Epidemiology and Predictors of Relapse in Giant Cell Arteritis: Results of the ARTESER Register

Javier Narvaez¹, Jesús Sanchez-Costa², Iñigo Hernández-Rodríguez³, Rafael Benito Melero-Gonzalez⁴, Eugenio De Miguel⁵, Irene Monjo⁶, Maite silva díaz⁷, LUCIA SILVA FERNANDEZ⁸, Joaquin Maria Belzunegui Otano⁹, Jesus Alejandro Valero-Jaimes¹⁰, Clara Moriano Morales¹¹, Ismael González¹², Julio Sanchez Martin¹³, Tomas Almorza Hidalgo¹⁴, Judit Lluch¹⁵, Eva Galindez-Agirregoikoa¹⁶, Itziar Calvo-Zorrilla¹⁶, Vicente Aldasoro¹⁷, Javier Mendizabal¹⁸, LYDIA ABASOLO¹⁹, PIA LOIS²⁰, Javier Loricera¹³, Noemi Garrido-Puñal²¹, ALBERTO MARIANO RUIZ ROMAN²², Santos Castañeda²³, Cristina Valero²³, Patricia Moya Albarado²⁴, Hector Corominas²⁵, Maria J. García-Villanueva²⁶, Carmen Larena²⁷, Paula V. Estrada-Alarcón²⁸, Vanessa Navarro²⁹, Carles Galisteo³⁰, Anne Riveros-Frutos³¹, Francisco Miguel Ortiz Sanjuan³², Selene Labrada-Arrabal³³, María Alcalde³⁴, Clara Molina Almela³⁵, Carlos Garcia Porrua³⁶, Maria García-González³⁷, Margarida Rocha³⁸, Antonio Juan Mas³⁹, Miguel A Gonzalez-Gay⁴⁰ and Ricardo Blanco⁴¹, ¹Hospital Universitario de Bellvitge, Barcelona, Spain, ²Unidad de Investigación de la Sociedad Española de Reumatología, Madrid, Spain, ³Hospital do Meixoeiro. Complejo Hospitalario Universitario de Vigo, Vigo, Spain, ⁴CHU Vigo, O Carballino, Spain, ⁵Hospital Universitario La Paz, Madrid, Spain, ⁶University Hospital La Paz, Madrid, Spain, ⁷Rheumatology department, Complexo Hospitalario Universitario A Coruña (CHUAC). Instituto de Investigación Biomédica A Coruña (INIBIC)., A Coruña, Spain, ⁸Complejo Hospitalario Universitario de la Coruña, Pontevedra, Spain, ⁹University Hospital Donostia, Donostia-San Sebasti, Spain, ¹⁰Hospital Bidasoa, Irún, Spain, ¹¹Rheumatology, Hospital Universitario de León, León, Spain, ¹²Hospital Universitario de León, León, Spain, ¹³Hospital Universitario Marqués de Valdecilla, Santander, Spain, ¹⁴Hospital Universitario 12 de Octubre, Madrid, Spain, ¹⁵Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, ¹⁶Basurto University Hospital, Bilbao, Spain, ¹⁷Hospital Universitario de Navarra, Pamplona, Spain, ¹⁸Complejo Hospitalario de Navarra, Pamplona, Spain, ¹⁹Hospital Clínico San Carlos, Madrid, Spain, ²⁰Hospital Clinico San Carlos, Madrid, Spain, ²¹Hospital Universitario Virgen del Rocío, Sevilla, Spain, ²²Department of Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain, ²³Hospital Universitario de la Princesa, Madrid, Spain, ²⁴Hospital Universitario de Sant Pau, Barcelona, Spain, ²⁵Hospital Universitario Sant Pau, Rheumatology, Barcelona, Spain, ²⁶Hospital Ramón y Cajal, Madrid, Spain, ²⁷Hospital Universitario Ramon y Cajal, Madrid, Spain, ²⁸Hospital de San Juan Despí Moisès Broggi, Barcelona, Spain, ²⁹Hospital de Sant Joan Despí – Moises Broggi, Barcelona, Spain, ³⁰Hospital Universitario Parc Taulí, Sabadell, Spain, ³¹Hospital Universitario Germans Trias i Pujol, Barcelona, Spain, ³²Hospital Universitario y Politecnico La Fe, Valencia, Spain, ³³Hospital del Mar, Barcelona, Spain, ³⁴Hospital Severo Ochoa, Madrid, Spain, ³⁵Hospital General de Valencia, Valencia, Spain, ³⁶Hospital Universitario Lucus Augusti, Lugo, Spain, ³⁷Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ³⁸Osakidetza, Bilbo, Spain, ³⁹Hospital Universitario Son Llàtzer, Mallorca, Spain, ⁴⁰IDIVAL and School of Medicine, UC, Santander; Department of Rheumatology, IIS-Fundación Jiménez Díaz, Madrid, Santander, Spain, ⁴¹Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Meeting: ACR Convergence 2023

Keywords: giant cell arteritis

Session Information

Date: Tuesday, November 14, 2023

Title: (2387–2424) Vasculitis – Non-ANCA-Associated & Related Disorders Poster III

Session Type: Poster Session C

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

Background/Purpose: The relapse rate of treated patients with giant cell arteritis (GCA) varied widely in observational series and randomized controlled trials. This study aimed to estimate the frequency and timing of relapse, the prevalence of multiple relapses, the characteristics of flares, and the predictors of relapse in a large cohort of Spanish patients with GCA.

