Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: To evaluate the frequency, timing, and characteristics of flares and to evaluate the frequency of long-term remission after glucocorticoids (GCs) suspension in an Italian cohort of patients with large-vessel (LV) giant cell arteritis (GCA) and to identify factors that may predict the occurrence of flares and long-term remission.
Methods: We evaluated 75 patients with LV GCA diagnosed and followed up at the Rheumatology Unit of Reggio Emilia Hospital (Italy) for whom information was available from the time of diagnosis until at least 2 years of follow-up. In all patients the diagnosis of LV GCA was confirmed by imaging. Flares were defined as reappearance of signs/symptoms or worsening in vascular imaging requiring treatment adjustment. Long-term remission was defined as complete clinical remission without elevation of inflammatory markers for at least one year after the GC withdrawal.
Results: 34 patients (45.3%) experienced one or more flares. Twenty (38.5%) of the 52 total flares were experienced during the first year after diagnosis. The majority of relapses occurred with doses of prednisone < 10 mg/day (80.7%), while only 3.8% for doses > 25 mg/day. Polymyalgia rheumatica (PMR) (34.6%) and worsening of LV imaging (34.6%) were the most frequently observed flaring manifestations. Cumulative prednisone dose during the first year and total cumulative prednisone dose were significantly higher in flaring patients compared to those without flares (p = 0.006 and p = 0.0001, respectively). The total duration of prednisone treatment was longer in flaring patients (p = 0.0001).
Patients with disease flares had at diagnosis more frequently fever > 38°C (p = 0.04) and less frequently jaw claudication (p = 0.02) compared to those without flares. In the multivariate model fever > 38 °C (HR 2.94, 95%CI:1.25-6.91, p = 0.01), PMR (HR 3.59, 95%CI: 1.61-8.03, p= 0.002), visual manifestations (HR 3.24, 95%CI: 1.09-9.67, p = 0.035) were significantly associated with an increased risk of flares, while jaw claudication (HR 0.11, 95%CI: 0.02-0.48, p = 0.004) with a reduced risk.
33 patients (44%) experienced long-term remission. PMR and disease flares were less frequently observed in patients with long-term remission compared to those without (p = 0.002 and p < 0.0001, respectively). The initial prednisone dosage was higher in patients with long-term remission (p = 0.03), while the total cumulative prednisone dose and the duration of prednisone treatment were significantly lower (p = 0.02 and p = 0.003, respectively). In the multivariate model the duration of prednisone treatment was significantly negatively associated with long-term remission (HR 0.97, 95%CI: 0.96-0.98, p < 0.0001).
Conclusion: In our cohort of patients with LV GCA a flaring course and long-term remission were observed in around half of the patients.
To cite this abstract in AMA style:Salvarani C, Boiardi L, Cavazza A, Casali M, Spaggiari L, Cimino L, Aldigeri R, Muratore F, Restuccia G, Pipitone N, Macchioni P. Flares and Long-term Remission in Large-vessel Giant Cell Arteritis in Northern Italy: Characteristics and Predictors in a Long-term Follow-up Study [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/flares-and-long-term-remission-in-large-vessel-giant-cell-arteritis-in-northern-italy-characteristics-and-predictors-in-a-long-term-follow-up-study/. Accessed June 6, 2020.
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