ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 874

The Short Term Damage Burden in Vasculitis and Vasculitis Mimics As Measured By the Vasculitis Damage Index

Alberto Floris1,2, Jan Sznajd3,4, Katarzyna Wawrzycka-Adamczyk1,5, Joanna Robson6, Anthea Craven7, Peter A. Merkel8, Richard A. Watts9, Raashid Luqmani3 and DCVAS investigators, 1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, 2Rheumatology Unit, University Clinic, Cagliari, Italy, Monserrato, Italy, 3Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, 4Jagiellonian University Medical College, Kraków, Poland, 5Jagiellonian University Medical College, Cracow, Poland, 6Rheumatology, University of Oxford, Oxford, United Kingdom, 7Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom, 8Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, 9Rheumatology Department Ipswich Hospital, University of East Anglia, Ipswich, United Kingdom

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Sunday, November 8, 2015

Title: Vasculitis Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Damage in vasculitis, which is due to both the vasculitic process itself and the complications of treatment, accumulates over time and accounts for significant morbidity across a variety of organs and body systems. It is not known whether comparator conditions mimicking vasculitis are associated with a similar spectrum and extent of damage. The aim of this study was to compare short term damage accrual in vasculitis and vasculitis mimics using the Vasculitis Damage Index (VDI).

Methods: We used data available from patients recruited into the ACR/EULAR Diagnostic and Classification Criteria in Vasculitis Study (DCVAS). VDI is recorded at 6 months from diagnosis in patients with vasculitis and also in patients with comparator conditions. We analysed total VDI score, system scores, and individual damage items in granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), microscopic polyangiitis (MPA), polyarteritis nodosa (PAN), giant cell arteritis (GCA), Takayasu’s arteritis (TAK), and their clinical context-specific comparator conditions. The diagnosis supplied by the recruiting physician (with recorded confidence > 75%) was used as the gold standard. We used predetermined criteria to identify comparator conditions for each of the vasculitides; some of the comparators were used for analyses with more than one type of vasculitis. Comparator conditions for each vasculitis are shown in table 1.

Results:  We analysed data from 1254 patients with vasculitis and 507 comparators. The vasculitis group was older (median age 64.1 (50.8-74.0) vs 58.1 (45.7-68.8) years; p<0.0001) and had shorter duration of symptoms (median 10.6 (7.9-16.4) vs 11.6 (7.8-21.7) months; p=0.0379). The median (IQR) number of VDI items was higher in all types of vasculitis vs comparators 1 (0-2) vs 0 (0-1), as well as for each form of vasculitis separately: GPA 1 (0-3) vs 0 (0-2); EGPA 2 (1-4) vs 0 (0-2); MPA 2 (0-3) vs 1 (0-2); PAN 1 (0-2) vs 0 (0-1) with p< 0.0001 for all; for TAK 2 (0-2) vs 0 (0-1) (p<0.0004); for GCA 0 (0-1) vs 0 (0-1) (p=0.0054). On multivariate analysis, average VDI scores were significantly higher in the vasculitides than comparators, except for GCA. Data on the individual damage items which were seen more frequently in each type of vasculitis, in comparison with the corresponding comparators, are presented in Table 2.

Conclusion: Patients with vasculitis accrue more damage in the first 6 months than disease comparators. A focus on reducing this early damage should be a key target of management in these patients.

Table 1. Comparator conditions for each form of vasculitis

GPA

controls

EGPA

controls

MPA

controls

PAN

controls

GCA

controls

TAK

controls

Dermatologic

4%

7%

4%

9%

2%

0%

Endocrine/Metabolic

1%

1%

1%

0%

1%

0%

Gastrointestinal

4%

4%

5%

2%

0%

0%

Genitourinary

2%

1%

4%

2%

0%

0%

Haematology

3%

5%

3%

4%

2%

6%

Infectious disease

9%

7%

8%

6%

5%

6%

Malignancy

4%

6%

3%

0%

4%

0%

Neurologic

8%

3%

8%

6%

35%

21%

Ophthalmologic

4%

1%

2%

0%

15%

0%

Respiratory

10%

14%

9%

2%

2%

0%

Rheumatologic*

46%

40%

50%

67%

24%

41%

Vascular

2%

1%

4%

6%

5%

26%

Toxic

0%

0%

0%

0%

0%

0%

Other

11%

14%

11%

7%

9%

0%

*Most frequent rheumatologic diseases included systemic lupus erythematosus,

myositis, sarcoidosis, antiphospholipid syndrome.

