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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)
Abstract
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)
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#1Marco A. AlbaH-Index: 14
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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...
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#1Ana García-Martínez (University of Barcelona)H-Index: 23
#2José Hernández-Rodríguez (University of Barcelona)H-Index: 33
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#1Carlo SalvaraniH-Index: 70
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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...
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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...
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