Background/Purpose: In granulomatosis with polyangiitis GPA), disease activity is assessed by physician-based measures. In some other rheumatic diseases, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS), the patient global assessment for disease activity (PtGA) contributes to composite disease activity scores such as the DAS28 (RA) and ASDAS (AS). The purpose of this study was i) to describe distribution of PtGA scores in patients with GPA enrolled in a clinical trial, ii) explore discordance between PtGA and physician global assessments for disease activity (MDglobal), and iii) determine if PtGA during disease remission is associated with future disease relapse.
Methods: Subjects were participants in a therapeutic clinical trial. Patients had active disease at enrollment, with study visits occurring at baseline, 6 weeks and every 3 months thereafter. PtgA was assessed on a visual analog scale (0-100) with the question: “Please mark the line below indicating how active you believe your Wegener’s granulomatosis has been in the past 28 days. Consider only how much your Wegener’s (the disease itself) is causing you problems. Do not count the effects of other medical problems or side effects of medications”. Disease activity was assessed with the Birmingham Vasculitis Activity Sore for WG (BVAS/WG). Remission was defined as BVAS/WG=0 and disease relapse was defined as BVAS/WG>0 after remission was achieved. MDglobal was assessed on a visual analog scale (0-100mm). PtGA-MDglobal discordance was defined as difference of 20 millimeters (mm) between PtGA and MDglobal scores. Logistic regression was used to explore association of PtGA-MDglobal discordance with demographic and disease associated factors. Mixed linear models were used to explore difference in PtGA scores between study visits during remission, but immediately prior to overt relapse, and other study visits during remission.
Results: Data from 180 subjects seen for total of 1719 study visits were used. At baseline mean PtGA was 64.2 (sd=27.4) and mean MDglobal was 55.5 (sd=23.4). At baseline, there was modest, but significant, correlation between PtGA and MDglobal scores (r=0.30, p<0.001); 54.4% of patients had a ≥20mm PtGA-MDglobal discordance. PtGA-MDglobal discordance at baseline was associated with relapsing (vs. new-onset) disease at baseline (OR 2.70, 95%CI: 1.47-1.96) but not associated with age, sex, or presence of renal or pulmonary disease. During follow-up, subjects were in disease remission during 1058 study visits, of which 103 immediately preceded disease relapse. At remission visits immediately preceding relapse the mean PtGA was 20.4 and at visits not followed by disease relapse the mean PtGA was 15.9, a difference of 4.5 (95% CI 0.66-8.4, p=0.02).
Conclusion: In GPA, patient and physician assessments are frequently discordant. Higher PtGA during apparent remission is associated with future overt disease relapse. These data imply that PtGA captures aspects of disease activity missed by physician-based measures. PtGA could contribute to a composite measure of disease activity in GPA.
Disclosure:
G. Tomasson,
None;
J. C. Davis Jr.,
None;
G. S. Hoffman,
None;
W. J. McCune,
None;
U. Specks,
None;
R. F. Spiera,
None;
E. W. St. Clair,
None;
J. H. Stone,
None;
P. A. Merkel,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-global-assessments-for-disease-activity-are-predictive-of-future-flare-in-granulomatosis-with-polyangiitis-wegeners/