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.
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 March 3, 2021.
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