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
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 .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-we-predict-the-relapse-of-giant-cell-arteritis/