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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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Hurtado-Arias JJ, Ramírez-Mulhern I, Gonzalez-Martínez C, Merayo-Chalico J, Barrera-Vargas A, Hinojosa-Azaola A. Patient-reported outcomes in ANCA-associated vasculitis: a cross-sectional study to explore the interactions between patients' and physicians' perspectives. Rheumatol Int 2023; 43:933-940. [PMID: 36814035 PMCID: PMC9946285 DOI: 10.1007/s00296-023-05288-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
To evaluate associations between the domains of the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) instrument and clinical variables. Patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), or renal-limited vasculitis (RLV) were recruited from a tertiary care center in Mexico City. Demographic, clinical, serological, and treatment-related data were retrieved. Disease activity, damage, patient and physician global assessments (PtGA and PhGA) were evaluated. All patients completed the AAV-PRO questionnaire, male patients also completed the International Index of Erectile Function (IIEF-5) questionnaire. Seventy patients (44 women and 26 men) were included, with a median age of 53.5 years (43-61), and a disease duration of 82 months (34-135). Moderate correlations were identified between the PtGA and the AAV-PRO domains: social and emotional impact, treatment side effects, organ-specific symptoms, and physical function. The PhGA correlated with the PtGA and prednisone doses. Subanalyses of the AAV-PRO domains according to sex, age, and disease duration showed significant differences in the treatment side effects domain, with higher scores in women, in patients < 50 years, and in patients with disease duration < 5 years. The domain of concerns about the future showed a higher score in patients with disease duration < 5 years. A total of 17/24 (70.8%) of men who completed the IIEF-5 questionnaire were classified as having some degree of erectile dysfunction. The domains of AAV-PRO correlated with other outcome measures, while differences were found between some of the domains according to sex, age, and disease duration.
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Affiliation(s)
- José Joel Hurtado-Arias
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Isabela Ramírez-Mulhern
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Carlos Gonzalez-Martínez
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Andrea Hinojosa-Azaola
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
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Floris A, Piga M, Laconi R, Espinosa G, Lopalco G, Serpa Pinto L, Kougkas N, Sota J, Lo Monaco A, Govoni M, Cantarini L, Bertsias G, Correia J, Iannone F, Cervera R, Vasconcelos C, Mathieu A, Cauli A. Accrual of organ damage in Behçet’s syndrome: trajectory, associated factors, and impact on patients’ quality of life over a 2-year prospective follow-up study. Arthritis Res Ther 2022; 24:253. [PMID: 36397162 PMCID: PMC9670626 DOI: 10.1186/s13075-022-02947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to investigate the trajectory of damage accrual, associated factors, and impact on health-related quality of life (HR-QoL) in a multicenter cohort of patients with Behçet’s syndrome (BS) over 2 years of follow-up. Methods Patients recruited in the BS Overall Damage Index (BODI) validation study were prospectively monitored for 2 years and assessed for damage accrual, defined as an increase ≥1 in the BODI score, and HR-QoL was evaluated by the SF-36 questionnaire. Logistic and multiple linear regression models were built to determine factors associated with damage accrual and impairment in the different SF-36 domains. Results During follow-up, 36 out of 189 (19.0%) patients had an increase ≥1 in the BODI score with a mean (SD) difference of 1.7 (0.8) (p <0.001). The incidence rate of damage accrual was stable over time, regardless of the disease duration. Out of 61 new BODI items, 25 (41.0%) were considered related to glucocorticoid (GC) use. In multivariate analysis, duration of GC therapy (OR per 1-year 1.15, 95% CI 1.07–1.23; p <0.001) and occurrence of ≥1 disease relapse (OR 3.15, 95% CI 1.09–9.12; p 0.038) were identified as predictors of damage accrual, whereas the use of immunosuppressants showed a protective effect (OR 0.20, 95% CI 0.08–0.54, p<0.001). Damage accrual was independently associated with the impairment of different physical domains and, to a greater extent, in emotional domains of the SF-36 questionnaire. Female sex, higher disease activity, and fibromyalgia were also significantly associated with impairment in HR-QoL. Conclusion In BS, organ damage accrues over time, also in long-standing disease, resulting in an impairment of the perceived physical and mental health. Adequate immunosuppressive treatment, preventing disease flares and minimizing exposure to GCs have a crucial role in lowering the risk of damage accrual. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02947-y.
