls (p < 0.001). GBTM revealed varied trajectories of fatigue: low fatigue stable (n = 23), moderate baseline fatigue improvers (n = 29), high baseline fatigue improvers (n = 61), and stable baseline high fatigue (n = 37). Participants who followed stable high fatigue trajectories had lower vasculitis activity compared to improvers, but no other demographic or clinical variables differed. CONCLUSION This study longitudinally measured fatigue levels in patients with AAV. Although most patients improved following treatment, an important subgroup of patients reported persistently high levels of fatigue that did not change. Few clinical or laboratory markers distinguished these patients, suggesting alternative interventions specific for fatigue are required. [clinicaltrialsregister.eu, RITUXVAS EudraCT number: 2005-003610-15; MYCYC EudraCT number: 2006-001663-33].
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Affiliation(s)
- Lucy O'Malley
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Katie L Druce
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Dimitrios Chanouzas
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Matthew D Morgan
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Rachel Jones
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - David R W Jayne
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Neil Basu
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma.,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham
| | - Lorraine Harper
- From the Institute of Clinical Sciences, University of Birmingham, Birmingham; Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester; Department of Medicine, University of Cambridge, Cambridge; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. .,LH, DRJ, and RJ have received research grants and speaker fees from F. Hoffmann-La Roche. LH, RJ, DRJ, MDM have been involved in studies in which rituximab was given free of charge by Roche and MMF was given free of charge by Vifor Pharma. .,L. O'Malley, MB ChB, Institute of Clinical Sciences, University of Birmingham; K.L. Druce, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D. Chanouzas, PhD, Institute of Clinical Sciences, University of Birmingham; M.D. Morgan, PhD, Institute of Clinical Sciences, University of Birmingham; R. Jones, MD, Department of Medicine, University of Cambridge; D.R. Jayne, MD, Department of Medicine, University of Cambridge; N. Basu, PhD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L. Harper, PhD, Institute of Clinical Sciences, University of Birmingham.
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Hogan SL, Nachman PH, Poulton CJ, Hu Y, Blazek LN, Free ME, Jennette JC, Falk RJ. Understanding Long-term Remission Off Therapy in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Kidney Int Rep 2019; 4:551-560. [PMID: 30993230 PMCID: PMC6451087 DOI: 10.1016/j.ekir.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/03/2018] [Accepted: 01/07/2019] [Indexed: 10/29/2022] Open
Abstract
Introduction In antineutrophil cytoplasmic antibody-associated (ANCA) vasculitis, relapse risk and long-term immunosuppressive therapy are problematic. Stopping immunotherapy has not been well described. Methods The Glomerular Disease Collaborative Network ANCA vasculitis inception cohort was evaluated. Patients who stopped all immunotherapy and those continuously on immunotherapy (≥2 years) were included. Time to first period off therapy was modeled with end-stage kidney disease and death as competing risks to understand influences of stopping therapy. Cause-specific hazard ratios (HRs) with 95% confidence intervals (CI) and P values are reported. Models controlled for age, sex, ANCA specificity, organ involvement, diagnosis era, and treatments (yes/no). Repeated events analysis was used to assess the time-dependent variable of time off treatment on recurrent relapse with HRs, 95% CIs, and P values are reported (same control variables without treatments). Results In 427 patients, 277 (65%) stopped therapy (median 20 months from initial induction); 14% for ≥2 different periods of time and 23% for periods ≥5 years. In multivariable models of time to discontinuation of treatment, women (HR 1.33; 95% CI 1.04-1.70; P = 0.024) and those treated with pulse methylprednisolone (HR 1.39; 95% CI 1.05-1.84; P = 0.020) were more likely to stop. The time-dependent variable of time off treatment was associated with fewer recurrent relapses (HR 0.51; 95% CI 0.41-0.63; P < 0.001). Conclusions Stopping immunotherapy was common. Women and those treated with methylprednisolone stop treatment more often, but underlying mechanisms are unknown. Stopping treatment was associated with fewer relapses, suggesting that even without guidelines there may be benefits without an untoward detriment of relapse.
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Affiliation(s)
- Susan L Hogan
- Division of Nephrology, Department of Medicine, and the Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Patrick H Nachman
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Caroline J Poulton
- Division of Nephrology, Department of Medicine, and the Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Yichun Hu
- Division of Nephrology, Department of Medicine, and the Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lauren N Blazek
- Division of Nephrology, Department of Medicine, and the Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Meghan E Free
- Division of Nephrology, Department of Medicine, and the Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - J Charles Jennette
- Division of Nephropathology, Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ronald J Falk
- Division of Nephrology, Department of Medicine, and the Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Hessels AC, van der Hoeven JH, Sanders JSF, Brouwer E, Rutgers A, Stegeman CA. Leg muscle strength is reduced and is associated with physical quality of life in Antineutrophil cytoplasmic antibody-associated vasculitis. PLoS One 2019; 14:e0211895. [PMID: 30716132 PMCID: PMC6361463 DOI: 10.1371/journal.pone.0211895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/22/2019] [Indexed: 02/04/2023] Open
Abstract
Objective Physical quality of life is reduced in ANCA-associated vasculitis (AAV). This study aims to investigate whether this may be explained by reduced muscle strength and physical activity resulting from disease damage and steroid myopathy. Methods Forty-eight AAV patients were sequentially included from the outpatient clinic. Patients in different stages of disease and treatment underwent measurements of muscle strength and anthropometric parameters. Patients filled in physical activity (Baecke) and quality of life questionnaires (RAND-36) and carried an accelerometer for a week. Muscle strength and physical activity were compared to quality of life, prednisolone use and disease duration. Results Most AAV patients had lower knee extension (76%) and elbow flexion (67%) forces than expected based on healthy norms. Also, physical (P<0.001) and mental (P = 0.01) quality of life were significantly reduced compared to healthy norm values. Lower knee extension force (P = 0.009), younger age <70 (P<0.001) and relapse of vasculitis (P = 0.003) were associated with lower age-adjusted physical quality of life. Lower Baecke index (P = 0.006), higher prednisolone dose (P = 0.005) and ENT involvement (P = 0.006) were associated with lower age-adjusted mental quality of life. Leg muscle strength showed no association with current or cumulative prednisolone use. Disease duration was longer in patients with knee extension force below healthy norms (P = 0.006). Conclusion Knee extension force and physical activity are positively associated with quality of life in AAV. Knee extension force decreases with longer disease duration, suggesting that disease- and treatment-related damage have a cumulative negative effect on muscle strength.
