Disease Relapses among Patients with Giant Cell Arteritis: A Prospective, Longitudinal Cohort Study

Published on Apr 15, 2015in The Journal of Rheumatology3.634
· DOI :10.3899/jrheum.141347
Tanaz A. Kermani18
Estimated H-index: 18
(Mayo Clinic),
Kenneth J. Warrington33
Estimated H-index: 33
(Mayo Clinic)
+ 11 AuthorsSteven R. Ytterberg40
Estimated H-index: 40
(Johns Hopkins University)
Objective. To evaluate the frequency, timing, and clinical features of relapses in giant cell arteritis (GCA). Methods. Patients with GCA enrolled in a prospective, multicenter, longitudinal study were included in the analysis. Relapse was defined as either new disease activity after a period of remission or worsening disease activity. Results. The study included 128 subjects: 102 women (80%) and 26 men (20%). Mean ± SD age at diagnosis of GCA was 69.9 ± 8.6 years. Mean followup for the cohort was 21.4 ± 13.9 months. Median (interquartile range) duration of disease at study enrollment was 4.6 months (1.2, 16.8). During followup, 59 relapses were observed in 44 patients (34%). Ten patients (8%) experienced 2 or more relapses. The most common symptoms at relapse were headache (42%) and polymyalgia rheumatica (51%), but ischemic (some transient) manifestations (visual symptoms, tongue or jaw claudication, and/or limb claudication) occurred in 29% of relapses (12% cohort). Forty-three relapses (73%) occurred while patients were taking glucocorticoid therapy at a median (range) prednisone dose of 7.5 (0–35) mg. In 21% of relapses, both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal. Among 69 patients enrolled in the cohort with newly diagnosed disease, 24% experienced a first relapse within 12 months after diagnosis. Conclusion. Among patients with GCA, relapses are common, often occurring during treatment. ESR and CRP are frequently normal at times of clinical relapse, highlighting the need for better biomarkers to assess disease activity in GCA. There remains a need for effective therapeutic alternatives to glucocorticoids in GCA.
  • References (20)
  • Citations (47)
📖 Papers frequently viewed together
351 Citations
10 Authors (Marco A. Alba, ..., Maria C. Cid)
59 Citations
188 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Marco A. AlbaH-Index: 14
Last. Maria C. CidH-Index: 52
view all 10 authors...
59 CitationsSource
Last. Miguel A. GonzH-Index: 73
view all 10 authors...
Abstract We conducted the present study to determine the incidence of disease flares (relapses and recurrences) in a series of patients with biopsy-proven giant cell arteritis (GCA). We assessed a series of 174 patients who were diagnosed with biopsy-proven GCA, uniformly treated, and followed at the rheumatology division of Hospital Xeral-Calde (Lugo, Spain), the single rheumatology division for a well-defined population. All of them were followed for at least 1 year after the disease diagnosis...
68 CitationsSource
#1Ana García-Martínez (University of Barcelona)H-Index: 23
#2José Hernández-Rodríguez (University of Barcelona)H-Index: 33
Last. Maria C. Cid (University of Barcelona)H-Index: 52
view all 8 authors...
Objective To assess the clinical relevance of increased circulating cytokines in patients with giant cell arteritis (GCA) after long-term followup. Methods We performed a cross-sectional evaluation of 54 patients with biopsy-proven GCA prospectively followed for a median of 5.4 years (range 4–10.5 years). GCA-related complications, vascular events, relapses, current prednisone dose, time required to achieve a maintenance prednisone dosage <10 mg/day, cumulated prednisone at that point, and adver...
55 CitationsSource
86 CitationsSource
#1Carlo SalvaraniH-Index: 70
#2Fabrizio CantiniH-Index: 45
Last. Gene G. Hunder (Mayo Clinic)H-Index: 77
view all 3 authors...
Polymyalgia rheumatica and giant-cell arteritis are closely related disorders that affect people of middle age and older. They frequently occur together. Both are syndromes of unknown cause, but genetic and environmental factors might have a role in their pathogenesis. The symptoms of polymyalgia rheumatica seem to be related to synovitis of proximal joints and extra-articular synovial structures. Giant-cell arteritis primarily affects the aorta and its extracranial branches. The clinical findin...
