Health-related quality of life in patients with newly diagnosed antineutrophil cytoplasmic antibody-associated vasculitis.
Walsh M., Mukhtyar C., Mahr A., Herlyn K., Luqmani R., Merkel PA., Jayne DRW.
OBJECTIVE: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) can present with a broad spectrum of signs and symptoms. The relative effects of different manifestations on health-related quality of life (HRQOL) are unknown. METHODS: We conducted an individual patient data meta-analysis of baseline Short Form 36 (SF-36) scores from 4 randomized controlled trials of patients with newly diagnosed AAV. We determined the associations between organ manifestations at trial entry and the SF-36 physical composite score (PCS) and mental composite score (MCS) using mixed-effects models adjusted for demographic factors. Associations with each of the 8 domains of the SF-36 were further explored using multivariate multiple regression. RESULTS: SF-36 data were available from 346 patients. Older age (-0.11 points/year [95% confidence interval (95% CI) -0.21, -0.012]; P = 0.029) and neurologic involvement (-5.84 points; P < 0.001) at baseline were associated with lower PCS. Physical functioning scores were the most affected and older age scores (-0.25 points/year [95% CI -0.38, -0.11]; P < 0.001) and neurologic involvement (-8.48 points [95% CI -12.90, -4.06]; P < 0.001) had the largest effects. The MCS was negatively affected only by chest involvement (P = 0.027), but this effect was not exerted in any particular domain. CONCLUSION: In patients with newly diagnosed AAV, HRQOL is complex and incompletely explained by their organ system manifestations.