Methods: All patients in the ARTESER (Registry of Giant Cell Arteritis Patients of the Spanish Society of Rheumatology) were reviewed. ARTESER is a multicentre observational retrospective longitudinal study conducted in 26 hospitals that included all consecutive patients diagnosed with GCA between 1 June 2013 and 29 March 2019. All cases were aged 50 years or older and had a confirmed diagnosis of GCA, that is, they met at least one of the following criteria: objective confirmation of the presence of vasculitis in a diagnostic test, at least three 1990 ACR criteria for GCA satisfied, and/or a diagnosis made based on the clinical judgment of the investigator. We diagnosed disease relapses if all the following criteria were satisfied: 1) reappearance of signs/symptoms of GCA and/or polymyalgia rheumatica (PMR); 2) resolution of signs/symptoms after increasing glucocorticoids; 3) presence of raised acute-phase reactants ESR and/or CRP, and 4) exclusion of other causes. The data were obtained by review of medical records.

Results: In total, 1675 patients were included. They were predominantly female (70.3%), with a mean (±SD) age at diagnosis of 76.9±8.1 years. Of them, 1284 patients were followed up for one or more years. During follow-up, 574 relapses were observed in 334 (26%) patients. One-year, 2-year, 3-year, and 4-year cumulative relapse rates were 18%, 27.9%, 37.6%, and 44.8%, respectively (see Table 1). Most relapses (81.2%) occurred within the first two years after diagnosis (55.3% in the first year and 26% during the second). The mean dose of prednisone at the first relapse was 13.95 mg/day (IQR25%-75%: 5-20 mg). Fifteen percent (34/232) of patients experienced > 1 flare within the first year of treatment and 10.5% (12/114) during the second year. The majority of flares corresponded to a minor relapse according to the EULAR consensus definitions for disease activity states in GCA (minor relapses 73% / major relapses 27%) In the multivariate analysis, we did not identify any clinical factor at diagnosis that was a predictor of relapse during the first three years of evolution: nor the age, sex, presence of cranial manifestations, severe ischemic complications, large vessel involvement, or a strong initial systemic inflammatory response. By contrast, the administration of intravenous (IV)methylprednisolone (MP) boluses was negatively associated with the occurrence of relapses (OR: 0.356, 95% CI 0.182 to 0.696; p< 0.01).

Conclusion: Relapses among patients with GCA are common, mainly during the first two years after diagnosis. Between 8 and 18% of patients had multiple relapses. Despite the relevance of this problem, we do not yet have any predictive factors to identify patients with a higher risk of flare. Induction treatment with high-dose IV MP boluses appears to decrease the risk of relapses.

Disclosures: J. Narvaez: None; J. Sanchez-Costa: None; I. Hernández-Rodríguez: None; R. Melero-Gonzalez: None; E. De Miguel: None; I. Monjo: Amgen, 6, Gedeon Richter, 6, Janssen, 6, Novartis, 6, Roche, 6, UCB, 6; M. silva díaz: None; L. SILVA FERNANDEZ: None; J. Belzunegui Otano: None; J. Valero-Jaimes: None; C. Moriano Morales: None; I. González: None; J. Sanchez Martin: None; T. Almorza Hidalgo: None; J. Lluch: None; E. Galindez-Agirregoikoa: None; I. Calvo-Zorrilla: None; V. Aldasoro: None; J. Mendizabal: None; L. ABASOLO: None; P. LOIS: None; J. Loricera: None; N. Garrido-Puñal: None; A. RUIZ ROMAN: None; S. Castañeda: None; C. Valero: None; P. Moya Albarado: None; H. Corominas: None; M. García-Villanueva: AstraZeneca, 6, GSK, 6, Otsuka, 1; C. Larena: None; P. Estrada-Alarcón: None; V. Navarro: None; C. Galisteo: None; A. Riveros-Frutos: None; F. Ortiz Sanjuan: None; S. Labrada-Arrabal: None; M. Alcalde: None; C. Molina Almela: None; C. Garcia Porrua: None; M. García-González: None; M. Rocha: None; A. Mas: None; M. Gonzalez-Gay: AbbVie/Abbott, 5, 6, Amgen, 5, 6, Pfizer, 5, 6; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6.

To cite this abstract in AMA style:

Narvaez J, Sanchez-Costa J, Hernández-Rodríguez I, Melero-Gonzalez R, De Miguel E, Monjo I, silva díaz M, SILVA FERNANDEZ L, Belzunegui Otano J, Valero-Jaimes J, Moriano Morales C, González I, Sanchez Martin J, Almorza Hidalgo T, Lluch J, Galindez-Agirregoikoa E, Calvo-Zorrilla I, Aldasoro V, Mendizabal J, ABASOLO L, LOIS P, Loricera J, Garrido-Puñal N, RUIZ ROMAN A, Castañeda S, Valero C, Moya Albarado P, Corominas H, García-Villanueva M, Larena C, Estrada-Alarcón P, Navarro V, Galisteo C, Riveros-Frutos A, Ortiz Sanjuan F, Labrada-Arrabal S, Alcalde M, Molina Almela C, Garcia Porrua C, García-González M, Rocha M, Mas A, Gonzalez-Gay M, Blanco R. Epidemiology and Predictors of Relapse in Giant Cell Arteritis: Results of the ARTESER Register [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/epidemiology-and-predictors-of-relapse-in-giant-cell-arteritis-results-of-the-arteser-register/. Accessed .

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