A Dutch Consensus Statement on the Diagnosis and Treatment of ANCA Associated Vasculitis

Ebru Dirikgil¹, Peter Verhoeven ², Sander Tas ³, Abraham Rutgers ⁴, Hein Bernelot Moens ⁵, Jacob van Laar ⁶, Willem Jan Bos ⁷ and Onno Teng ¹, ¹LUMC, Leiden, Netherlands, ²The Dutch Vasculitis Foundation, Silvolde, Netherlands, ³Amsterdam Rheumatology & immunology Center, Amsterdam UMC/University of Amsterdam, Amsterdam, Netherlands, ⁴University Medical Center Groningen, Groningen, Netherlands, ⁵Ziekenhuisgroep Twente, Almelo, Netherlands, ⁶UMC Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht, The Netherlands, Utrecht, Netherlands, ⁷St. Antoniusziekenhuis, Nieuwegein, Netherlands

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: ANCA, healthcare management and quality improvement, Vasculitis

Session Information

Date: Tuesday, November 12, 2019

Session Title: Vasculitis – ANCA-Associated Poster I

Session Type: Poster Session (Tuesday)

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

Background/Purpose: Several guidelines have been published on the diagnosis and treatment of anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV). These guidelines provide an evidence-based approach to support clinical-decision making and adequate implementation is needed to improve care. As part of an implementation strategy, national consensus meetings in the Netherlands were initiated in order to establish consensus on broad aspects of the diagnosis and treatment of AAV based upon the recently published guidelines, relevant to daily clinical practice.

Methods: A national, multidisciplinary working group of physicians (nephrologists, rheumatologists, immunologists, pulmonologist, pathologist) with expertise on AAV addressed the broad spectrum of diagnosing, treating and organisation of care for AAV patients. Consensus was established using a Delphi-based method in a national conference in conjunction with a nationally distributed online consensus survey. This survey was distilled from the current published international guidelines. Cut-off for consensus was 70% (dis-)agreement.

Results: Ninety-eight professionals were involved in the Delphi procedure to assess consensus on 52 statements regarding diagnosis, treatment and organisation of care for AAV patients. From 52 statements, consensus was achieved for 39 statements (75%). Consensus was achieved on aspects of AAV disease definition, nomenclature, distinct disease states through follow-up, treatment algorithm and organisation of care for AAV. No consensus was achieved on the necessity of histopathological evidence, regular blood testing for ANCAs and standard BVAS, VDI and PROMs assessment.

Conclusion: This study describes the results of a national consensus statement on diagnosing and treatment of AAV patients as part of an implementation strategy in the Netherlands of (inter-)national guideline-derived recommendations. Future studies should evaluate whether the consensus statement has facilitated local implementation, reduced clinical practice variation and, ultimately, improved care for AAV patients in the Netherlands.

Disclosure: E. Dirikgil, None; P. Verhoeven, None; S. Tas, None; A. Rutgers, None; H. Bernelot Moens, None; J. van Laar, Roche, 2, 8, Arthrogen, 5, Thermofisher, 2, BMS, 8, MSD, 2, Eli Lilly, 8, Gesynta, 5, Leadiant, 5, Arxx Tx, 5, Astra Zeneca, 2, Sanofi, 8; W. Bos, None; O. Teng, None.

To cite this abstract in AMA style:

Dirikgil E, Verhoeven P, Tas S, Rutgers A, Bernelot Moens H, van Laar J, Bos W, Teng O. A Dutch Consensus Statement on the Diagnosis and Treatment of ANCA Associated Vasculitis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/a-dutch-consensus-statement-on-the-diagnosis-and-treatment-of-anca-associated-vasculitis/. Accessed June 3, 2020.

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