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Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions

Published on Apr 7, 2020in Arthritis Research & Therapy4.148
· DOI :10.1186/S13075-020-02171-6
Takahiko Sugihara13
Estimated H-index: 13
(Tokyo Medical and Dental University),
Hitoshi Hasegawa33
Estimated H-index: 33
(Ehime University)
+ 18 AuthorsNoriyoshi Ogawa21
Estimated H-index: 21
(Hamamatsu University)
Abstract
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 criteria, or large vessel lesions (LVLs) detected by imaging based on the modified classification criteria. Poor treatment outcomes (non-achievement of clinical remission by week 24 or relapse during 52 weeks) were evaluated. Clinical remission was defined as the absence of clinical signs and symptoms in cranial and large vessel areas, polymyalgia rheumatica (PMR), and elevation of C-reactive protein (CRP) levels. A patient was determined to have a relapse if he/she had either one of the signs and symptoms that newly appeared or worsened after achieving clinical remission. Re-elevation of CRP without clinical manifestations was considered as a relapse if other causes such as infection were excluded and the treatment was intensified. Associated factors with poor treatment outcomes were analyzed by using the Cox proportional hazard model. RESULTS: Cranial lesions, PMR, and LVLs were detected in 77.7%, 41.7%, and 52.5% of the enrolled patients, respectively. Treatment outcomes were evaluated in 119 newly diagnosed patients who were observed for 24 weeks or longer. The mean initial dose of prednisolone was 0.76 mg/kg/day, and 29.4% received any concomitant immunosuppressive drugs at baseline. Overall, 41 (34.5%) of the 119 patients had poor treatment outcomes; 13 did not achieve clinical remission by week 24, and 28 had a relapse after achieving clinical remission. Cumulative rates of the events of poor treatment outcomes in patients with and without LVLs were 47.5% and 17.7%, respectively. A multivariable model showed the presence of LVLs at baseline was significantly associated with poor treatment outcomes (adjusted hazard ratio [HR] 3.54, 95% CI 1.52-8.24, p = 0.003). Cranial lesions and PMR did not increase the risk of poor treatment outcomes. CONCLUSION: The initial treatment intensity in the treatment algorithm of GCA could be determined based upon the presence or absence of LVLs detected by imaging at baseline.
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References48
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#1Bernhard Hellmich (University of Tübingen)H-Index: 37
#2Ana Filipa ÁguedaH-Index: 5
Last. Raashid Luqmani (University of Oxford)H-Index: 54
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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
#1John H. Stone (Harvard University)H-Index: 72
#2Katie Tuckwell (Genentech)H-Index: 9
Last. Neil Collinson (Hoffmann-La Roche)H-Index: 19
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OBJECTIVE: To evaluate glucocorticoid doses and serological findings in patients with giant cell arteritis (GCA) flares. METHODS: Patients with GCA were randomly assigned to receive double-blind dosing with subcutaneous tocilizumab (TCZ) 162 mg weekly plus 26-week prednisone (TCZ-QW+Pred-26), every-other-week TCZ plus 26-week prednisone (TCZ-Q2W+Pred-26), placebo plus 26-week prednisone (PBO+Pred-26), or placebo plus 52-week prednisone (PBO+Pred-52). Outcomes were prednisone dose, C-reactive pro...
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#1Tanaz A. Kermani (UCLA: University of California, Los Angeles)H-Index: 18
#2Sehriban Diab (McMaster University)H-Index: 2
Last. Nader Khalidi (McMaster University)H-Index: 25
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Abstract Objectives To evaluate large-vessel (LV) abnormalities on serial imaging in patients with giant cell arteritis (GCA) and discern predictors of new lesions. Methods Clinical and imaging data from patients with GCA (including subjects diagnosed by LV imaging) enrolled in a prospective, multicenter, longitudinal study and/or a randomized clinical trial were included. New arterial lesions were defined as a lesion in a previously unaffected artery. Results The study included 187 patients wit...
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#1Francesco Muratore (University of Modena and Reggio Emilia)H-Index: 3
#2Tanaz A. Kermani (UCLA: University of California, Los Angeles)H-Index: 18
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#1Christian DejacoH-Index: 29
#2Sofia Ramiro (LUMC: Leiden University Medical Center)H-Index: 29
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To develop evidence-based recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV) including giant cell arteritis (GCA) and Takayasu arteritis (TAK). European League Against Rheumatism (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (PET) in LVV. Based on evidence and expe...
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#1Hubert de Boysson (UNICAEN: University of Caen Lower Normandy)H-Index: 14
#2Aurélie DaumasH-Index: 1
Last. Achille Aouba (UNICAEN: University of Caen Lower Normandy)H-Index: 23
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Abstract Objectives Large-vessel involvement (LVI) can occur in giant-cell arteritis (GCA) and may represent a distinct disease subgroup with a higher risk for aortic dilation. This study aimed to better characterize the presentation and evolution of LVI in patients with GCA. Patients and methods A retrospective multicenter study enrolled 248 GCA patients with LVI and 301 GCA patients without LVI on imaging. Factors associated with aortic dilation were identified in a multivariable model. Result...
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#1Peter C. GraysonH-Index: 18
#2Sara AlehashemiH-Index: 1
Last. Mark A. AhlmanH-Index: 16
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Objectives To assess the clinical value of 18F-flurodeoxyglucose (FDG) positron emission tomography (PET) in a prospective cohort of patients with large-vessel vasculitis (LVV) and disease comparators. Methods Patients with Takayasu's arteritis (TAK) and giant cell arteritis (GCA) were studied, along with a comparator group consisting of patients with hyperlipidemia, diseases that mimic LVV, and healthy controls. Participants underwent clinical evaluation and FDG-PET imaging, and patients with L...
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Objectives: To evaluate damage and variables associated with damage in GCA. Methods: Patients with GCA enrolled in a prospective, multicentre, longitudinal study were included. Per-protocol assessments were made with the Vasculitis Damage Index and the Large-Vessel Vasculitis Index of Damage. Results: The study included 204 patients: 156 women (76%), mean age at diagnosis 71.3 years (s.d. 8.3), mean follow-up of 3.5 years (s.d. 1.9). One or more damage item was present in 54% at baseline and 79%...
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