Background/Purpose:

Vasculitis is a heterogeneous group of diseases often resulting in severe morbidity affecting patients’ quality of life. These morbidities are generally attributed to disease activity, end-organ damage, and the use of immunosuppressive therapy. Current tools for assessing vasculitis do not include patient-reported outcomes such as fatigue, pain, and functional disability. We measured various clinical outcomes using the Multi-Dimensional Health Assessment Questionnaire (MDHAQ) to determine if the outcomes correlate with disease activity, disease damage, glucocorticoid dose, and laboratory parameters. 

Methods:

Patients with large vessel vasculitis (LLV) and ANCA-associated vasculitides (AAV) treated at the Rush Vasculitis Clinic from 2010 to 2013 were administered the MDHAQ at every visit. The MDHAQ measures functional disability (score: 0 – 10), pain and fatigue (visual analogue scales: 0 – 10), and depression, anxiety, and sleep disturbance (each measure scored 0 – 3). For all MDHAQ scales higher scores mean worse symptom. The Birmingham Vasculitis Activity Score (BVAS) and the Vasculitis Damage Index (VDI) were used to calculate disease activity and damage, respectively. All evaluations reported here represent the baseline values at first visit.

Results:

51 patients participated in the study: 29 with AAV and 22 with LVV, 40 females, 31 Caucasians, 13 Hispanics, and 7 African-Americans. Mean age was 53.2 years. The mean BVAS was 5.1 ± 1.6 and mean VDI was 2.1 ± 0.3. 91% of patients were on prednisone, mean dose=23.2 ± 2.9 mg/day. Fatigue was the most frequently reported symptom (82%, mean=3.8 ± 0.4) followed by pain (77%, mean=3.2 ± 0.4), sleep disturbance (66%, mean=0.8 ± 0.1), anxiety (42%, mean= 0.52 ± 0.1) and depression (37%, mean= 0.4 ± 0.1). Functional disability was reported by 80% of patients (mean=1.7 ± 0.23). Fatigue, pain, and functional disability did not correlate with BVAS, VDI, dose of glucocorticoids, erythrocyte sedimentation rate (ESR) or hemoglobin level (Table 1).

Table 1.          Correlations between fatigue, pain and functional disability with the BVAS, VDI, glucocorticoid dose, ESR and Hemoglobin.

	BVAS		VDI		GC dose		ESR		Hb
	r	P	r	p	r	p	r	p	r	p
Fatigue	0.08	0.63	0.11	0.46	-0.03	0.82	-0.14	0.44	0.08	0.63
Pain	0.99	0.55	-0.4	0.06	0.04	0.82	0.4	0.06	0.04	0.85
Functional disability	0.04	0.75	-0.05	0.77	0.07	0.61	-0.19	0.25	-0.12	0.5

GC (Glucocorticoid), ESR (Erythrocyte Sedimentation Rate), Hb (Hemoglobin)

Conclusion:

Fatigue, pain, and functional disability are frequent self-reported symptoms in patients with AAV and LVV. These symptoms do not correlate with disease activity, damage, glucocorticoid dose, ESR, or hemoglobin level. While disease control is of prime importance, it is also important to address these symptoms that may not reflect disease activity or disease damage but can substantially impact patients’ quality of life.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fatigue-pain-and-functional-disability-among-patients-with-vasculitis/