Outcome Measures in Large Vessel Vasculitis: Relationship Between Patient‐, Physician‐, Imaging‐, and Laboratory‐Based Assessments

Abstract

Objective To assess the relationship between measures of disease assessment in patients with large vessel vasculitis. Methods Patients with giant cell arteritis (GCA) or Takayasu arteritis (TAK) were recruited into a prospective, observational cohort. Assessments within the following outcomes were independently recorded: 1) patient‐reported outcomes (Multidimensional Fatigue Inventory, patient global assessment of disease activity [PtGA], Short Form 36 health survey [SF‐36], Brief Illness Perception Questionnaire), 2) physician global assessment of disease activity (PhGA), 3) laboratory outcomes (C‐reactive protein [CRP] level, erythrocyte sedimentation rate [ESR]), and 4) imaging outcomes (PETVAS, a qualitative score of vascular 18F‐fluorodeoxyglucose–positron emission tomography activity). Results Analyses were performed on 112 patients (GCA = 56, TAK = 56), over 296 visits, with a median follow‐up of 6 months. Correlation network analysis revealed assessment measures clustered independently by type of outcome. PhGA was centrally linked to all other outcome types, but correlations were modest (ρ = 0.12–0.32; P < 0.05). PETVAS, CRP level, and PtGA were independently associated with clinically active disease. All 4 patient‐reported outcomes strongly correlated with each other (ρ = 0.35–0.60; P < 0.0001). Patient‐reported outcomes were not correlated with PETVAS, and only PtGA correlated with CRP level (ρ = 0.16; P < 0.01). Patients whose clinical assessment changed from active disease to remission (n = 29) had a corresponding significant decrease in ESR, CRP level, and PETVAS at the remission visit. Patients whose clinical assessment changed from remission to active disease (n = 11) had a corresponding significant increase in CRP level and PtGA at the active visit. Conclusion Measures of disease assessment in large vessel vasculitis consist of independent, yet complementary, outcomes, supporting the need to develop composite outcome measures or a standard set of measures covering multiple types of outcomes.

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

“…A further 42 articles were excluded following fulltext assessment. Eventually, 21 studies were selected for the qualitative analysis (systematic review) [16,17,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Eight studies were included in the meta-analysis since these reports contained sufficient data to either evaluate the accuracy of [18F]FDG-PET/CT for discriminating between active disease and remission during treatment [19,23,25,33] or to evaluate the proportion of patients in which the scan normalized during clinical remission in patients on treatment [17,20,22,36].…”

“…Contrast-enhanced CT was performed in two studies. Four studies from the same centre reported that [18F]FDG-PET/MRI was applied in paediatric patients, whereas the adult patients underwent [18F]FDG-PET/CT [16,21,29,31]. The injected [18F]FDG activity was quite heterogeneous and included both weight-based and fixed activities.…”

“…The cross-sectional studies mostly contained patients on treatment with a disease duration ranging from 2.0-6.9 years (Table 3). Four cross-sectional studies (19%) also contained patients with newly diagnosed LVV: in 1 study, at least 90% of all scans were performed during treatment [34], whereas this was unclear (at least 54%) in the other 3 studies [21,29,31]. Clinical disease activity was determined according to standardized instruments (i.e.…”

Patient-Reported Outcome Measures in Takayasu Arteritis: A Systematic Review and Meta-Analysis

“…Twenty-one studies (1311 patients with TAK, 308 healthy controls) were identified [ 37 – 57 ], all but one [ 52 ] were observational. Ten studies (559 patients with TAK, 182 healthy controls) were synthesized in meta-analysis [ 37 , 39 – 42 , 45 , 51 , 53 , 55 , 56 ], all of whom reported patients with prevalent disease (rather than newly diagnosed disease) on a variety of treatments (ESM Table S5). Most subjects included in the studies were female.…”

Measures of Fatigue in Patients With Rheumatic Diseases: A Critical Review

“…In addition to cancer and various long‐term conditions (eg, Parkinson disease and liver disease), the MFI has been used in several studies in RA, FMS, AS, primary SS, SLE, antineutrophil cytoplasmic antibody–associated vasculitis (AAV), and large‐vessel vasculitis .…”