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The characterisation and determinants of quality of life in ANCA associated vasculitis
  1. Neil Basu1,
  2. Andrew McClean2,
  3. Lorraine Harper2,
  4. Esther Nicole Amft3,
  5. Neeraj Dhaun4,
  6. Raashid A Luqmani5,
  7. Mark A Little6,
  8. David RW Jayne7,
  9. Oliver Flossmann8,
  10. John McLaren9,
  11. Vinod Kumar10,
  12. Lars P Erwig1,
  13. David M Reid1,
  14. Gareth T Jones1,
  15. Gary J Macfarlane1
  1. 1Musculoskeletal Collaboration, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
  2. 2School of Immunity and Infection, University of Birmingham, Birmingham, UK
  3. 3Department of Rheumatology, Western General Hospital, Edinburgh, UK
  4. 4Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  5. 5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  6. 6School of Medicine, Trinity College Dublin, Dublin, Ireland
  7. 7Department of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
  8. 8Renal Unit, Royal Berkshire Hospital, Reading, UK
  9. 9Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, UK
  10. 10Department of Rheumatology, Ninewells Hospital, Dundee, UK
  1. Correspondence to Dr Neil Basu, Musculoskeletal Collaboration (Epidemiology Group), School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK; neilbasu{at}abdn.ac.uk

Abstract

Objectives To contextualise and identify the determinants of poor health related quality of life (QOL) among patients with antineutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV).

Methods A multicentre AAV case–control study was conducted using two matched groups of population and chronic disease controls. Measures of physical and mental QOL as well as putative bio-psychosocial determinants of QOL impairment were collected. Concurrently, putative clinical QOL determinants were recorded. Conditional logistic regression analyses characterised group differences while multivariable logistic regression identified within-case QOL associations which were further quantified using population attributable risks (PAR).

Results Cases (n=410) experienced similar QOL to chronic disease controls (n=318) (physical QOL: OR 0.7, 95% CI 0.4 to 1.1; mental QOL: OR 1.1, 95% CI 0.8 to 1.6). However, they were substantially more likely to report poor QOL compared to general population controls (n=470) (physical QOL: OR 7.0, 95% CI 4.4 to 11.1; mental QOL: OR 2.5, 95% CI 1.7 to 3.6). A few clinical, but many more bio-psychosocial factors were independently associated with poor QOL. In population terms, fatigue was found to be of principal importance (physical QOL: PAR 24.6%; mental QOL: PAR 47.4%).

Conclusions AAV patients experienced significant QOL impairment compared to the general population, but similar to those with other chronic diseases whose considerable needs are already recognised. Potentially modifiable clinical determinants have been identified; however bio-psychosocial interventions are likely to provide the greater QOL gains in this patient population.

  • Systemic Vasculitis
  • Outcomes Research
  • Granulomatosis with Polyangiitis

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