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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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Piga M, Floris A, Espinosa G, Serpa Pinto L, Kougkas N, Lo Monaco A, Lopalco G, Orlando I, Pirani V, Santos E, Bertsias G, Cantarini L, Cauli A, Cervera R, Correia J, Govoni M, Iannone F, Neri P, Martins Silva A, Vasconcelos C, Muntoni M, Mathieu A. Development and preliminary validation of the Behçet's syndrome Overall Damage Index (BODI). RMD Open 2021; 6:rmdopen-2020-001192. [PMID: 32703843 PMCID: PMC7425117 DOI: 10.1136/rmdopen-2020-001192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/23/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
Objective To develop and validate the evidence-based and consensus-based Behçet’s Syndrome Overall Damage Index (BODI). Methods Starting from 120 literature-retrieved preliminary items, the BODI underwent multiple Delphi rounds with an international multidisciplinary panel consisting of rheumatologists, internists, ophthalmologists, neurologists, and patient delegates until consensus was reached on the final content. The BODI was validated in a cross-sectional multicentre cohort of 228 patients with Behçet’s syndrome (BS) through the study of (a) correlation between BODI and Vasculitis Damage Index (VDI) and (b) correlation between BODI and disease activity measures (ie, Behçet’s Disease Current Activity Form (BDCAF), Physician Global Assessment (PGA), Patient Global Assessment (PtGA)), c) content and face validity and (d) feasibility. Results The final BODI consists of 4 overarching principles and 46 unweighted-items grouped into 9 organ domains. It showed good to excellent reliability, with a mean Cohen’s k of 0.84 (95% CI 0.78 to 0.90) and a mean intra-class correlation coefficient of 0.88 (95% CI 0.80 to 0.95). Overall, 128 (56.1%) patients had a BODI score ≥1, with a median score of 1.0 (range 0–14). The BODI significantly correlated with the VDI (r=0.693, p<0.001), demonstrating to effectively measure damage (construct validity), but had greater sensitivity in identifying major organ damage and did not correlate with disease activity measures (ie, BDCAF: p=0.807, PGA: p=0.820, PtGA: p=0.794) discriminating damage from the major confounding factor. The instrument was deemed credible (face validity), complete (content validity) and feasible by an independent group of clinicians. Conclusions Pending further validation, the BODI may be used to assess organ damage in patients with BS in the context of observational and controlled trials.
