13 research outputs found
Pathways to renal biopsy and diagnosis among patients with ANCA small-vessel vasculitis
Objectives—Antineutrophil cytoplasmic antibody small-vessel vasculitis (ANCA-SVV) is an
autoimmune systemic process increasingly recognised since the advent of antibody testing for the
disease. Prompt diagnosis and institution of immunosuppressive therapy has been shown to
improve patient outcome. The goal of this study was to better understand how patients navigate
the health care system from symptom presentation to biopsy diagnosis, and to study the effects of
prompt versus delayed diagnosis.
Methods—Disease symptoms and number of physicians seen prior to renal biopsy were assessed
for 127 ANCA-SVV patients. Direct, delayed, and quest pathways to diagnosis and treatment of
vasculitis were defined for both patients and providers. Kruskal-Wallis and Fisher exact tests were
used to evaluate continual measures and compare categorical variables across pathways.
Results—Among patients who sought direct care, physician delay in referral to a nephrologist
was common (49/127, 71%, p=0.0023). Patients who delayed seeking care also experienced a
delayed diagnosis 57% of the time (p=0.0023). Patients presenting with prodromal flu or upper
respiratory involvement were more likely to have a delay/quest patient pathway (56% and 55%,
respectively) than a direct patient pathway (44%, p=0.033 and 45%, p=0.019, respectively). There
was a trend for patients with more severe loss of renal function to have a more direct referral to a
nephrologist.
Conclusion—Delay in diagnosis of ANCA SVV may be due to lack of or non-specific
symptoms, especially in patients who present with non-renal manifestations of disease. Better
algorithms are needed to identify extra-renal manifestations, expedite diagnosis and improve
patient outcomes
Adverse events and infectious burden, microbes and temporal outline from immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis with native renal function
Disease control in anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) with immunosuppression is effective but burdened by adverse events, especially infections. The study goal was to evaluate risks and types of infections in patients with AAV
Rituximab as an immunosuppressant in antineutrophil cytoplasmic antibody-associated vasculitis
Rituximab has been used in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) since 2003. Our objective was to describe outcomes and adverse events following rituximab since that time in an inception cohort
What Everybody is Doing but No One is Talking About: Use of Complementary and Alternative Medicine in the ANCA Associated Vasculitis Population
The use and impact of complementary and alternative medicine (CAM) for anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) has not been reported. AAV patients seeking care at our center inquired about CAM, prompting a formal study. Study objectives were to discern how many AAV patients used CAM and its perceived helpfulness in disease management.Methods: AAV patients completed a CAM questionnaire between July 2011 and May 2012. Patients were 18 years or older and had biopsy proven and/or clinical evidence of AAV. Medical record abstraction supplemented data. Classification detailed CAM type including “Mind†or “Mind-Bodyâ€. Perceived helpfulness of CAM was assessed as “veryâ€, “somewhat†or “not at all/don’t knowâ€.Results: A total of 107 patients participated and were a mean age of 53 (range: 18-85), 62% female; 48% proteinase 3 (PR3)-ANCA, 44% myeloperoxidase (MPO)-ANCA and 8% ANCA-negative. Top organs involved included kidney (87%), joints (55%), lung (53%) and upper respiratory (53%).At least one type of CAM treatment or self-help practice was reported by 81% of study participants, with the most frequent being prayer (64%), exercise (27%) and massage therapy (19%). Mind-based practices were used by 28% (excluding prayer) and Mind-Body practices by 14%. Most practices were used to improve wellbeing, and Mind and Mind-Body were deemed very helpful by 83% and 87% respectively. Only 24% of study participants discussed CAM with their physician.Conclusion: CAM practices were commonly used to improve well-being and found to be beneficial among AAV patients, but more open discussion is needed about CAM between physicians and patients