Supervisors info:
Βασιλόπουλος Δημήτριος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Μαυραγάνη Κλειώ, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή ΕΚΠΑ
Μπούμπας Δημήτριος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Summary:
Objective: ANCA associated vasculitides (AAVs) are rare, serious forms of
vasculitides. There are limited data regarding the quality of life in patients with AAVs
compared to other chronic inflammatory diseases. The purpose of this study was to
compare the quality of life between patients with AAV and those with a chronic
inflammatory rheumatic disease such as rheumatoid arthritis (RA).
Methods: Multicenter, cross-sectional study of AAV and RA patients followed in 3
tertiary referral centers. Literature data from 1007 healthy controls from the same
country served as historic controls. Health-Related Quality of Life (HRQoL) was
assessed with the Short Form 36 Health Survey (SF-36) which includes physical and
mental component summary scores (PCS and MCS). Disease activity were
assessed with the Birmingham Vasculitis Activity Score version 3 (BVAS 3) and the
DAS-28-ESR (for RA) respectively and organ damage/function with the Vasculitis
Damage Index (VDI) score and Health Assessment Questionnaire (HAQ) scores,
respectively.
Results: We included 66 patients with AAVs (GPA 62%, MPA 29% and EGPA 9%,
females 56%, mean age 63.4 years, generalized disease 74%, mean disease
duration 6.2 years, remission 73%) and 71 with RA (females 56%, mean age 63.3
years, remission 72%). As a whole, both AAV and RA patients had significantly lower
PCS and MCS scores compared to healthy controls (p < 0.05) while RA patients had
lower PCS and MCS scores compared to AAV patients (p < 0.5). Regarding disease
activity, there was no difference in the SF-36 scores between those with active
(BVAS > 1) and inactive (BVAS < 1) AAV, except for the energy-fatigue component
(55.0 ± 21.8 vs. 67.2 ± 20.7, p= 0.038) whereas patients with active RA (DAS28-ESR
> 3.2) had lower scores for all SF36 components compared to those with low disease
activity (DAS28-ESR < 3.2). Additionally, active RA patients had lower both PCS and
MCS scores compared to active AAV patients (p < 0.05). AAV patients with increased
organ damage (VDI > 3) had lower PCS score compared to those with less organ
damage (VDI < 3), (33.9 ± 10.1 vs. 49.1 ± 10.2, p < 0.001) while RA patients with
increased damage (HAQ ≥ 0.75) had lower both PCS and MCS scores compared to
those with less damage (HAQ ≤ 0.63), (35.0 ± 7.2 vs. 48.4 ± 8.6, p < 0.001) and (40.5
± 8.6 vs. 48.2 ± 7.6, p < 0.001 respectively). In addition, RA patients with increased
damage had lower score for the pain component compared to AAV patients (37.7 ±
28.6 vs. 61.2 ± 29.5, p= 0.024).
Conclusions: In general, both AAV and RA patients demonstrated impaired quality
of life compared to historical healthy controls. In the AAV group, quality of life
correlated more with organ damage and less with disease activity whereas in RA
patients, quality of life correlated with both disease activity and damage. These data
emphasize the need for AAV therapies aiming at preventing chronic organ damage
and improving quality of life.
Keywords:
ANCA Vasculitides, Rheumatoid Arthritis, Quality of Life, SF-36
