Abstract: SA-PO641
Chorioretinal Thickness Reflects Disease Activity in ANCA-Associated Vasculitis
Session Information
- Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Author
- Farrah, Tariq E., University of Edinburgh, Edinburgh, United Kingdom
Background
ANCA-associated vasculitis (AAV) is characterised by autoimmune-mediated injury of small blood vessels and often requires renal biopsy for diagnosis. A non-invasive means of detecting this microvascular injury would be of major clinical value. The eye acts as a window to the systemic microvasculature. Retinal optical coherence tomography (OCT) provides cross-sectional imaging of the retina and highly vascularized choroid with near-histological resolution. We have shown that systemic and renal inflammation associates with choroidal thinning. We hypothesized that OCT metrics would reflect disease activity in AAV and be modified with treatment.
Methods
We prospectively recruited 50 patients with active AAV and 50 age-and sex-matched healthy controls, excluding those with diabetes and previous eye disease. AAV patients were studied prior to receiving immunosuppression and once in disease remission, defined by a Birmingham Vasculitis Activity Score (BVAS) of 0 for a least 2 months on low dose steroid. All subjects were imaged with the Heidelberg SPECTRALIS® OCT device. Choroidal thickness was measured blinded at three locations: 2mm nasal to fovea (location I), subfoveal (location II) and 2mm temporal to the fovea (location III), Figure 1.
Results
AAV patients had a mean (±SD) age of 60±14 years, 20 (50%) were male and 24 (60%) were PR3+. Median (range) BVAS at entry was 13 (3-21). 30 (75%) patients were new presentations and 26 (65%) had renal involvement. Mean (±SD) choroidal thickness was thinner in active AAV patients compared to health: location I 202±84 vs. 248±76mm; location II 279±90 vs. 331±69mm; location III 276±90 vs. 309±65mm; all p<0.05. Choroidal thickness correlated negatively with baseline BVAS, r=0.57, p<0.05. Following disease remission, choroidal thickness increased by ~10% compared to active disease, p<0.01 at all locations, Figure 1.
Conclusion
Active AAV is associated with choroidal thinning compared to health. This improves with successful treatment. OCT-derived metrics may be a novel means of assessing disease activity and treatment response in AAV. Larger studies will explore these findings further.