ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 884

Health-Related Quality of Life in Giant Cell Arteritis

Tanaz A. Kermani1, Antoine Sreih2, Gunnar Tomasson3, David Cuthbertson4, Simon Carette5, Gary S. Hoffman6, Nader A. Khalidi7, Curry L. Koening8, Carol A. Langford9, Carol A. McAlear10, Paul A. Monach11, Larry W. Moreland12, Christian Pagnoux13, Philip Seo14, Kenneth J. Warrington15, Steven R. Ytterberg16 and Peter A. Merkel17, 1Rheumatology, University of California Los Angeles, Santa Monica, CA, 2Department of Rheumatology, University of Pennsylvania, Philadelphia, PA, 3Dept of Public Health Sciences, University of Iceland, Reykjavik, IS, 4Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, 5Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 6Rheumatic & Immunologic Dis, Cleveland Clinic Foundation, Cleveland, OH, 7McMaster University, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, 8Rheumatology, University of Utah, Salt Lake City, UT, 9Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, 10University of Pennsylvania, Philadelphia, PA, 11Rheumatology, Boston University School of Medicine, Boston, MA, 12Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, 13Division of Rheumatology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Canada, Toronto, ON, Canada, 14Division of Rheumatology, Johns Hopkins University, Baltimore, MD, 15Rheumatology, University of California Los Angeles, CA, USA Mayo, Rochester, MN, 16Rheumatology, Mayo Clinic, Rochester, MN, 17Division of Rheumatology, University of Pennsylvania, Philadelphia, PA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Vasculitis - Poster I: Large Vessel Vasculitis and Polymyalgia Rheumatica

Session Type: ACR Poster Session A

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

 

Background/Purpose: To evaluate health-related quality of life (HRQoL) in a large cohort of patients with giant cell arteritis (GCA) as measured by the 36-item Short Form Health Survey (SF-36).    

Methods: Patients with GCA enrolled in a multicenter, longitudinal cohort were included. Subjects were followed with standardized clinical assessments which include symptoms attributed to vasculitis at diagnosis and follow-up, physician global assessment (PGA, 0-10 visual analogue scale), patient global assessment (PtGA, 0-10 visual analogue scale), vasculitis damage index (VDI), SF-36. Physical component scores (PCS) and mental component scores (MCS) were calculated from SF-36 and normalized to the general population (mean ± SD=50 ± 10) with lower scores indicating poorer outcomes. Active disease at a study visit was defined as presence of any symptom attributable to vasculitis in the prior 28 days.   

Results: Data from 281 patients with GCA were included: 197 (70%) women; mean age at diagnosis = 72.1±8.4 years. Median (25th, 75th quartiles) time from diagnosis to entry in the cohort was 25 (7, 88) weeks. 108 subjects (39%) were enrolled into the cohort ≤ 12 weeks from diagnosis. Manifestations at time of diagnosis: positive temporal artery biopsy 180 of 224 (80%) patients in whom it was performed; visual manifestations in 109 patients (38%); limb claudication (upper or lower) in 59 patients (20%). VDI at entry into the cohort was 1 (0-2) with 149 subjects (60%) having at least 1 item of damage. Means±SD PCS and MCS were lower in patients with GCA compared to the general population at 39±11 and 47±13, respectively. Mean PCS was significantly lower in women, patients with active symptoms on the day of evaluation, those with elevated inflammatory markers, those with at least 1 damage item on VDI, and patients with PtGA ≥ 1 and/or PtGA ≥ 3 (Table). Mean MCS was lower in patients with active symptoms or with a PtGA≥1 or PtGA ≥ 3 (Table). Subjects with newly-diagnosed disease had similar PCS but lower MCS compared to the patients with established disease. When analysis was restricted to the subset with newly-diagnosed GCA, PCS was statistically lower in women, those with elevated acute phase reactants and the subset presenting with limb claudication or PtGA ≥ 3 while MCS was similar across these comparisons (Table). PCS and MCS was similar in patients with visual symptoms at diagnosis even when restricted to subjects with newly-diagnosed disease.   

Conclusion: Patients with GCA have reduced HRQoL, as measured by the SF-36. PCS appears sensitive to changes in disease status or health status while MCS did not appear to differentiate between the variables measured. SF-36 may be a useful tool in assessing patient reported outcomes in patients with GCA. These findings highlight the importance of measuring the burden of disease from the patient’s perspective when evaluating GCA.  

