To Örebro University

Background: Patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV), which includes Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), and Eosinophilic Granulomatosis with Polyangiitis (EGPA), can experience a substantial disease burden with lower Health-Related Quality of Life (HRQoL), higher levels of anxiety, depression and fatigue [1]. Several earlier studies have investigated the extent of patient experiences among two or three patient groups, however, only a few has studied any differences in between the three different AAV patient groups.

Objectives: The aim of this study is to analyse HRQoL, fatigue, anxiety and depression in patients with AAV and to identify any differences between patients with GPA, MPA, and EGPA.

Methods: This is a cross sectional study, consecutively including both newly diagnosed and current adult patients with AAV. For this study, the EQ Visual analogue scale (EQ-VAS, scale 0-100), and the first question in MAF (scale 1-10), assessing degree of fatigue were included in the analysis, besides the two dimensions of HADS anxiety (HADS-A, scale 0-21), and HADS-depression (HADS-D, scale 0-21). Disease activity was measured by Birmingham Vasculitis Activity Score (BVAS). BVAS scores of zero was considered as inactive disease, whereas a BVAS scores ≥ 1 was defined as active disease.

Patient reported outcomes (PROM) were analysed by Kruskal Wallis H test for differences between the tree diagnosis, and Mann-Whitney U test for differences between two groups, e.g short versus long disease duration. Additional bivariate correlations between PROMS and disease durations for patient groups were analysed with Spearman’s rank-order correlation.

Results: Three hundred and fifty-nine patients were included in the analysis, GPA n=250 (70%), MPA n=95 (27%), and EGPA n=14 (4%). In all, the AAV patients were equally distributed between men; 172 (48%) and women; 187 (52%), with a mean age of 59 years (SD 16.3, range 18-90). Forty-two percent of patients had a BVAS of zero, and 58 % a BVAS of ≥ 1. Mean disease duration was 3.7 years (SD 5.3, range 0-31). Sixty percent of patients had a disease duration of ≤ 2 years, and 40% ≥ 3 years.

Distributions of HRQoL, fatigue, anxiety and depression scores were similar for all AAV groups. HRQoL, fatigue, anxiety and depression scores for groups GPA, EGPA, MPA were not statistically significantly different (Table 1).

Patients with disease duration < 2 years compared to disease duration ≥ 3 years reported lower HRQoL (median 60, IQR 47-75, vs median 70, IQR 50-80, p= 0.005), higher fatigue (median 7, IQR 5-8 vs median 7, IQR 4-8, p= 0.014) and depression (median 6, IQR 3-9 vs median 4, IQR 2-7, p= 0.004). No significant differences were found for anxiety (median 4, IQR 2-7, vs median 3, IQR 1-6, p= 0.080), between short and long disease duration.

Significant, however weak associations were found between disease duration and HRQoL, fatigue, anxiety and depression in all patients (rs <0.29) and the subgroups GPA (rs < 0.30) and MPA (rs <0.31). In the small group of EGPA, disease duration had stronger associations than GPA and MPA, for disease duration and all explored PROMs (rs < 0.61) (Table 2.).

Conclusion: No significant differences in HRQoL, fatigue, anxiety and depression median scores were found between the three patient groups GPA, MPA, and EGPA. In all patients, a weak correlation was found between disease duration and HRQoL, fatigue, anxiety and depression. However, the group with EGPA had a stronger association between disease duration and both HRQoL and fatigue, which indicates some differences between diagnoses, that should be further explored. Additionally, patients with disease duration < 2 years reported worse HRQoL, fatigue, and depression which indicate that patients with AAV need special attention during the first two years after diagnosis.