Determinants of patient and physician global assessments of disease activity in anti-neutrophil cytoplasmic antibody-associated vasculitis

Abstract

ObjectiveTo compare physician and patient assessments of global disease activity in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and to identify associated factors.MethodsGlobal disease activity scores (0–10 points) were retrospectively analyzed from physicians and patients with AAV at each outpatient visit from 2010 to 2020. We compared the scores and performed a linear regression with a random effects to identify associated factors.ResultsPatients (n = 143, 1,291 pairs, 52% female) had a mean 64 (±15) years of age and a mean disease duration of 9 (±7) years. Patients and physicians global disease activity assessments showed a moderate correlation (Pearson R 0.31, CI [0.23–0.52], p < 0.001). Linear regression showed a strong association between the physician-documented disease activity scores and serum CRP levels (β = 0.22, CI [0.18, 0.28]), disease duration (β = −0.022, CI [−0.04,-0.01]) and patients’ assessment of disease activity (β = 0.08, CI [0.04, 0.12]). By contrast, patient assessments were strongly associated with the degree of pain (β = 0.30, CI [0.25, 0.35]), functional limitations in daily living (HAQ, β = 0.49, CI [0.21, 0.78]) and the global physical well-being (NRS, β = 0.39, CI [0.32, 0.46]).ConclusionPatients’ and physicians’ assessments of disease activity correlated. High CRP levels and disease duration were associated with physician-assessed disease activity scores, while subjective limitations were associated with higher patient-assessed disease activity scores. These findings highlight and support the need to develop and evaluate patient-reported outcomes to assess disease activity in patients diagnosed with AAV.

Trends in health care of patients with vasculitides, including giant cell arteritis, Takayasu arteritis, ANCA-associated vasculitis and Behçet’s disease: cross-sectional data of the German National Database 2007–2021

“…The high proportion of BD is caused by a special consultation for BD in one of the participating centres. The gender distribution shows, comparable to other European cohorts, the highest proportion of women in TAK [ 20 ], more women than men with GCA [ 21 ], more men than women with BD [ 22 ] and a relatively balanced ratio in AAV [ 19 , 23 – 25 ]. Considerable differences in the age of onset, ranging from 28 (BD) to 67 years (GCA), are indicated.…”

“…It can be assumed that the physician assessment is based on other parameters (laboratory parameters, organ involvement) than the patient assessment. A study by Rode et al confirms to this assumption showing a high association between physician-reported disease activity and increased CRP values as well as shorter disease duration in contrast to a high association between patient-reported disease activity and patient-reported limitations regarding pain, function and general well-being in patients with AAVs [ 23 ]. Hurtado-Arias et al found correlations between patient global assessment and social and emotional impact, physical function and concerns about the future in AAVs [ 36 ].…”