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Severity and determinants of psychosocial comorbidities in granulomatosis with polyangiitis and their impact on quality of life

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Abstract

Depression, anxiety, sleep disturbances, and fatigue are inadequately addressed comorbidities in granulomatosis with polyangiitis (GPA). We determined the prevalence, severity, determinants, and the impact of these comorbidities on quality-of-life (QoL) in GPA. This observational study included adult GPA patients; patients with RA and lupus were included as comparators. Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder 7-item scale for anxiety, Epworth Sleepiness Scale for sleep disturbances, and Fatigue Severity Scale for fatigue were administered prospectively to estimate prevalence and severity. QoL and disability were estimated using PROMIS-HAQ, HAQ-health and HAQ-pain. Correlations among these parameters were assessed. Stepwise regression analyses were performed to identify determinants of depression, anxiety, excessive sleepiness, and fatigue. One hundred eighty-one patients—62 GPA [mean age 43 (13) years], 57 RA and 62 SLE- were included. The prevalence of depression (47%), excessive sleepiness (21%), and fatigue (39%) in GPA were comparable to RA and lupus; anxiety was less prevalent (29% versus 46% and 53%, p = 0.02). Severity was mostly mild-moderate. Younger age [OR = 0.93 (0.89–0.98)], higher BMI [OR = 1.2 (1.0–1.4)], and greater disease damage [OR = 2.0 (1.3–3.3)] independently predicted presence of depression. Higher BMI [OR = 1.3 (1.1–1.5)] and concomitant FMS [OR = 80.9 (5.1–1289.2)] were independently associated with excessive sleepiness. No association with disease activity, duration, or gender was seen. GPA patients with depression, anxiety, excessive sleepiness, and fatigue had worse PROMIS-HAQ, HAQ-pain, and HAQ-health. In conclusion, depression, anxiety, sleep disturbances, and fatigue are common in GPA. Although their severity is mostly mild-moderate, they impair QoL significantly. Potentially modifiable determinants that can form targets for future interventions have been identified.

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Acknowledgements

A part of the study results were presented in abstract form at the EULAR annual conference in 2019 (Sharma A, Shrivastava A, Grover S, et al. AB0615 Prevalence of depression, anxiety, fatigue and sleep disturbances in patients of RA, SLE AND GPA. Ann Rheum Dis. 2019;78:1768. 1.0.11.36/annrheumdis-2019-eular.4062).

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

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Author notes

  1. Abhinav Shrivastava and Siddharth Jain have contributed equally to the manuscript as first authors.

Authors and Affiliations

  1. Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Abhinav Shrivastava, Siddharth Jain, Vikram Damaraju, G. S. R. S. N. K. Naidu, Varun Dhir, Sanjay Jain & Aman Sharma

  2. Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manish Rathi

  3. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Sandeep Grover

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  1. Abhinav Shrivastava
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Contributions

All authors met the four authorship criteria recommended by the ICMJE [namely (i) substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (ii) drafting the work or revising it critically for important intellectual content; AND (iii) final approval of the version to be published; AND (iv) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved). The individual author contributions are as follows: AmS and SG conceptualized the study. AbS, SiJ and ViD collected, analyzed and interpreted the data. SiJ and AmS drafted the manuscript. GN, VaD, MR, SG and SaJ provided critical, intellectual inputs on the same. All co-authors approved the final submitted version of the manuscript and take full responsibility for all aspects of the work.

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Correspondence to Aman Sharma.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee (IEC) of Postgraduate Institute of Medical Education and Research, Chandigarh, India (INT/IEC/2017/525, dated 3rd May 2017).

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Shrivastava, A., Jain, S., Damaraju, V. et al. Severity and determinants of psychosocial comorbidities in granulomatosis with polyangiitis and their impact on quality of life. Rheumatol Int 43, 1467–1477 (2023). https://doi.org/10.1007/s00296-023-05341-2

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