SNOT-22 questionnaire predicts ANCA-associated vasculitis relapse risk up to 2 years
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Key takeaways:
- Higher SNOT-22 scores were reported “months to years” prior to ANCA-associated vasculitis relapse.
- The questionnaire score could be useful in selective escalation or de-escalation of therapy.
Higher scores on a measure of sinonasal symptoms can predict ANCA-associated vasculitis relapse “months to years” ahead of time, according data published in Arthritis Care & Research.
The 22-item Sinonasal Outcome Test (SNOT-22) could enhance prediction of relapse among high-risk patients and may be useful in selectively escalating or de-escalating immunosuppressive therapy, Ellen Romich, MD, of the University of Pennsylvania, and colleagues wrote.
“Sinonasal symptoms are common in ANCA-associated vasculitis (AAV) and can negatively impact quality of life, but it can be challenging to measure sinonasal symptoms and their impact in clinical care,” Romich told Healio. “This work was prompted by a need for improved ways to assess sinonasal symptoms in AAV.”
To examine the relationship between sinonasal symptoms and disease activity, Romich and colleagues applied the SNOT-22 test, used previously in the management of chronic rhinosinusitis, to AAV. Their prospective, longitudinal study recruited patients through the Penn Vasculitis Center at the University of Pennsylvania, in Philadelphia, and tracked changes in SNOT-22 scores over time. The researchers then observed how participants’ scores correlated with AAV disease activity.
The SNOT-22 questionnaire was completed across 773 study visits by 168 patients with AAV, as well as 51 healthy controls. The relationships between questionnaire score at first remission visit and subsequent relapse risk over 2 years were evaluated using Cox proportional hazard models.
The group with AAV (mean age, 55 years; 58% women) included 107 patients with granulomatosis with polyangiitis (GPA) and 40 with eosinophilic GPA. Twenty-one cases of microscopic polyangiitis (MPA) were also included “as disease comparators, since MPA typically does not involve the sinonasal cavity,” the researchers wrote. The control patients did not have systemic vasculitis, other inflammatory disorders, allergic rhinitis or nasal polyps.
According to the researchers, among all patients with AAV, but particularly those with PGA, higher SNOT-22 scores were reported “months to years” prior to relapse, and were associated with an elevated risk for relapse (HR = 2.7; 95% CI, 1.2-6.2). Similar findings were observed among patients with — vs. without — sinonasal disease, as well as after removing relapses limited to the ear, nose and throat.
“We also found that higher SNOT-22 scores in the rhinologic domain were associated with increased risk of relapse, even among patients without known sinonasal disease,” Romich said. “This suggests that subtle sinonasal involvement may go unrecognized but could still play an important role in relapse, though additional studies are needed to confirm our findings.”
She added that further studies are needed to understand how SNOT-22 scores change with treatment and what score thresholds are important clinically for predicting disease.
“Overall, we think SNOT-22 is a promising tool for improving our ability to measure patient-reported sinonasal symptoms,” Romich said. “More work is still needed to validate our findings in other cohorts and determine optimal thresholds before the SNOT-22 is ready for use in clinical practice.”
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