The British Journal of Rheumatology, Vol 37, 57-63, Copyright © 1998 by British Society for Rheumatology
AR Exley, PA Bacon, RA Luqmani, GD Kitas, DM Carruthers and R Moots
Assessment of disease severity in systemic vasculitis encompasses
mortality, which is now uncommon, and morbidity, which is increasing in
significance. Morbidity includes permanent scars or damage, an evolving
concept offering a novel perspective which may be particularly valuable in
chronic disease. We have developed a method for assessing damage in
systemic vasculitis, but the relationship between damage and disease
severity was unknown. Therefore, we examined whether the number of items of
damage or the pattern of damage varied with the severity of systemic
vasculitis. We established the characteristics of severe disease by
examining fatal vasculitis as an example of the most severe disease
possible. We then showed that more damage occurred in fatal vasculitis,
more systems were damaged, and critical damage akin to organ failure was
more common in fatal than non-fatal vasculitis. These observations were
reproduced in specific diagnostic groups, namely classical Wegener's
granulomatosis and systemic rheumatoid vasculitis. Thus, severe disease was
characterized by many items of damage, multisystem damage and critical
damage. This pattern of damage was also seen in a subgroup of patients with
non-fatal vasculitis, who also have severe disease.
ORIGINAL PAPERS
Examination of disease severity in systemic vasculitis from the novel perspective of damage using the vasculitis damage index (VDI)
Department of Immunology, Birmingham Vasculitis Group, University of Birmingham.
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