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Abstract Number: 1969

Can We Predict the Relapse of Giant Cell Arteritis?

Alojzija Hocevar, Rok Ješe, Ziga Rotar, Sonja Praprotnik, Matija Tomšič and Saša Čučnik, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: giant cell arteritis, therapy and vasculitis

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Session Information

Date: Monday, November 9, 2015

Title: Vasculitis Poster II

Session Type: ACR Poster Session B

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

Background/Purpose:

Relapses during glucocorticoid (GC) tapering are frequent in giant cell arteritis (GCA). Anemia at the time of GCA diagnosis was a predictor of flare in a recent study.1 We aimed to determine the markers of relapsing GCA. 

Methods:

At a single secondary/tertiary rheumatology center we prospectively followed patients diagnosed with GCA between 01.09.2011 and 30.09.2014. Follow up visits with predetermined clinical and laboratory tests were performed 12, 24, 48, 96 and 144-weeks after diagnosis. Patients who completed  follow up visits at 6 months or later were included in the analysis. Patients were treated in line with the EULAR recommendations.2In short, patients with uncomplicated GCA with initial oral methylprednisolone (MP) 32-48 mg qd, while those with ischemic complications or large vessel disease first received MP 250 mg on 3 consecutive days intravenously. MP tapering was started 2-4 weeks after treatment initiation slowly to 4 mg qd which was continued for at least 1.5 years. In patients who relapsed during the MP tapering unscheduled visits were arranged and treatment was adjusted.  

Results:

During the observation period 74 (71.6% female) new GCA cases were identified, with a median (IQR) age 73.3 (67.3-77.2) years and symptom duration 30 (14-77) days. One patient died of cancer during the initial diagnostic work-up, 1 refused the treatment and 2 were lost to follow up. The remaining 70 (94.6%) patients were followed for a median (IQR) 102 (51–126) weeks. Throughout the observation period GCA relapsed in 32/70 (45.7%) patients. One patient suffered visual loss at relapse. One patient had two relapses, others one episode. Median (IQR) time to relapse was 24.8 (13.5–44.0) weeks. Median (IQR) prednisolone equivalent dose of MP at relapse was 6.0 (4.0-12.0) mg. Treatment adjustments in patients who relapsed included a temporary increase of MP dose (32/32), and add-on therapy with leflunomide 20 mg qd (18/32) or weekly methotrexate (2/32). Baseline characteristics of patients who relapsed and those who did not are presented in Table 1. At baseline, the patients who relapsed had a significantly higher erythrocyte sedimentation rate (p=0.024), C-reactive protein (p=0.007), as well as the serum amyloid A (p=0.002), haptoglobin (p=0.002), and fibrinogen (p=0.031) levels than those  who did not. Disease duration before treatment introduction, large vessel disease, GC dosing scheme and anemia were not a predictor of the GCA relapses. 

Characteristic

Relapsed (32)

Nonrelapsed (38)

p value

Median age (IQR) [years]

73.2 (65.7–77.0)

73.2(68.6–75.7)

0.596

% female

68.8

71.1

1.0

Median (IQR) disease duration [days]

30 (12–101)

30 (14–60)

0.855

% general symptoms

68.8

73.7

0.791

% PMR

15.6

21.1

0.759

% headache

65.6

78.9

0.283

% jaw claudication

31.3

39.5

0.617

% visual symptoms

31.3

36.8

0.801

% dry cough

25.0

13.2

0.232

% clinically changed TA

59.4

60.5

1.0

% LVV

38.7

31.3

0.603

% smoking history

43.8

36.8

0.628

IV pulse MP (250 mg)

43.8

42.1

1.0

Median (IQR) MP dose [mg/kg BW]

0.7 (0.6-0.8)

0.7(0.6-0.8)

0.675

Median (IQR) ESR [mm/h]

94 (71–107)

70 (52–90)

0.024

Median (IQR) CRP [mg/l]

90 (67–124)

52 (32–70)

0.007

Median (IQR) hemoglobin [g/l]

117 (103–124)

119 (108–130)

0.142

Median (IQR) platelets [x 109/l]

364 (305–440)

346 (286–430)

0.419

Median (IQR) albumin [mg/l]

31 (30-34)

34 (29–37)

0.106

Median (IQR) SAA [mg/l]

299 (178–738)

115 (40–270)

0.002

Median (IQR) ferritin [mcg/l]

366 (192–633)

210 (124–476)

0.149

Median (IQR) fibrinogen [g/l]

8.3 (7.9–8.6)

7.1 (6.1–8.4)

0.031

Median (IQR) haptoglobin [g/l]

5.7 (5.2–6.8)

3.7 (3.0–5.1)

0.002

Median (IQR) IL-6 [ng/l]

30.0 (8.0-80.8)

19.0 (6.3-36.3)

0.157

Legend: PMR polymyalgia rheumatica; TA temporal arteries; LVV  large vessel vasculitis (US or PET/CT); ESR erythrocyte sedimentation rate; CRP C-reactive protein; SAA serum amyloid A; IL-6 interleukin 6; BW body weight; IV pulse MP intravenous methyl-prednisolone pulse 250 mg qd on 3 consecutive days

In our cohort higher markers of systemic inflammation at baseline predicts the GCA relapse during the glucocorticoid taper.Conclusion:

References:

1. Martinez-Lado L et. Relapses and recurrences in giant cell arteritis: a population-based study of patients with biopsy-proven disease from northwestern Spain. Medicine (Baltimore).201;90(3):186-93.

2. EULAR Recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2009;68(3):318-323



Disclosure: A. Hocevar, None; R. Ješe, None; Z. Rotar, None; S. Praprotnik, None; M. Tomšič, None; S. Čučnik, None.

To cite this abstract in AMA style:

Hocevar A, Ješe R, Rotar Z, Praprotnik S, Tomšič M, Čučnik S. Can We Predict the Relapse of Giant Cell Arteritis? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/can-we-predict-the-relapse-of-giant-cell-arteritis/. Accessed .
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