Brief Report: The Value of a Patient Global Assessment of Disease Activity in Granulomatosis With Polyangiitis (Wegener's)

Tómasson, Gunnar; Davis, John C.; Hoffman, Gary S.; McCune, W. Joseph; Specks, Ulrich; Spiera, Robert; Clair, E. William St.; Stone, John H.; Merkel, Peter A.

doi:10.1002/art.38248

Cited by 34 publications

(28 citation statements)

References 13 publications

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“…Especially the latter should get more attention amongst researchers and clinicians in the future. In addition, the active involvement of the patient may result in a better prediction model for disease reactivation, as simply asking the patient how active he believes his disease has been in the past month is predictive of a future relapse [107].…”

Section: Expert Opinionmentioning

confidence: 99%

Maintaining remission in patients with granulomatosis with polyangiitis or microscopic polyangiitis: the role of ANCA

Kemna¹,

Paassen²,

Damoiseaux³

et al. 2017

Expert Opinion on Orphan Drugs

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Introduction: Granulomatosis with Polyangiitis (GPA; formerly Wegener's) and Microscopic Polyangiitis (MPA) are inflammatory disease entities affecting small to medium vessels. They are characterized by the presence of anti-neutrophil cytoplasmic antibodies (ANCA) and are frequently grouped together with Eosinophilic Granulomatosis with Polyangiitis (EGPA; formerly Churg Strauss Syndrome) under the term ANCA-associated Vasculitis (AAV). Due to effective immunosuppressive therapy that was introduced more than 45 years ago, AAV has become a chronic disease in which relapses occur frequently during maintenance treatment or later on after all immunosuppressive therapy is stopped. Since relapses are associated with morbidity and mortality, early detection and prevention of relapses is of great importance. Areas covered: This review focuses on the potential strategies to guide maintenance therapy in patients with GPA or MPA, with an emphasis on patient classifications and the role of serial ANCA measurements. Expert opinion: Risk factors for relapses, e.g., genetic background of the patient, have been studied during the last three decades. Only few of these risk factors directly influence the management of patients. One potentially important factor that may influence therapeutic decisions in AAV patients is serial measurement of ANCA. Recently, it became clear that serial ANCA measurement is an attractive approach in AAV patients with (a history of) capillaritis, e.g., renal involvement or alveolar haemorrhage, but not in patients with more limited disease. Whether ANCA rises can be used to guide therapy andhence-to prevent relapses has been a great debate during the last three decades. At present, we conclude that small studies do support such an approach but that these findings require further validation in larger randomized clinical trials. ARTICLE HISTORY

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Section: Expert Opinionmentioning

confidence: 99%

Maintaining remission in patients with granulomatosis with polyangiitis or microscopic polyangiitis: the role of ANCA

Kemna¹,

Paassen²,

Damoiseaux³

et al. 2017

Expert Opinion on Orphan Drugs

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“…www.jrheum.org Downloaded on August 1, 2020 from scaled to a 0-100 scale (0 -poor health, 100 -best possible health). The SF-36 responses can be condensed into a Physical Composite Score (PCS) and a Mental Composite Score (MCS) (17)(18)(19).…”

Section: Accepted Articlementioning

confidence: 99%

“…PtGA was assessed on a scale of 0 (no disease) to 10 (very severe disease). This measure has previously been validated in different forms of vasculitis (19,20).…”

Section: Patient Global Assessment (Ptga)mentioning

confidence: 99%

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Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis

et al. 2020

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Objective To assess the validity and clinical utility of the Brief Illness Perception Questionnaire (BIPQ) to measure illness perceptions in multiple forms of vasculitis. Methods Patients with giant cell arteritis (GCA), Takayasu’s arteritis (TAK), ANCA-associated vasculitis (AAV) and relapsing polychondritis (RP) were recruited into a prospective, observational cohort. Patients independently completed the BIPQ, Multidimensional Fatigue Inventory (MFI), SF-36 Health Survey (SF-36) and a Patient Global Assessment (PtGA) at successive study visits. Physicians concurrently completed a Physician Global Assessment (PhGA) form. Illness perceptions, as assessed by the BIPQ, were compared to responses from the full-length Revised Illness Perception Questionnaire (IPQ-R) and to other clinical outcome measures. Results 196 patients (GCA=47, TAK=47, RP=56, AAV=46) were evaluated over 454 visits. Illness perception scores in each domain were comparable between the BIPQ and IPQ-R (3.28 vs 3.47, p=0.22). Illness perceptions differed by type of vasculitis, with the highest perceived psychological burden of disease in RP. The BIPQ was significantly associated with all other patient-reported outcome measures (ρ=0.50-0.70, p<0.0001) but did not correlate with PhGA (ρ=0.13, p=0.13). A change in the BIPQ composite score of ≥7 over successive visits was associated with concomitant change in the PtGA. Change in the MFI and BIPQ scores significantly correlated over time (ρ= 0.38, p=0.0008). Conclusion The BIPQ is an accurate and valid assessment tool to measure and monitor illness perceptions in patients with vasculitis. Use of the BIPQ as an outcome measure in clinical trials may provide complimentary information to physician-based assessments.

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“…As shown in a recent study from the Vasculitis Clinical Research Consortium, an increase in the patient global assessment tool, which captures how patients judge their own disease activity, often precedes the detection of disease activity by the physician by at least 3 months. 19 In the absence of the elusive biomarker that reliably predicts relapses in each and every patient, the clinician needs to carefully weigh all of the following pieces of information for an individual patient in order to provide the best advice about the patient's individual relapse risk and best options for their prevention: disease phenotype (GPA versus MPA), ANCA type (PR3 versus MPA), organ involvement (for instance, renal versus nonrenal), treatment exposure (rituximab versus cyclophosphamide or methotrexate), individual ANCA response patterns over time, individual baseline of organ damage from previous bouts of disease activity (for instance, how much additional renal function can the patient "afford" to lose with a subsequent relapse), and last but not least, the patient's own perceptions.…”

mentioning

confidence: 99%

Brief Report: The Value of a Patient Global Assessment of Disease Activity in Granulomatosis With Polyangiitis (Wegener's)

Cited by 34 publications

References 13 publications

Maintaining remission in patients with granulomatosis with polyangiitis or microscopic polyangiitis: the role of ANCA

Maintaining remission in patients with granulomatosis with polyangiitis or microscopic polyangiitis: the role of ANCA

Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis

Accurate Relapse Prediction in ANCA-Associated Vasculitis–the Search for the Holy Grail

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