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| 2. |
- Yates, Max, et al.
(författare)
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Validation of the EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis by disease content experts
- 2017
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Ingår i: RMD Open. - : BMJ. - 2056-5933. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- The European League Against Rheumatism recommendations for the management of antineutrophil cytoplasmic antibody-associated vasculitis have been recently published. Unique to recommendation development, they were also voted on by members of a learned society. This paper explores the wider validity of the recommendations among people who self-identify as clinicians caring for patients with vasculitis. In addition to the task force, a learned society (European Vasculitis Society - EUVAS) was invited, through online survey, to rate independently the strength of evidence of each recommendation to obtain an indication of the agreement among the final target audience and ultimate end-users of the recommendations. The survey took place in June 2015. Of the 158 EUVAS members surveyed, there were 88 responses (55.7%). There was a large degree of agreement in the voting patterns between EUVAS survey participants and task force members. Notable exceptions were lower grades for the recommendation of the use of rituximab for remission induction in patients with eosinophilic granulomatosis with polyangiitis and for methotrexate and mycophenolate mofetil as remission maintenance agents in patients with granulomatosis with polyangiitis/microscopic polyangiitis by EUVAS members. These results are encouraging and suggest that the voting patterns of the task force are representative of the wider vasculitis community. We recommend future recommendations adopt this approach for data/expert-based treatment guidelines, especially for multisystem diseases.
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| 3. |
- Englund, Martin, et al.
(författare)
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Comorbidities in patients with antineutrophil cytoplasmic antibody-associated vasculitis versus the general population
- 2016
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 43:8, s. 1553-1558
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the consultation rates of selected comorbidities in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) compared with the general population in southern Sweden. Methods. We used data from a population-based cohort of patients with AAV diagnosed between 1998 and 2010 in Southern Sweden (701,000 inhabitants). For each patient we identified 4 reference subjects randomly sampled from the general population and matched for year of birth, sex, area of residence, and index year. Using the population-based Skåne Healthcare Register, we identified relevant diagnostic codes, registered between 1998 and 2011, for selected comorbidities assigned after the date of diagnosis of AAV or the index date for the reference subjects. We calculated rate ratios for comorbidities (AAV:reference subjects). Results. There were 186 patients with AAV (95 women, mean age 64.5 yrs) and 744 reference persons included in the analysis. The highest rate ratios (AAV:reference) were obtained for osteoporosis (4.6, 95% CI 3.0-7.0), followed by venous thromboembolism (4.0, 95% CI 1.9-8.3), thyroid diseases (2.1, 95% CI 1.3-3.3), and diabetes mellitus (2.0, 95% CI 1.3-2.9). For ischemic heart disease, the rate ratio of 1.5 (95% CI 1.0-2.3) did not reach statistical significance. No statistically significant differences were found for cerebrovascular accidents. Conclusion. AAV is associated with increased consultation rates of several comorbidities including osteoporosis and thromboembolic and endocrine disorders. Comorbid conditions should be taken into consideration when planning and providing care for patients with AAV.
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| 4. |
- Mohammad, Aladdin J., et al.
(författare)
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Rate of comorbidities in giant cell arteritis : A population-based study
- 2017
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 44:1, s. 84-90
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden. Methods. The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skane region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skane Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA:reference population) was also calculated. Results. There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95% CI 2.33-3.37), followed by venous thromboembolic diseases (2.36, 95% CI 1.61-3.40), severe infections (1.85, 95% CI 1.57-2.18), thyroid diseases (1.55, 95% CI 1.25-1.91), cerebrovascular accidents (1.40, 95% CI 1.12-1.74), and diabetes mellitus (1.29, 95% CI 1.05-1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95% CI 1.00-1.44). Conclusion. Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.
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| 5. |
- Mohammad, Aladdin J., et al.
(författare)
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Severe infection in antineutrophil cytoplasmic antibody-associated vasculitis
- 2017
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 44:10, s. 1468-1475
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV. Methods. The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age- and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects. Results. The rate ratio for all severe infections was 4.53 (95% CI 3.39-6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54-25.9), Clostridium difficile: 5.35 (1.54-23.8), nonspecific septicemia 4.55 (1.60-13.8), and skin 5.35 (1.69-19.8). Of the severe infections, 38.4% occurred within 6 months of diagnosis, 30.2% from 7-24 months, and 31.4% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p < 0.001). Of those with severe infection, 46.5% died during followup compared to 26% of patients without severe infection (p = 0.004). Conclusion. Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.
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| 6. |
- Saleh, Muna Atallah, et al.