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Affiliation(s)
- Arno C. Hessels
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Johannes H. van der Hoeven
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Stephan F. Sanders
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Coen A. Stegeman
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Harper L, Morgan MD, Chanouzas D, Caulfield HK, Coughlan L, Dean C, Fletcher K, Cramp F, Greenfield S, Hewitt CA, Ives NJ, Jowett S, Daley A. Treatment of fatigue with physical activity and behavioural change support in vasculitis: study protocol for an open-label randomised controlled feasibility study. BMJ Open 2018; 8:e023769. [PMID: 30377212 PMCID: PMC6224747 DOI: 10.1136/bmjopen-2018-023769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Fatigue is a major cause of morbidity, limiting quality of life, in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The aetiology of fatigue is multifactorial; biological and psychosocial mediators, such as sleep deprivation, pain and anxiety and depression, are important and may be improved by increasing physical activity. Current self-management advice is based on expert opinion and is poorly adhered to. This study aims to investigate the feasibility of increasing physical activity using a programme of direct contact and telephone support, to provide patient education, encourage behaviour self-monitoring and the development of an individual change plan with defined goals and feedback to treat fatigue compared with standard of care to inform the design of a large randomised controlled trial to test the efficacy and cost effectiveness of this programme. METHODS AND ANALYSIS Patients with AAV and significant levels of fatigue (patient self-report using multidimensional fatigue index score questionnaire ≥14) will be randomised in a 1:1 ratio to the physical activity programme supported by behavioural change techniques or standard of care. The intervention programme will consist of 8 visits of supervised activity sessions and 12 telephone support calls over 12 weeks with the aim of increasing physical activity to the level advised by government guidelines. Assessment visits will be performed at baseline, 12, 24 and 52 weeks. The study will assess the feasibility of recruitment, retention, the acceptability, adherence and safety of the intervention, and collect data on various assessment tools to inform the design of a large definitive trial. A nested qualitative study will explore patient experience of the trial through focus groups or interviews. ETHICS AND DISSEMINATION All required ethical and regulatory approvals have been obtained. Findings will be disseminated through conference presentations, patient networks and academic publications. TRIAL REGISTRATION NUMBER ISRCTN11929227.
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Affiliation(s)
- Lorraine Harper
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Matthew David Morgan
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Dimitrios Chanouzas
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hollie K Caulfield
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Linda Coughlan
- NIHR/Wellcome Trust Clinical Research Facility, UHB NHS Foundation Trust, Birmingham, UK
| | | | - Kate Fletcher
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Natalie J Ives
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Humoral immunity to memory antigens and pathogens is maintained in patients with chronic kidney disease. PLoS One 2018; 13:e0195730. [PMID: 29659606 PMCID: PMC5901993 DOI: 10.1371/journal.pone.0195730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/28/2018] [Indexed: 01/29/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of infection and poorer responses to vaccination. This suggests that CKD patients have an impaired responsiveness to all antigens, even those first encountered before CKD onset. To examine this we evaluated antibody responses against two childhood vaccine antigens, tetanus (TT) and diphtheria toxoids (DT) and two common pathogens, cytomegalovirus (CMV) and Salmonella enterica serovar Enteritidis (SEn) in two independent cohorts consisting of age-matched individuals with and without CKD. Sera were evaluated for antigen-specific IgG titres and the functionality of antibody to SEn was assessed in a serum bactericidal assay. Surprisingly, patients with CKD and control subjects had comparable levels of IgG against TT and DT, suggesting preserved humoral memory responses to antigens encountered early in life. Lipopolysaccharide-specific IgG titres and serum bactericidal activity in patients with CKD were also not inferior to controls. CMV-specific IgG titres in seropositive CKD patients were similar or even increased compared to controls. Therefore, whilst responses to new vaccines in CKD are typically lower than expected, antibody responses to antigens commonly encountered prior to CKD onset are not. The immunodeficiency of CKD is likely characterised by failure to respond to new antigenic challenges and efforts to improve patient outcomes should be focussed here.
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Patient and physician perspectives on the impact of health-related quality of life in Mexican patients with ANCA-associated vasculitis. Rheumatol Int 2017; 38:631-640. [DOI: 10.1007/s00296-017-3904-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
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