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Affiliation(s)
- Matteo Piga
- Rheumatology Unit, AOU University Clinic of Cagliari, Cagliari, Italy
| | - Alberto Floris
- Rheumatology Unit, AOU University Clinic of Cagliari, Cagliari, Italy
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luísa Serpa Pinto
- Hospital Santo Antonio Centro Hospitalar Do Porto, Unidade De Imunologia Clinica, Porto, Portugal
| | - Nikolaos Kougkas
- Rheumatology, Clinical Immunology and Allergy Unit, University of Crete, Heraklion, Greece
| | - Andrea Lo Monaco
- Rheumatology Unit - AOU, S. Anna, Ferrara, University of Ferrara, Ferrara, Italy
| | | | - Ida Orlando
- University of Siena, Rheumatology Unit, Siena, Italy
| | - Vittorio Pirani
- Ophthalmology Clinic, Università Politecnica Delle Marche, Ancona, Italy
| | - Ernestina Santos
- Centro Hospitalar Do Porto/Hospital De Santo António, Neurology Department, Porto, Portugal.,UMIB Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy Unit, University of Crete, Heraklion, Greece
| | | | - Alberto Cauli
- Rheumatology Unit, AOU University Clinic of Cagliari, Cagliari, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - João Correia
- Hospital Santo Antonio Centro Hospitalar Do Porto, Unidade De Imunologia Clinica, Porto, Portugal
| | - Marcello Govoni
- Rheumatology Unit - AOU, S. Anna, Ferrara, University of Ferrara, Ferrara, Italy
| | | | - Piergiorgio Neri
- Ophthalmology Clinic, Università Politecnica Delle Marche, Ancona, Italy.,Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ana Martins Silva
- Centro Hospitalar Do Porto/Hospital De Santo António, Neurology Department, Porto, Portugal
| | - Carlos Vasconcelos
- UMIB Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Monica Muntoni
- Associazione Italiana Sindrome E Malattia Di Behçet (SIMBA), Pontedera, Italy
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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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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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McCormick N, Marra CA, Aviña-Zubieta JA. Productivity Losses and Costs in the Less-Common Systemic Autoimmune Rheumatic Diseases. Curr Rheumatol Rep 2017; 19:72. [PMID: 29086172 DOI: 10.1007/s11926-017-0698-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We synthesised the literature on productivity losses and costs in the less-common systemic autoimmune rheumatic diseases: Sjogren's syndrome (SjS), systemic sclerosis (SSc), poly/dermatomyositis (PM/DM), and systemic vasculitides (SV). RECENT FINDINGS Of 29 studies located, 12 were published 2012 onwards (SSc = 6, SjS = 2, PM/DM = 2, SV = 2). In these, 25% of PM/DM, and 21-26% of SV, were work disabled, 22% of SSc stopped work within 3 years of diagnosis, and annual costs of absenteeism in SSc averaged $12,024 2017 USD. Very few studies reported on costs, presenteeism (working at reduced levels), or unpaid productivity loss. Across multiple systemic autoimmune rheumatic diseases (SARDs), major drivers of lost productivity were generalised items like pain, depression, and fatigue, rather than disease-specific factors. Evidence suggests that work disability is common in SSc and strikes quickly. However, in SSc and other SARDs, more comprehensive estimates are needed, which include absenteeism and presenteeism from paid and unpaid work, costs, and drivers of productivity loss.
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Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Arthritis Research Canada, Richmond, BC, Canada.
| | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, BC, Canada.,Division of Rheumatology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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McCormick N, Reimer K, Famouri A, Marra CA, Aviña-Zubieta JA. Filling the gaps in SARDs research: collection and linkage of administrative health data and self-reported survey data for a general population-based cohort of individuals with and without diagnoses of systemic autoimmune rheumatic disease (SARDs) from British Columbia, Canada. BMJ Open 2017; 7:e013977. [PMID: 28637725 PMCID: PMC5541381 DOI: 10.1136/bmjopen-2016-013977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Systemic autoimmune rheumatic diseases (SARDs) are a group of debilitating autoimmune diseases, including systemic lupus erythematosus and related disorders. Assessing the healthcare and economic burden of SARDs has been challenging: while administrative databases can be used to determine healthcare utilisation and costs with minimal selection and recall bias, other health, sociodemographic and economic data have typically been sourced from highly selected, clinic-based cohorts. To address these gaps, we are collecting self-reported survey data from a general population-based cohort of individuals with and without SARDs and linking it to their longitudinal administrative health data. PARTICIPANTS Using administrative data from the province of British Columbia (BC), Canada, we established a population-based cohort of all BC adults receiving care for SARDs during 1996-2010 (n=20 729) and non-SARD individuals randomly selected from the general population. BC Ministry of Health granted us contact information for 12 000 SARD and non-SARD individuals, who were recruited to complete the surveys by mail or online. FINDINGS TO DATE Four hundred individuals were initially invited to participate, with 135 (34%) consenting and 127 (94%) submitting the first survey (72% completed online). Sixty-three (49.6%) reported ≥1 SARD diagnosis. The non-SARDs group (n=64) was 92% female with mean age 57.0±11.6 years. The SARDs group (n=63) was 94% female with mean age 56.5±13.1 years. Forty-eight per cent of those with SARDs were current-or-former smokers (mean 10.6±16.2 pack-years), and 33% were overweight or obese (mean body mass index of 24.4±5.3). FUTURE PLANS Health and productivity data collected from the surveys will be linked to participants' administrative health data from the years 1990-2013, allowing us to determine the healthcare and lost productivity costs of SARDs, and assess the impact of patient-reported variables on utilisation, costs, disability and clinical outcomes. Findings will be disseminated through scientific conferences and peer-reviewed journals.
