PMID- 29124398 OWN - NLM STAT- MEDLINE DCOM- 20180924 LR - 20220409 IS - 1437-160X (Electronic) IS - 0172-8172 (Print) IS - 0172-8172 (Linking) VI - 38 IP - 4 DP - 2018 Apr TI - Patient perceptions of glucocorticoids in anti-neutrophil cytoplasmic antibody-associated vasculitis. PG - 675-682 LID - 10.1007/s00296-017-3855-6 [doi] AB - 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. FAU - Robson, Joanna C AU - Robson JC AUID- ORCID: 0000-0002-7939-5978 AD - Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK. Jo.Robson@uwe.ac.uk. AD - School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK. Jo.Robson@uwe.ac.uk. FAU - Dawson, Jill AU - Dawson J AD - Nuffield Department of Population Health, University of Oxford, Oxford, UK. FAU - Cronholm, Peter F AU - Cronholm PF AD - Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA. FAU - Ashdown, Susan AU - Ashdown S AD - , Oxfordshire, UK. FAU - Easley, Ebony AU - Easley E AD - Department of Family Medicine and Community Health, Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA. FAU - Kellom, Katherine S AU - Kellom KS AD - PolicyLab, Children's Hospital of Philadelphia, Philadelphia, US, USA. FAU - Gebhart, Don AU - Gebhart D AD - , Columbus, OH, USA. FAU - Lanier, Georgia AU - Lanier G AD - , Boston, MA, USA. FAU - Milman, Nataliya AU - Milman N AD - Department of Rheumatology, University of Ottawa, Ottawa, Canada. FAU - Peck, Jacqueline AU - Peck J AD - , Oxfordshire, UK. FAU - Luqmani, Raashid A AU - Luqmani RA AD - Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. FAU - Shea, Judy A AU - Shea JA AD - School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. FAU - Tomasson, Gunnar AU - Tomasson G AD - Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland. FAU - Merkel, Peter A AU - Merkel PA AD - Division of Rheumatology, Departments of Medicine and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA. LA - eng GR - MR/N011775/1/MRC_/Medical Research Council/United Kingdom GR - U54 RR019497/RR/NCRR NIH HHS/United States GR - Postgraduate rheumatology fellowship award/UCB/Canadian Rheumatology Association/ Arthritis Society/ GR - 1098/Oxfordshire Health Services Research Committee/ GR - NIHR lectureship/National Institute for Health Research/ GR - U01AR51874/National Institute of Arthritis and Musculoskeletal and Skin Diseases (US)/ GR - U54 AR057319/AR/NIAMS NIH HHS/United States GR - U01 AR051874/AR/NIAMS NIH HHS/United States GR - Research Fellowship/Department of Medicine, Ottawa Hospital/ PT - Journal Article PT - Multicenter Study DEP - 20171109 PL - Germany TA - Rheumatol Int JT - Rheumatology international JID - 8206885 RN - 0 (Glucocorticoids) SB - IM MH - Aged MH - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis/*drug therapy/psychology MH - Canada MH - Disease Progression MH - Female MH - Glucocorticoids/adverse effects/*therapeutic use MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Interviews as Topic MH - Male MH - Mental Health MH - Middle Aged MH - Patient Safety MH - Patients/*psychology MH - Qualitative Research MH - Quality of Life MH - Recurrence MH - Remission Induction MH - Risk Assessment MH - Treatment Outcome MH - United Kingdom MH - United States PMC - PMC5854718 OTO - NOTNLM OT - ANCA-associated vasculitis OT - Eosinophilic granulomatosis with polyangiitis OT - Glucocorticoids OT - Granulomatosis with polyangiitis (Wegener's) OT - Microscopic polyangiitis OT - Patient perspectives COIS- JR, JD, SA, EE, KK, DG, GL, NM, JP, RL, JS, PC, PM have no conflicts of interest in regard to this work. EDAT- 2017/11/11 06:00 MHDA- 2018/09/25 06:00 PMCR- 2017/11/09 CRDT- 2017/11/11 06:00 PHST- 2017/04/07 00:00 [received] PHST- 2017/10/13 00:00 [accepted] PHST- 2017/11/11 06:00 [pubmed] PHST- 2018/09/25 06:00 [medline] PHST- 2017/11/11 06:00 [entrez] PHST- 2017/11/09 00:00 [pmc-release] AID - 10.1007/s00296-017-3855-6 [pii] AID - 3855 [pii] AID - 10.1007/s00296-017-3855-6 [doi] PST - ppublish SO - Rheumatol Int. 2018 Apr;38(4):675-682. doi: 10.1007/s00296-017-3855-6. Epub 2017 Nov 9.