377 CitationsSource
Objective. Giant cell arteritis (GCA) has a variable course. We assessed whether intensity of initial systemic in- fl ammatory response (ISIR) can predict the course of GCA. Methods. Charts of 130 GCA patients were reviewed. ISIR intensity at presen- tation was determined by 5 parameters of infl ammation: sedimentation rate >100mm/h, thrombocytosis >400,000/ μl, hemoglobin 11000/μl, and fever >37.5 μl, and fever >37.5 μ o C. Patients were divided into 3 groups according to ISIR intensity: strong...
18 Citations
Objective: Open label studies have suggested that tumour necrosis factor (TNF) antagonists led to sustained improvement and corticosteroid sparing effect in patients with giant cell arteritis (GCA). To confirm these observations, we conducted a randomised, double-blind, placebo controlled trial with etanercept in patients with biopsy-proven GCA with side effects secondary to corticosteroids. Methods: We randomly assigned patients with GCA to receive etanercept (n = 8) or placebo (n = 9) over 1 y...
206 CitationsSource
#1Alfred Mahr (BU: Boston University)H-Index: 56
#2Juan Ángel Jover (Hospital Clínico San Carlos)H-Index: 17
Last. Peter A. Merkel (BU: Boston University)H-Index: 67
view all 7 authors...
Objective To reevaluate the efficacy and safety of adjunctive low-dose methotrexate (MTX) in giant cell arteritis (GCA). Methods An individual patient data meta-analysis of 3 randomized placebo-controlled trials in patients with newly diagnosed GCA was performed. Treatment consisted of initial high-dose corticosteroids and randomly assigned oral MTX therapy (7.5–15 mg/week) or placebo. Time-to-event outcomes were compared between groups using Cox proportional hazards models stratified by trial, ...
319 CitationsSource
#1Gary S. Hoffman (Cleveland Clinic)H-Index: 61
#2Maria C. Cid (University of Barcelona)H-Index: 52
Last. Mahboob RahmanH-Index: 57
view all 10 authors...
383 CitationsSource
#1Colin ChanH-Index: 15
#2Mark PaineH-Index: 20
Last. Justin O'DayH-Index: 16
view all 3 authors...
Background: The competing interests of preventing recurrent ischemic optic neuropathy (ION) and minimizing medication side effects make corticosteroid dose reduction in giant cell arteritis (GCA) a difficult problem. The authors sought to determine whether any factors were predictive of recurrent ION. Methods: Retrospective review of the records of 100 consecutive patients with biopsy-proven giant cell arteritis diagnosed in two Australian hospitals between 1988 and 1998. Among 67 patients who m...
20 CitationsSource
Cited By47
Abstract Objective To evaluate characteristics and predictors of relapses and long-term remission in an Italian cohort of patients with large-vessel (LV) giant cell arteritis (GCA). Methods We evaluated 87 consecutive patients with LV-GCA followed up at the Rheumatology Unit of Reggio Emilia Hospital (Italy) for at least 2 years. Patients with relapses and long-term remission were compared to those without. A group of 34 patients with biopsy proven GCA without LV vasculitis (LVV) at diagnosis wa...
#1Rona M. Smith (University of Cambridge)H-Index: 12
#2David Jayne (University of Cambridge)H-Index: 80
#1Takahiko Sugihara (Tokyo Medical and Dental University)H-Index: 13
#2Hitoshi Hasegawa (Ehime University)H-Index: 34
Last. Noriyoshi Ogawa (Hamamatsu University)H-Index: 13
view all 21 authors...
BACKGROUND: Relapses frequently occur in giant cell arteritis (GCA), and long-term glucocorticoid therapy is required. The identification of associated factors with poor treatment outcomes is important to decide the treatment algorithm of GCA. METHODS: We enrolled 139 newly diagnosed GCA patients treated with glucocorticoids between 2007 and 2014 in a retrospective, multi-center registry. Patients were diagnosed with temporal artery biopsy, 1990 American College of Rheumatology classification cr...
