Background ANCA–associated vasculitis (AAV) is a potentially life threatening condition which requires immediate intervention with immunosuppressive treatment. Although patient survival from disease had improved, unfortunately patients survive to experience long term complications of both the disease and the treatment. The major cause of early mortality in this population is infection with increased later risks of malignancy and cardiovascular disease. Patients are also at risk of other treatment related morbidity such as impaired fertility. These complications are a major cause of morbidity and mortality in these patients, therefore it is vital to implement all the available preventative measures when indicated
Objectives The aim for this audit was to assess whether patients were receiving the correct adjuvant treatment and counselling in order to protect them against the long term complications of ANCA-associated vasculitis and the side effects from treatment.
Methods Patients under the Rheumatology/Renal vasculitis clinic at the University Hospital of South Manchester (UHSM), with a diagnosis of an AAV, were identified. Audit standards were set using 2008 EULAR recommendations and BSR/BHPR guidelines for management of patients with vasculitis, therefore patients diagnosed before the publication of the 2008 EULAR recommendations (April 2008) were excluded from this audit. Standards were set at 100% unless stated otherwise. Data was collected retrospectively from patient's medical records and electronic secondary care records.
Results We identified 22 patients diagnosed with AAV at UHSM after April 2008, comprising of 12 male and 10 female patients, ranging from 23 to 70 years of age. The median age is 51 and the interquartile range is 22.5. Of these patients, 25% were assessed for their risk of tuberculosis prior to treatment and 77.2% and 72.7%, were given the influenza and pneumococcal vaccines respectively. Only 4.76% of patients had a full cardiovascular risk assessment in the 12 months prior to this audit. This comprised of monitoring the patients' blood pressure (95.24%), weight (90.48%), cholesterol (80.95%) and HbA1c/ fasting glucose levels (76.19%) and counselling patients about smoking cessation (0% documented) and exercise (23.81% documented). Of the 13 patients treated with intravenous cyclophosphamide, 87.5% received Mesna, 91.6% were monitored for bladder cancer with a urinalysis and 40% of women were documented to have been advised to have cervical smears. 37.5% of patients were informed about the risk of infertility; however, no male patients had a documented offer of sperm banking.
Conclusions Optimal preventative management for the complications of disease and treatment were not uniformly applied to patients with AAV. Awareness and screening for cardiovascular risks were good however areas for improvement include counselling these patients about possible risks associated with treatment of the disease, such as infertility and encouraging uptake of protective measures
Disclosure of Interest None declared