Presentation and Management of Giant Cell Arteritis in a Real-World Setting (Artemis Study)

Alfred Mahr¹, Eric Hachulla ², Hubert de BOYSSON ³, Nassim Guerroui ⁴, Emmanuel Héron ⁵, Stéphane Vinzio ⁶, Jonathan Broner ⁷, François-Xavier Lapebie ⁸, Martin Michaud ⁹, Laurent Sailler ⁸, Thierry Zenone ¹⁰, Mohamed Djerad ¹¹, Mathieu Jouvray ¹², Emilie Shipley ¹³, Nathalie Tieulie ¹⁴, Isabelle Idier ¹⁵, Marc Paccalin ¹⁶ and Valérie Devauchelle Pensec ¹⁷, ¹Hospital Saint-Louis, University Paris Diderot, Paris, France, ²Dept. of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, University of Lille, Lille, France, Lille, France, ³University Hospital of Caen, Caen, France, ⁴European Hospital of Marseille, Marseille, France, ⁵Quinze-Vingt Hospital, Paris, France, ⁶GHM Grenoble, Grenoble, France, ⁷University Hospital of Nîmes, Nîmes, France, ⁸University Hospital of Toulouse, Toulouse, France, ⁹Joseph Ducuing Hospital, Toulouse, France, ¹⁰Hospital of Valence, Valence, France, ¹¹Hospital of Nevers, Nevers, France, ¹²Hospital of Arras, Arras, France, ¹³Hospital of Dax, Dax, France, ¹⁴University Hospital of Nice, Nice, France, ¹⁵Chugai Pharma France, Paris La Défense, France, ¹⁶University Hospital of Poitiers, Poitiers, France, ¹⁷University Hospital of Brest, Brest, France

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: diagnosis and medical management, giant cell arteritis, large vessel vasculitis

Session Information

Date: Tuesday, November 12, 2019

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster III: Giant Cell Arteritis

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: We have few real-world data on the natural history and care of patients with giant cell arteritis (GCA). The objective of this observational study (ARTEMIS) was to describe the characteristics and care of patients with GCA in real-life settings in France.

Methods: This cross-sectional, non-interventional, multicentre, single-visit survey was conducted among hospital-based physicians specialized in internal medicine or rheumatology. Investigators enrolled consecutive patients ≥50 years old who consulted for GCA and were under treatment. Information on patient characteristics and diagnostic journey, diagnostic methods and specific GCA treatments were collected on an electronic case report form. Newly-diagnosed GCA was defined as diagnosis-to-visit interval < 6 weeks. Descriptive statistics were used for quantitative and qualitative data.

Results: Over the 3-month inclusion period (August–November 2018), 306 patients were recruited (females: 67%, mean age: 74.0±7.9 years) by 69 investigators (internists: 85%, rheumatologists: 15%) and 53 hospital departments; 13% had newly-diagnosed GCA and overall mean follow-up was 21.0±26.4 months. The original referral of patients to specialized centres was from general practitioners (56%), ophthalmologists (10%), neurologists (7%), emergency physicians (5.6%), internists (4%) and rheumatologists (5%). The most common medical histories were hypertension (46%), psychiatric disorders (10%), dyslipidemia (12%), diabetes (9%) and osteoporosis (6%). Initial GCA presentations included cranial symptoms (89% of patients), constitutional symptoms (74%), polymyalgia rheumatica (48%), and other extra-cranial manifestations (35%). Temporal artery biopsy, high-resolution temporal artery Doppler, 18FDG-PET and aortic angio-CT were performed for 85%, 31%, 26% and 30% of patients, respectively, and contributed to the GCA diagnosis for 67%, 53%, 70% and 37%. All patients received glucocorticoids (GCs) and GC therapy was ongoing for 89%. The mean total cumulative oral GC dose, assessed for 87 patients, was 5179±4987 mg. In all, 87 (28%) patients also received ≥1 adjunctive medication, mainly methotrexate (58 patients [19%]) and/or tocilizumab (47 patients [15%]). Overall, 40% of patients had ≥1 relapse (mean number of relapses: 1.7±1.0) after a mean time to a first relapse of 13.3±12.8 months. Thirty-seven percent had ≥1 comorbidity related to or aggravated by GCs, most frequently diabetes (12%), hypertension (10%), osteopenia/osteoporosis/osteoporotic fractures (7%), insomnia (3%) and infections (3%).

Conclusion: This observational, cross-sectional study of a large number of recently diagnosed patients provides insight into current medical practices for GCA in France. Despite extensive use of large-vessel imaging, the proportion of patients with a diagnosis of non-cranial GCA is low (11%). The substantial proportion of patients with relapsing disease results in high cumulative doses of GCs. Methotrexate and tocilizumab were the most commonly prescribed adjunct medications.

Disclosure: A. Mahr, Celgene, 8, Chugai Pharma France, 8, Roche, 8, Roche, Chugai, 8; E. Hachulla, Actelion, 2, 5, Bayer, 2, 5, Chugai Pharma France, 8, GSK, 2, 5, Pfizer, 2, 5, Roche SAS, 5; H. de BOYSSON, Chugai Pharma France, 5, Roche Chugai, 2, 5; N. Guerroui, None; E. Héron, None; S. Vinzio, None; J. Broner, None; F. Lapebie, None; M. Michaud, None; L. Sailler, None; T. Zenone, None; M. Djerad, None; M. Jouvray, None; E. Shipley, None; N. Tieulie, None; I. Idier, Chugai Pharma France, 3; M. Paccalin, Chugai Pharma France, 8; V. Devauchelle Pensec, Bristol_myers Squibb, 2, CHUGAI, 2, Chugai Pharma France, 8, Roche, 2.

To cite this abstract in AMA style:

Mahr A, Hachulla E, de BOYSSON H, Guerroui N, Héron E, Vinzio S, Broner J, Lapebie F, Michaud M, Sailler L, Zenone T, Djerad M, Jouvray M, Shipley E, Tieulie N, Idier I, Paccalin M, Devauchelle Pensec V. Presentation and Management of Giant Cell Arteritis in a Real-World Setting (Artemis Study) [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/presentation-and-management-of-giant-cell-arteritis-in-a-real-world-setting-artemis-study/. Accessed .

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