#1Susan P. Mollan (University Hospitals Birmingham NHS Foundation Trust)H-Index: 12
#1Susan P Mollan (University Hospitals Birmingham NHS Foundation Trust)H-Index: 3
Last. Alexandra J. Sinclair (HealthPartners)H-Index: 17
view all 5 authors...
BACKGROUND AND AIM: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. METHODS: The...
#1Lena Horvath (University of Tübingen)
#2Bernhard Hellmich (University of Tübingen)H-Index: 35
Patienten mit unbehandelter aktiver Riesenzellarteriitis sind durch das Risiko eines permanenten Visusverlusts akut gefahrdet, sodass umgehend eine Therapie mit Glukokortikoiden in einer Initialdosis von 40–60 mg Prednisolonaquivalent pro Tag begonnen werden sollte. Sobald eine Remission eingetreten ist, sollte die Prednisolon-Dosis innerhalb von 2 bis 3 Monaten auf 15–20 mg und danach innerhalb 1 Jahres auf ≤5 mg pro Tag reduziert werden. Bei Patienten mit erhohtem Risiko fur oder bereits beste...
#1Stina W Borresen (UCPH: University of Copenhagen)
#2Toke Bjørk Thorgrimsen (Copenhagen University Hospital)
Last. Henning Locht (Copenhagen University Hospital)H-Index: 17
view all 7 authors...
OBJECTIVES: Glucocorticoid treatment is fundamental in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), but carries a risk of glucocorticoid-induced adrenal insufficiency. Adrenal insufficiency can cause reluctance to stop glucocorticoid treatment after disease remission as symptoms can resemble PMR/GCA flare. We aimed to determine the prevalence of adrenal insufficiency in prednisolone-treated patients with PMR/GCA. METHODS: We included 47 patients with PMR (n = 37), GCA (n = 1) or ...
#1M. VautierH-Index: 4
#2Axelle Dupont (Paris Diderot University)H-Index: 1
Last. Patrice CacoubH-Index: 72
view all 12 authors...
Abstract Objectives To assess prognosis factors and outcome of large vessel involvement (LVI) in large vessels vasculitis (LVV) patients. Methods Retrospective multicenter study of characteristics and outcomes of 417 patients with LVI including 299 Takayasu arteritis (TAK) and 118 Giant cell arteritis (GCA-LVI) were analyzed. Logistic regression analysis assessed prognosis factors in LVV patients. Outcome of LVI among TAK and GCA-LVI patients (ischemic complications, aneurysms complications, rel...
#1A. Dumont (UNICAEN: University of Caen Lower Normandy)H-Index: 3
#2Jean-Jacques Parienti (UNICAEN: University of Caen Lower Normandy)H-Index: 26
Last. Hubert de Boysson (UNICAEN: University of Caen Lower Normandy)H-Index: 12
view all 10 authors...
Objective To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant-cell arteritis (GCA). Methods We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses. Results The 326 patients (73% women) were followed up for 62 [12—262] months. During follow-up, 171 (52%) patients relapsed, including 113 (35%) who d...
6 CitationsSource
#2Kaitlin QuinnH-Index: 2
Last. Peter C. GraysonH-Index: 16
view all 9 authors...
Objective Disease activity in large-vessel vasculitis (LVV) is traditionally assessed by clinical and serological parameters rather than vascular imaging. This study determined the effect of treatment on 18F-fluorodeoxyglose positron emission tomography (FDG-PET) vascular activity in relationship to clinical and serologic-based assessments. Methods Patients with giant cell arteritis (GCA) or Takayasu’s arteritis (TAK) were prospectively evaluated at 6-month intervals in an observational cohort. ...
6 CitationsSource
#1Bernhard Hellmich (University of Tübingen)H-Index: 35
#2Ana Filipa ÁguedaH-Index: 3
Last. Raashid Luqmani (University of Oxford)H-Index: 53
view all 26 authors...
Background Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations. Methods Using EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systemati...
48 CitationsSource