Background Accurate initial assessment of organ involvement in Wegener’s granulomatosis (WG) is essential to determine immediate and future management. Renal and pulmonary involvement are associated with a worse outcome.
Objectives We audited the initial assessment of patients referred to the Rheumatic Diseases Unit (RDU) who were subsequently confirmed to have WG. As there are no published gold standards on what should be assessed, the following essential items were chosen following consensus discussion: blood pressure (BP), urinalysis (and microscopy if haematuria present) and serum creatinine for renal involvement and chest radiograph (CXR) for pulmonary involvement. Tissue biopsy from symptomatic sites was important to establish evidence of granulomata or inflammation (ear, nose and throat (ENT)), vasculitis (cutaneous/ENT) or focal segmental glomerulonephritis (renal).
Methods All patients with WG referred to the RDU over 8 years until Sept 2000 were identified by search of the computer database. Patients with incomplete medical records and re-referrals were excluded. 35 patients were identified and their medical records and CXRs were reviewed to establish if basic investigations had been performed and if so, their results.
Results Demographics: 19 F:16 M. Mean age 53, range 13–85. 83% of patients were referred by either general practitioners, general physicians or ENT surgeons. Features at presentation (%): ENT (94), arthralgia (66), cutaneous (51), renal (40), ocular (29), pulmonary (20) and neurological (17). The results are presented in the table. In 29% (10/35) of patients at least one test was not performed. 11% (4/35) of patients had hypertension (diastolic BP > 99) and in none were recommendations made for BP to be rechecked or treatment to be commenced. 6% (2/35) of patients with microscopic haematuria did not have urine microscopy or a renal biopsy performed (one patient also had an elevated creatinine). 9 patients had an abnormal CXR: 1 had evidence of previous tuberculosis, 4 had active pulmonary disease and 4 had further investigation to exclude infection.
Conclusion 71% of patients referred to a tertiary rheumatology centre and later confirmed to have WG received adequate basic investigation at presentation. Patients found to be hypertensive should have their BP repeated and those with haematuria should have urine microscopy performed. These results indicate that we should be more vigilant in performing basic tests in patients with suspected WG and in this regard our data have been presented to our department by means of an audio visual presentation and written information. The audit will be repeated in 2005 to reassess the recording of basic investigations in patients with WG.