Vasculitis damage swift, accumulating

Nov 22 2013

By Lynda Williams, Senior medwireNews Reporter

Study findings reveal the significant burden of disease among patients with antineutrophil-cytoplasm antibody associated vasculitis (AAV), with many individuals showing irreversible damage shortly after diagnosis.

Data for 629 European clinical trial patients with a new diagnosis of granulomatosis with polyangiitis (GPA or Wegener’s) or microscopic polyangiitis (MPA) showed that 34.5% of the group had at least one marker of damage on the 64-item Vasculitis Damage Index (VDI) at baseline and 5.1% of the group met criteria for five or more items.

Moreover, long-term follow-up questionnaire results including VDI results were available for 302 patients, an average of 7.1 years after AAV diagnosis. Just 7.9% of participants had no items of damage on the scale at this point and 34.4% had five or more items.

Renal damage was common at both time points, as indicated by proteinuria, a glomerular filtration rate below 50 mL/min, and/or hypertension. Nasal crusting, hearing loss, and peripheral neuropathy were also frequent.

Of note, the pattern of damage differed by diagnosis, with renal issues more common in patients with MPA and non-renal complications experienced more often by those with GPA, note Joanna Robson (University of Oxford, UK) and co-authors.

Potentially treatment-related damage was also reported at long-term follow-up by 65.6% of the 270 patients with complete data, with 30.0% having at least one item and 16.7% three or more items on the VDI. The most common issues reported were hypertension, osteoporosis, malignancy, and diabetes; the frequency of these rose between baseline and long-term follow-up by a significant 36.7%, 14.1%, 12.6% and 9.3%, respectively.

“Damage should, therefore, continue to be an important outcome in AAV clinical trials and long-term cohort studies, with use of the VDI as a primary outcome measure,” the researchers emphasize in the Annals of the Rheumatic Diseases.

“Such focus may potentially aid refinement of therapeutic regimens and limit long-term damage, with possible benefits in terms of associated mortality.”

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