Outcome Measures in Large-Vessel Vasculitis: Relationships Between Patient, Physician, Imaging, and Laboratory-Based Domains

Casey A. Rimland¹, Kaitlin Quinn ², Joel S. Rosenblum ³, Mollie Schwartz ⁴, K Bates Gribbons ⁵, Elaine Novakovich ⁶, Antoine Sreih ⁷, Peter Merkel ⁷, Mark A. Ahlman ⁸ and Peter C. Grayson ⁹, ¹National Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), Bethesda, MD, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, Chapel Hill, NC, ²Georgetown University Hospital/National Institutes of Health, Washington, DC, ³National Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), Bethesda, MD, Bethesda, MD, ⁴University of Maryland, Baltimore, MD, ⁵National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, ⁶National Institutes of Health, Bethesda, MD, ⁷University of Pennsylvania, Philadelphia, PA, ⁸Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, Bethesda, MD, ⁹National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health, Bethesda, MD, Bethesda, MD

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: giant cell arteritis, large vessel vasculitis, Outcome measures, takayasu arteritis and positron emission tomography (PET)

Session Information

Date: Sunday, November 10, 2019

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster I: Takayasu's Arteritis & Polymyalgia Rheumatica

Session Type: Poster Session (Sunday)

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

Background/Purpose: Large-vessel vasculitis (LVV) is characterized by inflammation of the aorta and its major branches. The most common forms of LVV include giant cell arteritis (GCA) and Takayasu’s arteritis (TAK). No standardized set of outcome measures currently exist to evaluate treatment response in patients with LVV. Various outcome domains have been proposed for LVV, including patient-reported outcomes (PROs), physician assessment of disease activity, vascular imaging, and laboratory assessment. However, data examining the relationships between these domains is limited. The objective of the current study was to assess the relationship structure between patient, physician, imaging, and laboratory-based outcome measure domains in patients with LVV.

Methods: Patients fulfilling the ACR 1990 criteria for the classification of TAK or the modified ACR 1990 criteria for the classification of GCA were recruited into a prospective, observational cohort. Assessments within the following domains were independently recorded: patient-reported outcomes [multi-dimensional fatigue inventory (MFI); patient global assessment (PtGlobal); 36-item short form health survey (SF-36); brief-illness perception questionnaire (BIPQ)], physician global assessment (PhGlobal), acute-phase reactants (CRP, ESR), and imaging assessment (PETVAS, a qualitative score of vascular FDG-PET activity). To visualize the relationship between domains, Spearman’s correlation network analysis was performed. This analysis enables visualization of the strength and directionality of correlations and clusters variables most correlated to one another. Change over time in outcome measures was compared using the Wilcoxon signed rank test in patients with a change in clinical status from active disease (PhGlobal >0) to remission (PhGlobal=0) or from remission to active disease. Multivariable nominal logistic regression was performed to determine the outcome measures associated with clinically active disease.

Results: Analyses were performed on 112 patients (GCA=56, TAK=56), over 296 visits, with a median follow-up interval of 6 months. Correlation network analysis revealed outcome measures clustered independently and by specific domain (Figure). PhGlobal was centrally linked to all other domains, but correlations were modest (ρ=0.12 – 0.31, p < 0.05). All four PROs strongly correlated with each other (ρ=0.35-0.60, p < 0.0001). PROs were not correlated with PETVAS and only PtGlobal correlated with CRP (ρ=0.16, p< 0.01). Patients whose clinical assessment changed from active disease to remission (n=29) had corresponding significant decrease in ESR, CRP, and PETVAS at the remission visit. Patients whose clinical assessment changed from remission to active disease (n=11) had corresponding significant increase in CRP and PtGlobal at the active visit. PETVAS, CRP, and PtGlobal were independently associated with clinically active disease in regression analyses.

Conclusion: Measures of disease assessment in large-vessel vasculitis consist of independent, yet complementary domains, supporting the need to develop multidimensional and/or composite outcome measures, or a standard set of measures covering all domains.

Figure 1_abstract

Figure. Correlation network of outcome measure domains in patients with LVV.

Correlation network of the significant Spearman ρ correlation coefficients -p<0.05- between outcome measures created using the R package corrr. Color and thickness of the edges between nodes indicates the strength of the correlation. Nodes for each outcome measure are clustered in space using multidimensional scaling of the absolute values of the correlations, such that outcome measures with the highest overall magnitude of correlation with each other are closer in space. For ease of visualization, the SF-36 PCS and MCS measures were multiplied by -1 so that a higher score would indicate a worse outcome. MFI= Multi-dimensional fatigue inventory; BIPQ= brief illness perception questionnaire; Neg SF-36 PCS= negatively transformed 36-item short form health survey physical component summary score; Neg SF-36 MCS= negatively transformed 36-item short form health survey mental component summary score; CRP= c-reactive protein; ESR= erythrocyte sedimentation rate; PETVAS= qualitative score of vascular FDG-PET activity.

Disclosure: C. Rimland, None; K. Quinn, None; J. Rosenblum, None; M. Schwartz, None; K. Gribbons, None; E. Novakovich, None; A. Sreih, Bristol-Meyers Squibb, 3, Bristol-Myers Squibb, 3; P. Merkel, AbbVie, 5, AstraZeneca, 2, 5, Biogen, 5, Boeringher-Ingelheim, 2, 5, Bristol-Myers Squibb, 2, 5, Celgene, 2, 5, ChemoCentryx, 2, 5, CSL Behring, 5, Genentech/Roche, 2, 5, Genzyme/Sanofi, 5, GlaxoSmithKline, 2, 5, InflaRx, 5, Insmed, 5, Jannsen, 5, Kiniksa, 5, Kypha, 2, TerumoBCT, 2, UpToDate, 7; M. Ahlman, None; P. Grayson, None.

To cite this abstract in AMA style:

Rimland C, Quinn K, Rosenblum J, Schwartz M, Gribbons K, Novakovich E, Sreih A, Merkel P, Ahlman M, Grayson P. Outcome Measures in Large-Vessel Vasculitis: Relationships Between Patient, Physician, Imaging, and Laboratory-Based Domains [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/outcome-measures-in-large-vessel-vasculitis-relationships-between-patient-physician-imaging-and-laboratory-based-domains/. Accessed .

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