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Martins-Martinho J, Ponte A, Dourado E, Khmelinskii N, Barreira SC, Cruz-Machado AR, Macieira C, Teixeira V, Rodrigues AM, Telles-Correia D, Fonseca JE, Ponte C. Anxiety and depression in patients with giant cell arteritis. Rheumatol Adv Pract 2024; 8:rkae013. [PMID: 38384323 PMCID: PMC10879746 DOI: 10.1093/rap/rkae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives To compare the prevalence of anxiety and depression in patients with GCA with that in the general population, using the Hospital Anxiety and Depression Scale (HADS), and to identify independent predictors of these psychiatric manifestations in patients with GCA. Methods We conducted a cross-sectional study including all patients diagnosed with GCA followed during 1 year in a vasculitis outpatient clinic. The HADS and 36-item Short Form (SF-36) questionnaires were prospectively collected. Patients' HADS results were compared with an age- and gender-matched control group. HADS anxiety (HADS-A) and HADS depression (HADS-D) scores between 8 and 10 defined possible anxiety and depression and ≥11 defined probable anxiety and depression, respectively. Results We included 72 patients and 288 controls. Compared with controls, patients with GCA had a statistically significant higher prevalence of HADS-A ≥8 (48.6% vs 26.4%), HADS-A ≥11 (30.6% vs 12.2%) and HADS-D ≥11 (33.3% vs 18.1%). GCA was an independent predictor of HADS-A ≥8 [odds ratio (OR) 3.3 (95% CI 1.9, 5.9)], HADS-A ≥11 [OR 3.8 (95% CI 2.0, 7.4)] and HADS-D ≥11 [OR 2.6 (95% CI 1.4, 4.7)]. Among patients with GCA, a negative correlation was observed between HADS-A/D and SF-36 mental health scores (r = -0.780 and r = -0.742, respectively). Glucocorticoid therapy was a predictor of HADS-A ≥8 [OR 10.4 (95% CI 1.2, 94.2)] and older age of HADS-D ≥8 [OR 1.2 (95% CI 1.1, 1.3)] and HADS-D ≥11 [OR 1.1 (95% CI 1.0, 1.2)]. Conclusions Compared with the general population, patients with GCA have a higher prevalence of anxiety and depression and GCA is an independent predictor of these symptoms. Glucocorticoid treatment and older age are predictors of anxiety and depression, respectively, in patients with GCA.
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Affiliation(s)
- Joana Martins-Martinho
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - André Ponte
- Psychiatry Department, Hospital Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | - Eduardo Dourado
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
- Egas Moniz Health Alliance, Aveiro, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia C Barreira
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana R Cruz-Machado
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Vítor Teixeira
- Rheumatology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana M Rodrigues
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Telles-Correia
- Psychiatry Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João E Fonseca
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Dejaco C, Kerschbaumer A, Aletaha D, Bond M, Hysa E, Camellino D, Ehlers L, Abril A, Appenzeller S, Cid MC, Dasgupta B, Duftner C, Grayson PC, Hellmich B, Hočevar A, Kermani TA, Matteson EL, Mollan SP, Neill L, Ponte C, Salvarani C, Sattui SE, Schmidt WA, Seo P, Smolen JS, Thiel J, Toro-Gutiérrez CE, Whitlock M, Buttgereit F. Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica. Ann Rheum Dis 2024; 83:48-57. [PMID: 36828585 PMCID: PMC10803996 DOI: 10.1136/ard-2022-223429] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/11/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR). METHODS A systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS Five overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment. CONCLUSION These are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.
