title: The future of damage assessment in vasculitis.
abstract: Damage denotes the aspects of chronic disease that do not reverse with therapy. This concept is particularly important for the primary systemic vasculitides, since the careful differentiation between activity and damage may help avoid unnecessary exposure to cytotoxic medications. Damage significantly influences both longterm prognosis and quality of life. Because the primary systemic vasculitides have diverse manifestations, the use of a damage assessment instrument is crucial to ensure reproducibility. The Vasculitis Damage Index (VDI) is the only validated measure for damage assessment in vasculitis. Use of the VDI in recent clinical trials has shown that it may not adequately determine the full spectrum of damage experienced by patients with vasculitis of small- and medium-size vessels. We propose reexamining the way in which damage is assessed, focusing on vasculitides of small- and medium-size vessels, and outline an initiative to create a substantially revised and improved damage assessment instrument using data-driven approaches. This initiative is part of a larger international effort to create a unified approach to disease assessment for the primary systemic vasculitides.
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Seo
authors.forename: Raashid A
authors.initials: RA
authors.lastname: Luqmani
authors.forename: Oliver
authors.initials: O
authors.lastname: Flossmann
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hellmich
authors.forename: Karen
authors.initials: K
authors.lastname: Herlyn
authors.forename: Gary S
authors.initials: GS
authors.lastname: Hoffman
authors.forename: David
authors.initials: D
authors.lastname: Jayne
authors.forename: Cees G M
authors.initials: CG
authors.lastname: Kallenberg
authors.forename: Carol A
authors.initials: CA
authors.lastname: Langford
authors.forename: Alfred
authors.initials: A
authors.lastname: Mahr
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Mukhtyar
authors.forename: Tuhina
authors.initials: T
authors.lastname: Neogi
authors.forename: Abraham
authors.initials: A
authors.lastname: Rutgers
authors.forename: Ulrich
authors.initials: U
authors.lastname: Specks
authors.forename: John H
authors.initials: JH
authors.lastname: Stone
authors.forename: Steven R
authors.initials: SR
authors.lastname: Ytterberg
authors.forename: Peter A
authors.initials: PA
authors.lastname: Merkel
mesh_terms: D004185:Disability Evaluation; D005060:Europe; D006801:Humans; D007391:International Cooperation; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014481:United States; D014657:Vasculitis / Q000145:classification / Q000473:pathology* / Q000503:physiopathology*