abstract details

The summaries are free for public use. ARTHROS will continue to add and archive summaries of articles deemed relevant to ARTHROS by our Faculty.

Patient perceptions of glucocorticoids in anti-neutrophil cytoplasmic antibody-associated vasculitis

Author information

Robson JC1,2, Dawson J3, Cronholm PF4, Ashdown S5, Easley E6, Kellom KS7, Gebhart D8, Lanier G9, Milman N10, Peck J5, Luqmani RA11, Shea JA12, Tomasson G13, Merkel PA14. Rheumatol Int. 2018 Apr;38(4):675-682. doi: 10.1007/s00296-017-3855-6. Epub 2017 Nov 9.

Abstract

Author information

1 Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK. Jo.Robson@uwe.ac.uk.

2 School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK. Jo.Robson@uwe.ac.uk.

3 Nuffield Department of Population Health, University of Oxford, Oxford, UK.

4 Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA.

5 , Oxfordshire, UK.

6 Department of Family Medicine and Community Health, Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA.

7 PolicyLab, Children's Hospital of Philadelphia, Philadelphia, US, USA.

8 , Columbus, OH, USA.

9 , Boston, MA, USA.

10 Department of Rheumatology, University of Ottawa, Ottawa, Canada.

11 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

12 School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

13 Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.

14 Division of Rheumatology, Departments of Medicine and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) are multisystem diseases of small blood vessels, collectively known as the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). This study explores the patient's perspective on the use of glucocorticoids, which are still a mainstay of treatment in AAV. Patients with AAV from the UK, USA, and Canada were interviewed, using purposive sampling to include a range of disease manifestations and demographics. The project steering committee, including patient partners, designed the interview prompts and cues about AAV, its treatment, and impact on health-related quality of life. Interviews were transcribed and analysed to establish themes grounded in the data. A treatment-related code was used to focus analysis of salient themes related to glucocorticoid therapy. Fifty interviews were conducted. Individual themes related to therapy with glucocorticoids emerged from the data and were analysed. Three overarching themes emerged: (1) Glucocorticoids are effective at the time of diagnosis and during relapse, and withdrawal can potentiate a flare, (2) glucocorticoids are associated with salient emotional, physical, and social effects (depression, anxiety, irritation, weight gain and change in appearance, diabetes mellitus, effect on family and work); and (3) patient perceptions of balancing the risks and benefits of glucocorticoids. Patients identified the positive aspects of treatment with glucocorticoids; they are fast-acting and effective, but, they voiced concerns about adverse effects and the uncertainty of the dose-reduction process. These results may be informative in the development of novel glucocorticoid-sparing regimens.