A Dutch consensus statement on the diagnosis and treatment of ANC A-associated vasculitis

E. Dirikgil, S. W. Tas, A. Rutgers, P. M. J. Verhoeven, J. M. van Laar, E. C. Hagen, J. Tekstra, A. E. L. Hak, P. van Paassen, M. R. Kok, R. Goldschmeding, B. van Dam, C. E. Douma, H. H. F. Remmelts, J. F. Sanders, J. T. Jonker, T. J. Rabelink, J. G. M. C. Damoiseaux, H. J. Bernelot Moens, W. J. W. BosY. K. O. Teng*, Arthritis Research & Collaboration Hub consortium

*Corresponding author for this work

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Abstract

Introduction: Despite the availability of several guidelines on the diagnosis and treatment of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), clinical routine practice will only improve when an implementation strategy is in place to support clinical decision making and adequate implementation of guidelines. We describe here an initiative to establish national and multidisciplinary consensus on broad aspects of the diagnosis and treatment of AAV relevant to daily clinical practice in the Netherlands.

Methods: A multidisciplinary working group of physicians in the Netherlands with expertise on AAV addressed the broad spectrum of diagnosis, terminology, and immunosuppressive and non-immunosuppressive treatment, including an algorithm for AAV patients. Based on recommendations from (inter)national guidelines, national consensus was established using a Delphi-based method during a conference in conjunction with a nationally distributed online consensus survey. Cut-off for consensus was 70% (dis)agreement.

Results: Ninety-eight professionals were involved in the Delphi procedure to assess consensus on 5o statements regarding diagnosis, treatment, and organisation of care for AAV patients. Consensus was achieved for 37/50 statements (74%) in different domains of diagnosis and treatment of AAV including consensus on the treatment algorithm for AAV.

Conclusion: We present a national, multidisciplinary consensus on a diagnostic strategy and treatment algorithm for AAV patients as part of the implementation of (inter)national guideline-derived recommendations in the Netherlands. Future studies will focus on evaluating local implementation of treatment protocols for AAV, and assessments of current and future clinical practice variation in the care for AAV patients in the Netherlands.

Original languageEnglish
Pages (from-to)71-82
Number of pages12
JournalNetherlands Journal of Medicine
Volume78
Issue number2
Publication statusPublished - Mar 2020

Keywords

  • ANCA-associated vasculitis
  • pauci-immune glomerulonephritis
  • recommendations
  • PNEUMOCYSTIS-CARINII-PNEUMONIA
  • ANTIBODY-ASSOCIATED VASCULITIS
  • ANTINEUTROPHIL CYTOPLASM ANTIBODY
  • AZATHIOPRINE MAINTENANCE THERAPY
  • DAILY ORAL CYCLOPHOSPHAMIDE
  • NATIVE KIDNEY BIOPSY
  • RANDOMIZED-TRIAL
  • MICROSCOPIC POLYANGIITIS
  • INTERNATIONAL CONSENSUS
  • WEGENERS-GRANULOMATOSIS

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