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Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Richmond, Canada
| | - Kathryn Reimer
- Arthritis Research Canada, Richmond, Canada
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Richmond, Canada
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - J. Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, Canada
- Division of Rheumatology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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Jobard S, Magnant J, Blasco H, Ferreira-Maldent N, Griffoul I, Diot E, Maillot F. Quality of life of patients treated for giant cell arteritis: a case-control study. Clin Rheumatol 2017; 36:2055-2062. [PMID: 28405843 DOI: 10.1007/s10067-017-3619-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/27/2017] [Indexed: 11/28/2022]
Abstract
The objective of the study was to assess the quality of life (QOL) of patients with giant cell arteritis (GCA), following high dose of corticosteroids (CS). Thirty patients with GCA who had stopped CS or who were under long-term low dose of CS were included and matched to 60 controls. QOL was measured by the SF-36 score and a specific questionnaire. GCA patients had no impairment of QOL compared to controls according to SF-36. Most of them (57%) estimated that their general condition was improved following treatment. Patients with GCA complications or CS therapy side effects had no significant impairment of their QOL compared with patients without complications or adverse effects. Only the patients who had gained weight had a lower score on the domain "Vitality" (VT; p = 0.013). Walking difficulties were the most frequent complaints. They were associated with impaired scores on the physical summary score (p = 0.0340) and on the "General Health" (GH; p = 0.005) and "Physical Functioning" (PF, p = 0.0298) domains. Falls among GCA patients were associated with altered scores on the domain VT (p = 0.0058) and on the mental summary score if they had fallen at least three times (p = 0.0460). GCA patients following high dose of CS or under long-term low doses of CS have no significant impairment of their QOL compared to controls. GCA complications, including visual impairment, do not seem to have any major impact on QOL.
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Affiliation(s)
- Stéphanie Jobard
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais, 2 boulevard Tonnellé, 37044 Cedex 9, Tours, France.
| | - Julie Magnant
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais, 2 boulevard Tonnellé, 37044 Cedex 9, Tours, France
| | - Hélène Blasco
- CHRU de Tours, Laboratoire de biochimie et biologie moléculaire, Inserm U930, Université François-Rabelais, Tours, France
| | - Nicole Ferreira-Maldent
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais, 2 boulevard Tonnellé, 37044 Cedex 9, Tours, France
| | - Isabelle Griffoul
- CHRU de Tours, Service de Rhumatologie, Université François-Rabelais, Tours, France
| | - Elisabeth Diot
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais, 2 boulevard Tonnellé, 37044 Cedex 9, Tours, France
| | - François Maillot
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais, 2 boulevard Tonnellé, 37044 Cedex 9, Tours, France
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Flossmann O. Risks of treatments and long-term outcomes of systemic ANCA-associated vasculitis. Presse Med 2015; 44:e251-7. [DOI: 10.1016/j.lpm.2015.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022] Open
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Novakovich E, Grayson PC. What matters for patients with vasculitis? Presse Med 2015; 44:e267-72. [PMID: 25986940 DOI: 10.1016/j.lpm.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/02/2015] [Indexed: 11/30/2022] Open
Abstract
Advances in clinical care for patients with vasculitis have improved survival rates and created new challenges related to the ongoing management of chronic disease. Lack of curative therapies, burden of disease, treatment-related side effects, and fear of relapse contribute to patient-perceived reduction in quality of life. Patient-held beliefs about disease and priorities may differ substantially from the beliefs of their health care providers, and research paradigms are shifting to reflect more emphasis on understanding vasculitis from the patient's perspective. Efforts are ongoing to develop disease outcome measures in vasculitis that better represent the patient experience. Health care providers who care for patients with vasculitis should be sensitive to the substantial burdens of disease commonly experienced by patients living with the disease and should strive to provide comprehensive care directed towards the medical and biopsychological needs of these patients.
