Background/Purpose: Given the rarity and non-specific symptoms associated with ANCA-associated vasculitis (AAV), rheumatology clinicians are challenged to use best practices for patient recognition and management, resulting in delayed and/or suboptimal treatment. Case-based continuing education (CE) is a proven method to address knowledge and practice gaps while revealing persisting educational needs that can be used to tailor future CE.

Methods: A live, case-based CE program was provided at American College of Rheumatology (ACR) Convergence 2023. Knowledge, confidence, and behaviors were assessed before and after learning to determine the impact of education and identify persisting educational needs.

Results: Two hundred twenty-three rheumatology clinicians completed the education. Despite high baseline scores on the differential diagnosis of AAV (69%), only 11% of attendees noted current use of evidence-based tools for the early detection of patients with AAV. Moreover, 40% of attendees were unaware of the appropriate use of renal biopsy to assess a patient with worsening AAV, suggesting inappropriate use of assessment tools even after diagnosis. Regarding treatment, although the baseline reported use of steroid-sparing regimens was high (81%), baseline knowledge of steroid-sparing impact of novel AAV therapy avacopan was low (57%). This translated to only 31% of attendees reporting always or frequently using avacopan in eligible patients. In case-based questioning, in patients with worsening symptoms, 54% of attendees would use rituximab plus avacopan accompanied by glucocorticoid (GC) taper to induce remission. However, they had varied opinions regarding the duration of maintenance therapy. Post-learning, there was a 20% relative increase in knowledge, demonstrating robust impact of the education on knowledge. These knowledge gains translated into 77% of attendees having high levels of post-education confidence regarding their ability to maximize the use of steroid-sparing approaches in AAV management.

Conclusion: In this study, rheumatology clinicians had inadequate baseline knowledge regarding tools for AAV detection and novel AAV therapies. There was a lack of consensus regarding when to use GC tapering and for how long to keep patients on maintenance therapy. While the education provided had a robust impact on knowledge and confidence, these findings highlight the need for subsequent education regarding evidence-based practices for patient assessment and how to incorporate steroid-sparing regimens into practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/using-case-based-continuing-education-to-identify-and-address-knowledge-and-behavior-gaps-in-anca-associated-vasculitis/