AB0645 Anca vasculitis: the experience and trends in patient care from a single centre
Authors: A. Bankole, K. McCoy, B. Yeary, G. Verma, Gita
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> ANCA-associated vasculitis [AAV] is a small-medium vessel vasculitis that presents in a multi-systemic fashion, and is associated with significant mortality. Outcomes have improved with the introduction of immunosuppressive medications [ISM], the evidence supporting the initial choice ISM in AAV is limited, and may be influenced by health disparities related to social factors. <h3>Objectives</h3> The objective of this study was to compare various factors known to influence management and outcomes in AAV. Factors including, patient demographics, socioeconomics, clinical presentations, and medication choices were reviewed in relation to outcomes within the cohort. <h3>Methods</h3> This was a retrospective, single centre, hospital-affiliated cohort study. A list of all patients seen by the Rheumatology service between 2011 and 2016 with a diagnosis of AAV was generated. A review of the 3000 charts confirmed 77 patients that met the 1990 American College of Rheumatology criteria for AAV. General demographic data including age, gender, zip code, and median household income as well as disease related data including serology, disease manifestation, and treatment were obtained through a chart review and recorded in the database. Supplemental socioeconomic information for each patient zip code was obtained from the United States Government Census website. <h3>Results</h3> In our cohort the anti-proteinase 3 [PR3] antibody was the most common positive antibody. There was a relationship between PR3 antibody positivity rate and body mass index [table 1]. Given the low number of non-Caucasians we were unable to comment on the relationship between antibody and race. Medication choice and mortality were independent of mean household income. Rituximab was the most commonly prescribed ISM [44%]. The median age of rituximab exposure patients was 65 years and 60 years for unexposed patents. There was no significant relationship between age and medication choice. Rituximab was prescribed 60% of the time in renal AAV [p&lt;0.01] and 53% of the time in pulmonary AAV [p&lt;0.01]. Other commonly prescribed medications in the cohort included Mycophenolate [20%], Methotrexate [24%] and Cyclophosphamide [28%]. The overall mortality rate was 17% [13/75] [figure 1]. There was no significant difference in the mortality rate of patients 65 years and older [23%, 9/39] compared to patients 64 and younger [11%, 4/36; p=0.17]. The mortality rate was also independent of median household income. <h3>Conclusions</h3> There was no relationship between age, sex, income, immunosuppressive therapy, and mortality in our AAV cohort. The mortality rate was higher in more severe disease and rituximab was more commonly used in such cases as well as in older patients. The limitations of the study include this being a hospital based cohort, where social demographics may have less of an impact. There was a lack of racial diversity, though the cohort did reflect the general demographics in southwest Virginia. <h3>Disclosure of Interest</h3> None declared