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Affiliation(s)
- Elaine Novakovich
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States
| | - Peter C Grayson
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States.
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Abstract
The anti-neutrophil cytoplasm antibody-associated vasculitides are complex multi-system disorders with many overlapping clinical features. Their outcome has been transformed by effective immunosuppression, preventing death in over 70% of cases. The quality of survival is affected by the disease course, which is characterized by a significant likelihood of relapse in 38%, chronic effects from the disease and its treatment, as well as emerging or worsening comorbidity, all of which contribute to the patient's clinical condition and outcome. Whilst imaging and laboratory testing including histology are important aspects of diagnosis, they are of limited value in assessing response to therapy or subsequent disease course. We have developed standardized validated clinical methods to quantify disease activity and damage; we are developing effective measures of patient experience to complement these procedures. This approach provides a rational basis for clinical management as well as being essential in the conduct of clinical trials and studies in vasculitis, by providing reproducible definitions of relapse, remission and response to therapy for patients with systemic vasculitis. Clinical assessment remains the current gold standard for evaluating disease progress, but requires regular training to ensure standardization. The development of biomarkers in future may produce a more accurate description of disease and identify potential targets for therapy as well as predictors of response to drugs.
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Affiliation(s)
- Raashid Ahmed Luqmani
- NIHR Oxford Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, Oxfordshire, UK
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Outcome measures for antineutrophil cytoplasmic antibody-associated vasculitis. Curr Opin Rheumatol 2015; 27:38-44. [DOI: 10.1097/bor.0000000000000135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yilmaz N, Can M, Oner FA, Kalfa M, Emmungil H, Karadag O, Yildiz F, Kimyon G, Yilmazer B, Gerdan V, Bilge SY, Ilhan B, Cobankara V, Kasifoglu T, Cefle A, Kisacik B, Onat AM, Akar S, Onen F, Erken E, Kiraz S, Aksu K, Keser G, Mumcu G, Direskeneli H. Impaired quality of life, disability and mental health in Takayasu's arteritis. Rheumatology (Oxford) 2013; 52:1898-904. [PMID: 23873821 DOI: 10.1093/rheumatology/ket238] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Patient-reported outcomes (PROs) are increasingly accepted to be among the major tools for outcome assessment in rheumatic disorders. In this study we aimed to assess quality of life (QoL), disability, anxiety and depression in patients with Takayasu's arteritis (TAK). METHODS Patients followed with the diagnosis of TAK (n = 165) and healthy controls (HCs) (n = 109) were enrolled to the study. The 36-item Short Form Health Survey (SF-36) and hospital anxiety and depression scales (HADS) were used to assess QoL and mental status together with HAQ for disability. RESULTS In SF-36 subscale assessment, all items were observed to be statistically lower in TAK patients; similarly HAQ scores were also higher (P < 0.001) in this group. In mental assessment, anxiety was found to be more common in TAK patients [90 (54.5%) vs 38 (34.9%), P = 0.001]. Depression also tended to be higher in TAK patients [70 (66.7%) vs 35 (33.3%)], without reaching significance (P = 0.086). Most of the SF-36 subgroup parameters were lower in TAK patients with active disease. Patients having anxiety and depression or with high HAQ scores reported worse SF-36 scores. In multivariate analysis, HADS-A, HADS-D and HAQ were associated with most SF-36 subscales. CONCLUSION PROs demonstrate that not only general health but also physical and social functioning with physical role limitations and mental health parameters were impaired in TAK. Our results, especially in active disease, suggest that PROs such as SF-36 can be core domains of disease assessment in TAK, similar to ANCA-associated vasculitides.
