Prognostic impacts of glucocorticoid treatment in patients with polymyalgia rheumatica and giant cell arteritis

Abstract

Identifying comorbidities in polymyalgia rheumatica/giant cell arteritis (PMR/GCA) is crucial for patients’ outcomes. The present study aimed to evaluate the impact of the inflammatory process and glucocorticoid treatment on aortic arterial stiffness and body composition in PMR/GCA. 77 patients with newly diagnosed PMR/GCA were treated with oral glucocorticoids and followed for 40 weeks. Aortic pulse wave velocity (PWV) was measured at baseline and during the follow-up period and compared to the results of temporal artery biopsy (TAB) and 18F-FDG PET/CT. Body composition was assessed by total body DXA at baseline and the end of the study. Of 77 patients (49 (63.6%) female, mean of age: (71.8 ± 8.0)), 64 (83.1%) had pure PMR, 10 (13.0%) concomitant PMR and GCA, and 3 (3.9%) pure GCA. Compared to baseline values, aortic PWV was initially decreased at week 16 (p = 0.010) and remained lower than baseline at week 28 (p = 0.002) and week 40 (p < 0.001), with no association with results of TAB and 18F-FDG PET/CT. Aortic PWV was significantly associated with age, male gender, left systolic and diastolic blood pressure, right diastolic blood pressure, and CRP. Total bone mineral content (BMC) was decreased in both genders (p < 0.001), while fat mass (FM) was significantly increased (p < 0.001). However, lean body mass did not significantly change during the study. Changes in FM were correlated with cumulative prednisolone dose (rho: 0.26, p = 0.031). Glucocorticoid treatment of patients with PMR/GCA had several prognostic impacts. Arterial stiffness was decreased due either to the treatment or a reduction in the inflammatory load. Additionally, treatment led to changes in body composition, including a decrease in BMC and FM excess.

Association of clinical, imaging and laboratory parameters with adverse effects of glucocorticoid therapy in patients with giant cell arteritis

“…Therefore, initially, we expected an association between inflammatory markers and the emergence of glucocorticoid adverse effects ( 33 ). Similarly, other studies have demonstrated that aortic PWV decreases and aortic PWV is correlated with the percentage change in plasma CRP in patients with GCA and PMR under glucocorticoid therapy ( 34 , 35 ). Hafner et al ( 36 ) reported that glucocorticoid administration in patients with GCA had been associated with a reduction of carotid IMT.…”

Updates on the Prognosis of Giant Cell Arteritis: A Systematic Review

“…Our results included nine studies with 2600 patients diagnosed with GCA, most of which 1853 (71.3%) were females. Seven studies were conducted in France [ 15 - 21 ], three in the United States of America (USA) [ 22 - 24 ], one in Austria [ 25 ], and one in Denmark [ 26 ]. Nine of the included studies were retrospective [ 15 - 17 , 19 - 21 , 23 , 25 , 26 ], one was prospective [ 24 ], one was a case-control [ 18 ], and one was cross-sectional [ 22 ].…”

“…Serious complications, including aortic aneurysms or dissection, might result from aortitis in GCA [ 15 , 20 ]. Risk of bias assessment showed high risk in two studies [ 17 , 20 ], moderate risk in seven studies [ 15 , 16 , 18 , 22 , 24 - 26 ], and unclear risk in three studies [ 19 , 21 , 23 ].…”

The dichotomy of glucocorticosteroid treatment in immuneinflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice

“…Despite being anti-inflammatory and immunosuppressive drugs, their use is restrained by the fear of the occurrence of adverse effects (AEs). The therapeutic effects of GCs range from pain relief and disease-modifying effects in arthritides, such as rheumatoid arthritis (RA), to strong immunosuppressive actions in systemic autoimmune diseases such as systemic lupus erythematosus (SLE) or vasculitides [2,4,5].…”