title: Glucocorticoid treatment and damage in the anti-neutrophil cytoplasm antibody-associated vasculitides: long-term data from the European Vasculitis Study Group trials.
abstract: OBJECTIVE
  Granulomatosis with polyangiitis and microscopic polyangiitis are ANCA-associated vasculitides (AAVs). The Vasculitis Damage Index (VDI) quantifies damage. This study aims to determine the factors associated with long-term damage in the AAVs.
  
  
  METHODS
  Data from 535 patients from four European Vasculitis Study Group trials were studied. A long-term follow-up (LTFU) questionnaire at 7 years post-diagnosis was completed. The associations between baseline (age, creatinine and BVAS score) and cumulative (number of relapses and duration of glucocorticoid use) factors and damage accrued (total VDI scores and individual treatment-related damage items) during follow-up were explored. Multiple regressions identified independent associations between baseline measures, cumulative factors and VDI scores at LTFU.
  
  
  RESULTS
  Two hundred and ninety-six patients had glucocorticoid use and VDI data available at LTFU, with the mean length of glucocorticoid use being 40.4 months (S.D. 16.7). High levels of damage were independently associated with older age at baseline (P = 0.051), lower glomerular filtration rate (P = 0.041), higher BVAS scores (P = 0.046), increased cumulative glucocorticoid use (P = 0.016) and increasing number of relapses. Patients with longer duration of glucocorticoid treatment were more likely to have a total VDI score ≥5 [odds ratio 1.26 per 12 months of glucocorticoid use (95% CI 1.03, 1.53), P = 0.022]. The main limitation is that approximately half of the patients enrolled had no LTFU data available; these patients were older with more severe initial disease.
  
  
  CONCLUSIONS
  Long-term damage in the AAVs may be associated with severity of initial disease, age, number of relapses and duration of glucocorticoid use.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden. joanna.robson@ndorms.ox.ac.uk.
authors.forename: Joanna
authors.initials: J
authors.lastname: Robson
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Helen
authors.initials: H
authors.lastname: Doll
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Ravi
authors.initials: R
authors.lastname: Suppiah
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Oliver
authors.initials: O
authors.lastname: Flossmann
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Harper
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Höglund
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Jayne
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Alfred
authors.initials: A
authors.lastname: Mahr
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Westman
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
authors.forename: Raashid
authors.initials: R
authors.lastname: Luqmani
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy* / Q000473:pathology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids
keywords: epidemiology; granulomatosis with polyangiitis; immunosuppressives; microscopic polyangiitis; outcomes; vasculitis