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Affiliation(s)
- Neslihan Yilmaz
- Arpaemini Cad. Tatlıpınar Cad., No: 6/2 - 34270, Fatih/Istanbul, Turkey.
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Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DRW, Flossmann O, McLaren J, Kumar V, Erwig LP, Reid DM, Macfarlane GJ, Jones GT. Explaining fatigue in ANCA-associated vasculitis. Rheumatology (Oxford) 2013; 52:1680-5. [PMID: 23740186 DOI: 10.1093/rheumatology/ket191] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To identify the determinants of fatigue among patients with ANCA-associated vasculitis (AAV). METHODS A multicentre cross-sectional study was conducted. Subjects fulfilling the European Medicines Agency criteria for granulomatosis with polyangiitis (Wegener's), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss) were approached according to consecutive clinic attendance and invited to complete a questionnaire assessing fatigue and putative biopsychosocial determinants of this symptom. Concurrently, potential clinical determinants were recorded. Independent associations of fatigue were identified using forward stepwise logistic regression modelling and their overall impact expressed as population attributable risk (PAR). RESULTS The majority (74.8%) of participants (n = 410) reported high levels of fatigue that were found to be significantly associated with numerous biopsychosocial and clinical factors. Sleep disturbance [odds ratio (OR) 5.3, 95% CI 2.7, 10.5] and pain (OR 3.8, 95% CI 2.0, 7.3) were the strongest independent associations of fatigue and, on a population level, each was more than twice as important as any other putative determinant (PAR 18.1% and 16.5%, respectively). Female gender (OR 2.1, 95% 1.1, 4.0), elevated CRP (OR 3.7, 95% CI 1.7, 8.1) and the dysfunctional coping strategies of behavioural disengagement (OR 2.4, 95% CI 1.04, 5.6) and denial (OR 2.4, 95% CI 0.9, 6.7) were also independently associated with fatigue. CONCLUSION The data suggest that AAV-related fatigue is multifactorial in origin. Sleep disturbance and pain were found to be most important, although inflammation, as measured by CRP, was also associated. This study has identified potentially modifiable determinants that will inform future interventions aimed at alleviating fatigue.
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Affiliation(s)
- Neil Basu
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
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Quality of life and outcome measures in vasculitis. Best Pract Res Clin Rheumatol 2013; 27:69-77. [PMID: 23507058 DOI: 10.1016/j.berh.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/14/2013] [Indexed: 11/23/2022]
Abstract
The primary vasculitides are a life- and organ-threatening set of diseases with a course often marked by alternating periods of active vasculitis and remission. As opposed to clinical trials within the fields of cardiology and oncology, where treatment interventions have been tested in a controlled fashion using hard 'end' points, such as mortality and hospitalisation, surrogate 'end' points have to be used in randomised clinical trials (RCTs) in vasculitis. Given the multisystem nature of the vasculitides, their heterogeneous clinical presentations and rarity, outcome-measure development is a challenging task. The objective of this review is to summarise the data on how health-related quality of life is affected by vasculitis, to describe the currently used outcome measures and provide insight into future outcome-measures development. The primary focus is on anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, where the most data exist and outcome measure development is farthest along. Data on other vasculitides will also be briefly discussed.
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Affiliation(s)
- Lorraine Harper
- University of Birmingham, Renal Immunobiology, Division of Immunity and Infection, Edgbaston, Birmingham B15 2TT, UK.
