Martin N. Gerding

Development of a disease specific quality of life questionnaire for patients with Graves’ ophthalmopathy: the GO-QOL

AIM To develop a reliable and valid disease specific quality of life questionnaire (the GO-QOL) for patients with Graves’ ophthalmopathy (GO), that can be used to describe the health related quality of life and changes in health related quality of life over time as a consequence of disease and treatment. METHODS 70 consecutive GO patients (age >18 years) who were referred for the first time to the combined outpatient clinic of the orbital centre and the department of endocrinology completed the 16 questions of the GO-QOL. Additional information on general quality of life and disease characteristics was obtained. Construct validity and internal consistency of the disease specific questionnaire was determined, based on principal component analysis, Cronbach alphas and correlations with MOS-24, three subscales of the SIP, demographic, and clinical measures. RESULTS The a priori expected subdivision of the questionnaire in two subscales, one measuring the consequences of double vision and decreased visual acuity on visual functioning, and one measuring the psychosocial consequences of a changed appearance, was confirmed in the principal component analysis. Both scales had a good reliability and high face validity. Correlations with other measures supported construct validity. Mean scores (range 0–100) were 54.7 (SD 22.8) for visual functioning and 60.1 (24.8) for appearance (higher score = better health). CONCLUSION The GO-QOL is a promising tool to measure disease specific aspects of quality of life in patients with GO and provides additional information to traditional physiological or biological measures of health status.

Smoking and disease severity are independent determinants of serum adhesion molecule levels in Graves’ ophthalmopathy

Adhesion molecules play a key role in autoimmune disorders, and serum concentrations of soluble adhesion molecules are increased in Graves’ ophthalmopathy (GO). Whether this is due to the strong association with smoking is unknown. It is also not known if the severity or activity of GO determine the serum levels of adhesion molecules. We measured serum concentrations of sICAM‐1, sVCAM‐1 and sELAM‐1 in 62 euthyroid Graves’ patients with untreated GO, in 62 healthy controls matched for sex, age and smoking habits, and in 26 euthyroid Graves’ patients without GO. GO severity was assessed by the Total Eye Score and the activity by the Clinical Activity Score. Adhesion molecules were measured by highly sensitive ELISAs. GO patients had higher levels than controls (median values in ng/ml with range): sICAM‐1 300 [171–575] versus 244 [119–674], P < 0·001; sVCAM‐1 457 [317–1060] versus 410 [238–562], P < 0·001; and sELAM‐1 61 [19–174] versus 53 [23–118], P = 0·021. Euthyroid Graves’ disease patients without GO had levels similar to controls: sICAM‐1 273 138–453), sVCAM‐1 386 [260–1041] and sELAM‐1 46 [22–118]. Smoking had an independent effect and was associated with higher levels of sICAM‐1 and lower levels of sVCAM‐1 in both GO patients and controls; sELAM‐1 levels were comparable. In the 62 GO patients, sICAM‐1 correlated significantly with severity of eye disease (r = 0·40, P = 0·002). No correlation was found with the duration of GO, the Clinical Activity Score or TBII levels. Multivariate analysis of all 150 subjects showed that the presence of GO and smoking are independent determinants of sICAM‐1 and sVCAM‐1 concentrations. In GO patients, the Total Eye Score was a stronger determinant than smoking. It is concluded that (i) smoking is associated with increased sICAM‐1 and decreased sVCAM‐1 levels; (ii) independent from smoking, euthyroid GO patients have higher levels of sICAM‐1, sVCAM‐1 and sELAM‐1 than patients with euthyroid Graves’ disease or healthy controls; (iii) the major determinant of sICAM‐1 in GO patients is the severity of their eye disease.