Relapses in Patients With Giant Cell Arteritis

Abstract

Giant cell arteritis (GCA) is a relapsing disease. However, the nature, chronology, therapeutic impact, and clinical consequences of relapses have been scarcely addressed. We conducted the present study to investigate the prevalence, timing, and characteristics of relapses in patients with GCA and to analyze whether a relapsing course is associated with disease-related complications, increased glucocorticoid (GC) doses, and GC-related adverse effects. The study cohort included 106 patients, longitudinally followed by the authors for 7.8 ± 3.3 years. Relapses were defined as reappearance of disease-related symptoms requiring treatment adjustment. Relapses were classified into 4 categories: polymyalgia rheumatica (PMR), cranial symptoms (including ischemic complications), systemic disease, or symptomatic large vessel involvement. Cumulated GC dose during the first year of treatment, time required to achieve a maintenance prednisone dose <10 mg/d (T10), <5 mg/d (T5), or complete prednisone discontinuation (T0), and GC-related side effects were recorded. Sixty-eight patients (64%) experienced at least 1 relapse, and 38 (36%) experienced 2 or more. First relapse consisted of PMR in 51%, cranial symptoms in 31%, and systemic complaints in 18%. Relapses appeared predominantly, but not exclusively, within the first 2 years of treatment, and only 1 patient developed visual loss. T10, T5, and T0 were significantly longer in patients with relapses than in patients without relapse (median, 40 vs 27 wk, p < 0.0001; 163 vs 89.5 wk, p = 0.004; and 340 vs 190 wk, p = 0.001, respectively). Cumulated prednisone dose during the first year was significantly higher in relapsing patients (6.2 ± 1.7 g vs 5.4 ± 0.78 g, p = 0.015). Osteoporosis was more common in patients with relapses compared to those without (65% vs 32%, p = 0.001). In conclusion, the results of the present study provide evidence that a relapsing course is associated with higher and prolonged GC requirements and a higher frequency of osteoporosis in GCA.

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

“…In clinical trials, 12–22% subjects developed ischemic symptoms 9,13 while in a retrospective study, 13% (7 of 54 patients) experienced symptomatic vascular complications 7 . In a prospective cohort of 106 patients with biopsy-positive GCA, only 1 patient developed new visual changes while none developed manifestations of large-vessel involvement during relapses 9 . The observation in our study may have to do with the inclusion of patients with large-artery manifestations from GCA.…”

“…In retrospective studies, at least 1 disease relapse was reported in 28% to 62% of patients 2,3,5,7,8 . Of the 3 prospective observational studies to date evaluating relapses in GCA, relapses were reported in 36% (21 of 58), 60% (15 of 25), and 68% (68 of 106) of patients 4,6,9 . The current study includes a large prospective cohort of patients with GCA with standardized assessments at regular intervals including comprehensive information on symptoms at relapse.…”

“…The current study includes a large prospective cohort of patients with GCA with standardized assessments at regular intervals including comprehensive information on symptoms at relapse. In contrast to a recent prospective study where only patients with biopsy-positive GCA were included 9 , our cohort also included patients with imaging findings of large-artery stenosis from GCA.…”

“…While symptoms respond to therapy, relapses are common 2,3,4,5,6,7,8,9 . Further, in a single autopsy series, nearly all patients with GCA were noted to have changes of active arteritis even though the disease was thought to be clinically quiescent 10 .…”

Is vascular endothelial growth factor a useful biomarker in giant cell arteritis?

“…Despite early treatment with high-dose glucocorticoids, 34-79% relapse. [31][32][33][34] We cannot predict which patients are likely to relapse; identification of relapse is complicated by presentation with non-specific symptoms coupled with normal laboratory tests in up to 20%. 32 It is possible that VEGF may be a useful marker for the identification of relapsing patients, and this should be tested in future studies.…”