Association between clinical variables and SF-36 physical component and mental component scores in 281 patients with giant cell arteritis

Variable

PCS

MCS

 

Yes

No

p-value

Yes

No

p-value

Female sex

39.1

42.6

0.02

47.0

47.4

0.82

Positive TAB

41.2

37.5

0.08

46.9

44.5

0.31

Active symptoms on day of visit

37.8

41.3

0.01

45.0

48.6

0.02

ESR ≥ 20 mm/hour or CRP ≥ 5 mg/L

37.7

43.8

<0.01

47.0

47.5

0.76

Vision loss at diagnosis

40.1

40.0

0.94

48.1

46.7

0.36

Limb claudication at diagnosis

39.1

40.3

0.51

46.2

47.5

0.49

VDI ≥1

38.0

41.8

0.01

47.6

45.7

0.26

PtGA≥1

38.6

45.5

<0.01

45.8

52.3

<0.01

PtGA≥3

34.9

45.2

<0.01

44.0

50.3

<0.01

New diagnosis*

39.2

40.7

0.29

44.9

48.6

0.02

Female sex*

36.5

43.6

<0.01

44.1

46.1

0.43

Positive TAB*

39.9

37.6

0.49

43.9

48.8

0.16

Active symptoms on day of visit*

37.8

41.2

0.18

44.9

44.4

0.86

ESR ≥ 20 mm/hour or CRP ≥ 5 mg/L*

36.6

42.8

0.02

45.1

43.8

0.61

Vision loss at diagnosis*

40.1

38.5

0.50

46.7

43.3

0.20

Limb claudication at diagnosis*

32.0

40.1

0.03

41.6

45.2

0.36

VDI ≥ 1*

36.7

40.6

0.12

44.8

43.7

0.66

PtGA ≥ 1

38.4

42.5

0.20

44.2

48.4

0.19

PtGA ≥ 3

34.0

45.8

<0.01

44.5

45.5

0.70

Yes/No indicates whether variables under study were present. PCS: SF-36 physical component score; MCS: SF-36 mental component score; TAB: temporal artery biopsy; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; VDI: Vasculitis Damage Index; PtGA: patient global assessment; *restricted to subset enrolled within 12 weeks of diagnosis

 

Disclosure: T. A. Kermani, GlaxoSmithKline, 2; A. Sreih, Bristol-Myers Squibb, 2,Celgene, 2,Chemocentryx, 2,Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2,Krog and Partners, 5; G. Tomasson, None; D. Cuthbertson, None; S. Carette, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2; G. S. Hoffman, None; N. A. Khalidi, Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2; C. L. Koening, None; C. A. Langford, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2,Bristol-Myers Squibb, 2; C. A. McAlear, None; P. A. Monach, Genentech and Biogen IDEC Inc., 2,Bristol-Myers Squibb, 2,MedScape, 5,GlaxoSmithKline, 2,Vasculitis Foundation Board of Directors, 6,Editorial Board of Arthritis and Rheumatology, 6; L. W. Moreland, Genentech and Biogen IDEC Inc., 2,Pfizer Inc, 2,questcor, 2,Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2,Pfizer Inc, 5,Boehringer Ingelheim, 5,Acerta, 5,CVS/Caremark, 5,Smith Kline Beecham, 5; C. Pagnoux, Chemocentryx, 5,Chemocentryx, 9,Roche Pharmaceuticals, 9,Roche Pharmaceuticals, 5,Sanofi-Aventis Pharmaceutical, 5,Hoffmann-La Roche, Inc., 8; P. Seo, None; K. J. Warrington, GlaxoSmithKline, 2; S. R. Ytterberg, Sanofi-Aventis Pharmaceutical, 5; P. A. Merkel, Bristol Myers Squibb, 2,CaridianBCT, 2,Celgene, 2,Chemocentryx, 2,Genentech/Roche, 2,GlaxoSmithKline, 2,Kypha, 2,Bristol-Myers Squibb, 5,Chemocentryx, 5,Genentech/Roche, 5,GlaxoSmithKline, 5,PrinicipioBio, 5,Auven, 5,Proteon Therapeutics, 5.

To cite this abstract in AMA style:

Kermani TA, Sreih A, Tomasson G, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Warrington KJ, Ytterberg SR, Merkel PA. Health-Related Quality of Life in Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/health-related-quality-of-life-in-giant-cell-arteritis/. Accessed .

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