382. Utility of the 22-Item Sinonasal Outcome Test Patient-Reported Outcome Instrument in ANCA-Associated Vasculitis
Creators: name: Romich1, Ellen
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives:</strong> ANCA-associated vasculitis (AAV) causes sinus symptoms that negatively impact quality of life. The 22-item Sinonasal Outcome Test (SNOT-22) is a patient-reported outcome measure to assess symptoms and quality of life in chronic rhinosinusitis but has not been well-studied in AAV. We compared SNOT-22 scores during remission and active disease in patients with AAV with and without sinus involvement and investigated if SNOT-22 can predict subsequent relapse. <strong>Methods:</strong> Subjects with AAV (granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA) and healthy controls were followed longitudinally with data collected on disease activity measures [BVAS/WG, physician global assessment (PGA)], SNOT-22, and treatments. SNOT-22 questions score on a 0-5 scale with higher scores for worse symptoms and include 5 subdomains: rhinologic, extra-nasal rhinologic, ear/facial, psychological, and sleep. Generalized estimating equations evaluated the association between SNOT-22 scores and disease activity. Models were adjusted for concomitant seasonal allergies and use of antibiotics, immunosuppressive drugs, and sinus rinses. <strong>Results:</strong> This analysis included data from 159 subjects with AAV (106 GPA, 21 MPA, 32 EGPA) with 747 visits (110 active disease visits, ~3.5 months between visits) and 70 controls. 122 (77%) subjects with AAV had baseline sinonasal involvement. Baseline SNOT-22 scores were higher in AAV vs. controls (mean (SD): 27.5 (1.6) vs. 15.4 (2.1), <em>p</em>&lt;0.01) and higher for subjects with AAV with vs. without sinus involvement (mean (SD): 30.3 (20.5) vs. 17.8 (13.2), <em>p</em>&lt;0.01). Adjusted SNOT-22 scores were higher during active disease vs. remission for GPA and EGPA, but not MPA (Figure 1A). For all subjects with AAV, higher PGA was associated with higher SNOT-22 (p&lt;0.01). In GPA, active disease was associated with higher scores in each SNOT-22 subdomain except sleep. Compared to remission visits, active disease was associated with worse scores in psychological and sleep subdomains for MPA and in rhinologic subdomain for EGPA (Figure 1B). Prior SNOT-22 total scores were not associated with subsequent relapse among all visits, but when limiting visits to those 2 months apart, increase in SNOT-22 score at the prior visit was associated with subsequent relapse (adjusted OR 1.15 per score change of 5, 95% CI: 1.0-1.3, <em>p</em>=0.03). <strong>Conclusions:</strong> In patients with AAV SNOT-22 scores are higher during active disease vs. remission, particularly among patients with prior sinus involvement. The subdomains impacted most by disease activity differ by disease type. When measured within 2 months, change in SNOT-22 scores at remission are associated with subsequent relapse. SNOT-22 may be an informative patient-reported outcome measure to monitor disease activity in AAV. <strong>Disclosures</strong>: None