Table 2. VDI items significantly more frequent in vasculitides than comparators

 

GPA (n=397)

Controls (n=364)

p value

Nasal blockage/chronic discharge/crusting

111

28%

9

2%

<0.0001

Hearing loss

88

22%

6

2%

<0.0001

Estimated/measured GFR < 50%

63

16%

13

4%

<0.0001

Proteinuria > 0.5g/24h

43

11%

8

2%

<0.0001

Chronic sinusitis/radiological damage

40

10%

6

2%

<0.0001

Peripheral neuropathy

38

10%

14

4%

0.0022

Nasal bridge collapse/septal perforation

30

8%

3

1%

<0.0001

Osteoporosis/vertebral collapse

16

4%

5

1%

0.0274

 

EGPA (n=106)

Controls (n=134)

p value

Peripheral neuropathy

59

56%

5

4%

<0.0001

Chronic asthma

47

44%

4

3%

<0.0001

Nasal blockage/chronic discharge/crusting

17

16%

8

6%

0.0202*

Chronic sinusitis/radiological damage

15

14%

5

4%

0.0045

Cardiomyopathy

8

8%

2

1%

0.0243*

Myocardial infarction

5

5%

0

0%

0.0159*

Proteinuria > 0.5g/24h

4

4%

0

0%

0.0368*

 

MPA (n=161)

Controls (n=185)

p value

Estimated/measured GFR < 50%

62

39%

8

4%

<0.0001

Proteinuria > 0.5g/24h

47

29%

8

4%

<0.0001

Peripheral neuropathy

27

17%

11

6%

0.0024

Diastolic BP > 95 or requiring antihypertensive

22

14%

6

3%

0.0008

Osteoporosis/vertebral collapse

17

11%

2

1%

<0.0001

Diabetes

12

7%

5

3%

0.0480*

End stage renal disease

10

6%

2

1%

0.0150

Nasal bridge collapse/septal perforation

8

5%

1

1%

0.0140

Cataract

6

4%

0

0%

0.0010

 

PAN (n=39)

Controls (n=54)

p value

Peripheral neuropathy

13

33%

4

7%

0.0022

Gut infarction/resection

6

15%

0

0%

0.0043

 

GCA (n=458)

Controls (n=127)

p value

Diabetes

31

7%

1

1%

0.0006

Osteoporosis/vertebral collapse

26

6%

0

0%

0.0025

 

TAK (n=93)

Controls (n=34)

p value

Claudication > 3 months

44

47%

4

12%

0.0002

Major vessel stenosis

42

45%

4

12%

0.0004

Absent pulses in one limb

41

44%

4

12%

0.0007

p values were calculated using Chi-squared or Fisher’s exact test.

*non-significant after Benjamini-Hochberg correction for multiple comparisons with false discovery rate of 0.25 and total number of variables 64. Correction was performed for each subgroup analysis.

Disclosure: A. Floris, None; J. Sznajd, None; K. Wawrzycka-Adamczyk, None; J. Robson, None; A. Craven, None; P. A. Merkel, None; R. A. Watts, None; R. Luqmani, GSK, 5,Chemocentryx, 5,Roche Pharmaceuticals, 5.

To cite this abstract in AMA style:

Floris A, Sznajd J, Wawrzycka-Adamczyk K, Robson J, Craven A, Merkel PA, Watts RA, Luqmani R. The Short Term Damage Burden in Vasculitis and Vasculitis Mimics As Measured By the Vasculitis Damage Index [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-short-term-damage-burden-in-vasculitis-and-vasculitis-mimics-as-measured-by-the-vasculitis-damage-index/. Accessed .

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