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Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DRW, Flossmann O, McLaren J, Kumar V, Erwig LP, Reid DM, Jones GT, Macfarlane GJ. The characterisation and determinants of quality of life in ANCA associated vasculitis. Ann Rheum Dis 2013; 73:207-11. [DOI: 10.1136/annrheumdis-2012-202750] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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The impact of current health-related quality of life on future health outlook in patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Clin Rheumatol 2013; 32:779-85. [PMID: 23329351 PMCID: PMC3682098 DOI: 10.1007/s10067-013-2169-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/17/2012] [Accepted: 01/03/2013] [Indexed: 12/03/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, autoimmune small and medium vessel vasculitis. EGPA is accompanied by asthma and involves mainly the blood vessels of the lungs, gastrointestinal system, and peripheral nerves; however, the skin, kidneys, and heart may be also affected. To investigate if patients with EGPA experience reduced health-related quality of life (HRQOL), and the effect of this parameter on their own perception of future health outlook. Twenty-six EGPA patients are in disease remission and completed a custom-designed questionnaire and the Medical Outcomes Study Short Form 36 (SF-36). Using the RAND method, eight HRQOL dimensions were calculated: general health, physical functioning, emotional role limitations, physical role limitations, social functioning, mental health, bodily pain, and vitality. Using norm-based scores, the HRQOL of patients was compared with that of the general population. EGPA patients had decreased HRQOL across all eight dimensions of the SF-36. Patients with higher mental component score felt more positive about their future health, while patients with low physical component score were likely not to feel negatively about their future health. Also, 36 % of older patients (>50 years) had a positive outlook compared to 47 % of younger patients (<50 years) and patients with a longer disease course were much less likely to have a positive outlook (30 % positive) than those with a shorter course (50 % positive). Although not statistically significant, these correlations warrant further investigation with a larger patient population. Despite being in disease remission, EGPA patients had decreased quality of life, which in turn influenced their perception of their future health outlook.
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Tomasson G, Boers M, Walsh M, LaValley M, Cuthbertson D, Carette S, Davis JC, Hoffman GS, Khalidi NA, Langford CA, McAlear CA, McCune WJ, Monach PA, Seo P, Specks U, Spiera R, St Clair EW, Stone JH, Ytterberg SR, Merkel PA. Assessment of health-related quality of life as an outcome measure in granulomatosis with polyangiitis (Wegener's). Arthritis Care Res (Hoboken) 2012; 64:273-9. [PMID: 21954229 DOI: 10.1002/acr.20649] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess a generic measure of health-related quality of life (HRQOL) as an outcome measure in granulomatosis with polyangiitis (Wegener's) (GPA). METHODS Subjects were participants in the Wegener's Granulomatosis Etanercept Trial (WGET) or the Vasculitis Clinical Research Consortium Longitudinal Study (VCRC-LS). HRQOL was assessed with the Short Form 36 (SF-36) health survey that includes physical and mental component summary scores (PCS and MCS, respectively). Disease activity was assessed with the Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS/WG). RESULTS The data from 180 subjects in the WGET (median followup 2.3 years, mean number of visits 10) and 237 subjects in the VCRC-LS (median followup 2.0 years, mean number of visits 8) were analyzed. A 1 unit increase in the BVAS/WG corresponded to a 1.15 unit (95% confidence interval [95% CI] 1.02, 1.29) decrease for the PCS and a 0.93 (95% CI 0.78, 1.07) decrease for the MCS in the WGET, and to a 1.16 unit decrease for the PCS (95% CI 0.94, 1.39) and a 0.79 unit decrease for the MCS (95% CI 0.51, 1.39) in the VCRC-LS. In both arms of the WGET study, SF-36 measures improved rapidly during the first 6 weeks of treatment followed by gradual improvement among patients achieving sustained remission (0.5 improvement in PCS per 3 months), but worsened slightly (0.03 decrease in PCS every 3 months) among patients not achieving sustained remission (P = 0.005). CONCLUSION HRQOL, as measured by the SF-36, is reduced among patients with GPA. SF-36 measures are modestly associated with other disease outcomes and discriminate between disease states of importance in GPA.
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