ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 789

Markers of Inflammation and Patient-Reported Measures As Predictors of Relapse in Giant Cell Arteritis

Tanaz A. Kermani1, Antoine G. Sreih2, Gunnar Tomasson3, David Cuthbertson4, Renee Borchin5, Simon Carette6, Lindsy J. Forbess7, Nader A. Khalidi8, Curry L. Koening9, Carol A. McAlear10, Paul A. Monach11, Larry W. Moreland12, Christian Pagnoux6, Philip Seo13, Robert F. Spiera14, Kenneth J. Warrington15, Steven R. Ytterberg15, Carol A. Langford16 and Peter A. Merkel17,18, 1Rheumatology, University of California Los Angeles, Los Angeles, CA, 2Rheumatology, University of Pennsylvania, Philadelphia, PA, 3University of Iceland, Faculty of Medicine, Reykjavik, IS, 4Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, 5University of South Florida, Tampa, FL, 6Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 7Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 8Rheumatology, McMaster University, Hamilton, ON, Canada, 9Rheumatology, University of Utah, Salt Lake City, UT, 10University of Pennsylvania, Philadelphia, PA, 11Boston University School of Medicine, Boston, MA, 12Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, 13Medicine, Johns Hopkins University, Baltimore, MD, 14Rheumatology, Hospital for Special Surgery, New York, NY, 15Rheumatology, Mayo Clinic, Rochester, MN, 16Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, 17Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, 18Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania, Philadelphia, PA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , ,

Session Information

Date: Sunday, November 5, 2017

Title: Vasculitis Poster I: Large Vessel Vasculitis

Session Type: ACR Poster Session A

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

Background/Purpose: The significance of increasing erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in clinically asymptomatic individuals with giant cell arteritis (GCA) is controversial. Patient-reported outcomes may be useful in distinguishing disease states but have not been well studied in GCA. This study evaluated the association of changes in ESR, CRP, and patient-reported measures as predictors of subsequent relapse in patients with GCA. 

Methods: Data from patients with GCA enrolled in a multicenter, longitudinal cohort and/or a clinical trial were included. Subjects were followed with standardized clinical assessments including symptoms attributed to vasculitis, patient global assessment (PtGA) on an 11 point numberical scale (0-10) and The Short Form Health Survey (SF-36). Physical component scores (PCS) and mental component scores (MCS) were calculated from SF-36 and normalized to the general population (mean ± SD=50 ± 10) with lower scores indicating poorer outcomes. Relapse was defined as presence since the last visit of any symptom attributable to vasculitis by the treating physician. Robust generalized estimating equations in logistic regression models were used to evaluate the association between change in PtGA, PCS, MCS, ESR, CRP from the visit prior to relapse with subsequent relapse.

 

Results: The study included 202 patients; 149 (74%) women; mean age at diagnosis = 71.6±8.3 years. All subjects met ACR classification criteria modified to include subjects with angiographic evidence of large-vessel vasculitis. Temporal artery biopsy was positive in 135/163 (82%) in whom it was performed. In the multivariable model, increase in PtGA (OR 1.18, 95% CI 1.08, 1.28), decrease in PCS (OR 1.05; 95% CI 1.02, 1.08), and increase in ESR (OR 1.03, 95% CI 1.00, 1.05) were all associated with relapse (Table 1). Change in MCS or CRP were not associated with relapse (Table 1). Increase in ESR or CRP was not associated with relapse in subjects when there was no change in PtGA from prior visit (change in PtGA <1) (Table 1).

Conclusion: In GCA increases in ESR are not associated with relapse if PtGA is unchanged. Where patient-reported measures worsen compared to a prior visit, a change in ESR is significant and is associated with an increased risk of relapse. Changes in PtGA are more strongly associated with relapse than ESR or PCS. Changes in CRP are not associated with relapses, regardless of patient-reported measures. Patients’ self-reports are important in the clinical assessment of disease activity in GCA and in predicting relapse as currently defined. These results support the incorporation of patient-reported outcomes into disease assessment in clinical trials and practice for GCA.  

 

Table 1. Multivariate analysis evaluating predictors of relapse in 202 patients with giant cell arteritis

Variable

Model 1 with all variables OR (95%CI)

Model 2 with no change in PtGA OR (95% CI)

Age, years

1.0 (1.0, 1.0)

1.0 (1.0, 1.0)

Male sex

0.45 (0.25, 0.81)

0.44 (0.19, 1.02)

Caucasian ethnicity

1.34 (0.47, 3.82)

1.07 (0.29, 3.90)

Unit increase ESR, mm/hour

1.03 (1.00, 1.05)

1.02 (0.99, 1.06)

Unit increase CRP, mg/L

1.01 (0.98, 1.04)

1.00 (0.95, 1.05)

Unit increase PtGA

1.18 (1.08, 1.28)

N/A

Unit decrease MCS

1.02 (0.99, 1.04)

N/A

Unit decrease PCS

1.05 (1.02, 1.08)

N/A

OR = odds ratio; CI = confidence interval; PtGA = patient global assessment;
ESR = erythrocyte sedimentation rate; CRP = C-reactive protein;
MCS = mental component score; PCS = physical component score; N/A = not applicable

 

Disclosure: T. A. Kermani, None; A. G. Sreih, None; G. Tomasson, None; D. Cuthbertson, None; R. Borchin, None; S. Carette, None; L. J. Forbess, None; N. A. Khalidi, None; C. L. Koening, None; C. A. McAlear, None; P. A. Monach, None; L. W. Moreland, None; C. Pagnoux, None; P. Seo, None; R. F. Spiera, None; K. J. Warrington, None; S. R. Ytterberg, None; C. A. Langford, None; P. A. Merkel, None.

To cite this abstract in AMA style:

Kermani TA, Sreih AG, Tomasson G, Cuthbertson D, Borchin R, Carette S, Forbess LJ, Khalidi NA, Koening CL, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Spiera RF, Warrington KJ, Ytterberg SR, Langford CA, Merkel PA. Markers of Inflammation and Patient-Reported Measures As Predictors of Relapse in Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/markers-of-inflammation-and-patient-reported-measures-as-predictors-of-relapse-in-giant-cell-arteritis/. Accessed .

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