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Affiliation(s)
- Christian Dejaco
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria
- Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
| | - Andreas Kerschbaumer
- Abteilung für Rheumatologie, Medizinische Universitat Wien Universitatsklinik fur Innere Medizin III, Wien, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medizinische Universität Wien, Wien, Austria
| | - Milena Bond
- Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, University of Genoa, Genova, Italy
| | - Dario Camellino
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Italy
| | - Lisa Ehlers
- Department of Rheumatology and Clinical Immunology, Charite Medical Faculty Berlin, Berlin, Germany
| | - Andy Abril
- Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Simone Appenzeller
- Departamento de Clínica Médica. Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Peter C Grayson
- National Institutes of Health/NIAMS, Bethesda, Maryland, USA
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatolgie und Immunologie, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany
| | - Alojzija Hočevar
- Department of Rheumatology, Universitiy Medical Centre, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Tanaz A Kermani
- Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Susan P Mollan
- Ophthalmology, University Hospitals Birmingham, Birmingham, UK
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Lorna Neill
- Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Nethy Bridge, UK
| | - Cristina Ponte
- Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sebastian Eduardo Sattui
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Philip Seo
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Josef S Smolen
- Rheumatology, Medical University of Vienna, Wien, Austria
| | - Jens Thiel
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria
- Clinic for Rheumatology and Clinical Immunology, University Hospital Freiburg, Faculty of Medicine, Freiburg, UK
| | - Carlos Enrique Toro-Gutiérrez
- Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia
| | | | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Crawshaw H, Janagan S, Austin K, Baker C, Day J, Robson JC. Patient-reported outcomes in vasculitis. Best Pract Res Clin Rheumatol 2023; 37:101829. [PMID: 37277246 DOI: 10.1016/j.berh.2023.101829] [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: 03/29/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 06/07/2023]
Abstract
Systemic vasculitis encompasses a group of multisystem disorders; both the diseases and the treatment strategies can have a significant impact on a patient's health-related quality of life (HRQoL). Using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) to evaluate the patient's view of their condition, treatments, and healthcare journey is essential to the patient-centered care approach. In this paper, we discuss the use of generic, disease-specific, and treatment-specific PROMs and PREMs in systemic vasculitis and future research goals.
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Affiliation(s)
- Helena Crawshaw
- Rheumatology Department Gloucestershire Royal Hospital NHS Trust, Great Western Road, Gloucester, Gloucestershire, GL1 3NN, UK.
| | - Shalini Janagan
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Keziah Austin
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK; Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Combe Park, Bath, BA1 3NG, UK.
| | - Charlotte Baker
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Julia Day
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, Room 5-054, Rheumatology Research B502, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
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Janagan S, Guly C, Skeoch S, Robson JC. Comment on: Benchmarking tocilizumab use for giant cell arteritis. Rheumatol Adv Pract 2022; 6:rkac069. [PMID: 36133959 PMCID: PMC9479882 DOI: 10.1093/rap/rkac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shalini Janagan
- Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust , Bristol, UK
| | - Catherine Guly
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust , Bristol, UK
| | - Sarah Skeoch
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals , Bath, UK
| | - Joanna C Robson
- Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust , Bristol, UK
- Rheumatology Research, Faculty of Health and Applied Science, University of the West of England , Bristol, UK
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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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Abstract
Purpose of Review The goal of this paper is to review current and future uses of patient-reported outcomes in large vessel vasculitis. The large vessel vasculitides comprise Giant Cell Arteritis and Takayasu arteritis; both are types of systemic vasculitis which affect the larger blood vessels. Patient-reported outcomes (PROs) capture the impact of these diseases on health-related quality of life. Recent Findings Generic PROs such as the SF-36 are currently used to compare HRQOL of people with GCA and TAK within clinical trials and observational studies and to make comparisons with the general population and HRQoL in other diseases. The development of a disease-specific PRO for GCA is currently underway. Beyond clinical trials, there is much interest in the use of PROs within routine clinical care, particularly E-PROs for remote use. Summary Further work will be needed to complete the development of disease-specific PROs for people with large vessel vasculitis and to establish feasibility, acceptability, and utility of E-PROs.
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Affiliation(s)
- Joanna Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK. .,Rheumatology Department, University Hospitals Bristol and Weston NHF Foundation Trust, Bristol, UK.
| | - Sarah Mackie
- Vascular Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Rheumatology Department, Leeds Teaching Hospital NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.,Division of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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