(författare)
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Visual complications in patients with biopsy-proven giant cell arteritis : A population-based study
- 2016
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Ingår i: Journal of Rheumatology. - Lund : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 43:8, s. 1559-1565
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the clinical and laboratory characteristics of patients with biopsy-proven giant cell arteritis (GCA) with visual complications, and to evaluate the incidence rate of visual complications in GCA compared to the background population. Methods. Data from 840 patients with GCA in the county of Skane, Sweden, diagnosed between 1997 and 2010, were used for this analysis. Cases with visual complications were identified from a diagnosis registry and confirmed by a review of medical records. The rate of visual complications in patients with GCA was compared with an age-and sex-matched reference population. Results. There were 85 patients (10%) who developed ≥ 1 visual complication after the onset of GCA. Of the patients, 18 (21%) developed unilateral or bilateral complete visual loss. The mean age at diagnosis was 78 years (± 7.3); 69% were women. Compared with patients without visual complications, those with visual complication had lower C-reactive protein levels at diagnosis and were less likely to have headache, fever, and palpable abnormal temporal artery. The use of-adrenergic inhibitors was associated with visual complications. The incidence of visual complications among patients with GCA was 20.9/1000 person-years of followup compared to 6.9/1000 person-years in the reference population, resulting in a rate ratio of 3.0 (95% CI 2.3.3.8). Conclusion. Ten percent of patients with GCA developed visual complications, a rate substantially higher than that of the general population. Patients with GCA who had visual complications had lower inflammatory responses and were more likely to have been treated with 1β-adrenergic inhibitors compared with patients without visual complications.
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| 7. |
- Stamatis, Pavlos, et al.
(författare)
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Coronary Artery Disease in a Population-Based Cohort of Biopsy-Proven Giant Cell Arteritis in Southern Sweden
- 2019
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Ingår i: Arthritis & Rheumatology. - : Wiley. - 2326-5205 .- 2326-5191. ; 71:Suppl 10
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background/Purpose: The aim of this study was to estimate the incidence rate and prevalence of coronary artery diseases (CAD) in patients with temporal artery positive giant cell arteritis (TAB+GCA) from a defined population in southern Sweden, and to describe characteristics of CAD in this sample.Methods: The study cohort consisted of 1202 patients (71.9% women) diagnosed with TAB+GCA between 1997 and 2016. Patients were identified from the database of the Department of Pathology which covers all the hospitals in the Skåne region of Sweden. The cohort was linked to the registry for acute coronary care (SWEDEHEART) which provides nationwide coverage since 1995. All the GCA patients with symptoms suggesting acute coronary syndrome who had been admitted to a coronary care unit (CCU) were identified. CAD was defined as an admission to a CCU for ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), stable angina, or unstable angina. For incidence rate analyses, the person-years of follow-up was calculated from GCA diagnosis until first CAD, death or December 31, 2016, whichever came first.Results: 126 of 1202 GCA patients had suffered at least one acute coronary event (Table 1) yielding the cumulative incidence of 10.5% (95% CI 8.7-12.3). Of the 126 patients with CAD, 44 (34.9%) were diagnosed with CAD before their GCA diagnosis, 11 (8.7%) both before and after their diagnosis, and 71 (56.3%) solely after their GCA diagnosis. The total number of CCU admissions of all the 126 GCA CAD+ patients was 209: 101 admissions (48.3%) for NSTEMI, 55 (26.3%) for stable angina, 29 (13.9%) for STEMI, and 24 (11.5%) for unstable angina. Eighty-two GCA patients (61% women) developed CAD after their diagnosis of GCA. During a total follow-up time of 8047 person-years, the incidence rate of CAD in patients with TAB+GCA was 1.0 per 100 person-years (95% CI 0.8-1.2) for all patients, 0.8 (95% CI 0.6-1.1) for women and 1.6 (95% CI 1.1-2.2) for men, p=0.02. Fifteen GCA patients suffered from a CAD event in 1156 person-years during the first year after the GCA diagnosis, resulting in an incidence rate of 1.3 per 100 person-years (95% CI 0.6-2.0). 703/1202 (58.5%) GCA patients were alive on December 31, 2016, of which 72 patients had at least one previous CAD event yielding a prevalence of CAD in GCA of 10.2%.Conclusion: The incidence of CAD in GCA is comparable to what has been previously found in the Swedish background population. The incidence rate is higher among men compared to women. Coronary artery disease affects every tenth patient with TAB+GCA in this cohort. Further studies are needed to explore the impact of CAD on clinical outcomes in patients with GCA.
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