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Abstract Number: 2357

Relapses in Patients with Giant-Cell Arteritis: Prevalence, Characteristics and Associated Clinical Findings in a Prospectively Followed Cohort of 106 Patients

Marco A. Alba1, Ana García-Martínez2, Itziar Tavera-Bahillo1, Sergio Prieto-González1, Montserrat Butjosa3, Georgina Espígol4, Marc Corbera4, Ester Planas4, Jose Hernandez-Rodriguez5 and Maria C. Cid6, 1Systemic Autoimmune Diseases, Vasculitis Research Unit. Hospital Clínic. University of Barcelona. IDIBAPS, Barcelona, Spain, 2Department of Emergency Medicine, Vasculitis Research Unit. Hospital Clínic. University of Barcelona. IDIBAPS, Barcelona, Spain, 3Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clinic University Barcelona, Barcelona, Spain, 4Systemic Autoimmune Diseases, Vasculitis research unit. Hospital Clínic. University of Barcelona. IDIBAPS, Barcelona, Spain, 5Hospital Clínic. University of Barcelona. IDIBAPS, Barcelona, Spain, 6Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: giant cell arteritis, prednisolone, prednisone and treatment

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Session Information

Session Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose: In spite of the satisfactory initial response to glucocorticoid treatment, patients with giant cell arteritis (GCA) frequently experience relapses during follow-up. The objectives of this study were 1) To investigate the prevalence and characteristics of relapses in a prospectively followed cohort of patients with GCA. 2) To determine whether clinical or analytical findings at presentation may predict relapses and 3) To analyze whether a relapsing course is associated with higher cumulated GC doses and more prolonged treatment periods.

Methods: Between 1995 and 2007, 187 patients were diagnosed with biopsy-proven GCA at our institution. Among them, 106 patients fulfilled the following inclusion criteria: prospective treatment by the authors according to uniform criteria and prospective follow-up for at least 4 years. GCA features and blood tests at diagnosis (acute phase reactants, blood cell counts and liver function tests), ischemic complications, relapses, and prednisone doses for at least 4 years. Relapses were defined as reappearance of disease related symptoms accompanied by elevation of acute-phase reactants that required treatment adjustment. Type of relapse was defined as PMR, cranial symptoms, severe cranial ischemic complications or systemic disease (anemia, fever and/or weight loss). Chi-square test, student T test and Kaplan-Meyer survival analysis/log-rank test were used for statistical comparison. 

Results: During the follow-up period (mean 7.6 ± 3.3 years), 66 (62%) patients experienced at least 1 relapse and 38 (36%) 2 or more. Relapses consisted of PMR in 33 (50%), cranial symptoms in 19 (29%), systemic complaints in 13 (19.5%) and cranial ischemic complications in 1 (1.5%). Mean time (in weeks) to first relapse was 72 ± 71 (11-339). There were no differences in clinical findings or blood test results at presentation between patients who relapsed and those who achieved sustained remission. However, 23 (60.5%) of patients with ≥ 2 relapses had a strong systemic inflammatory response at presentation (defined as at least 3 of the following fever >38oC, weight loss >5 kg, hemoglobin < 11 gr/L or ESR >85 mm/hour) which was present in only 5 (18%) of the remaining patients (p=0.001). Patients with ≥ 2 relapses presented significantly higher levels of ESR and C-reactive protein at 6 months and lower concentrations of hemoglobin at baseline, at 6 months (all p<0.01) and at 24 months (p=0.045). Patients with relapses required longer periods of time to reach a stable maintenance dose of prednisone <10mg/day (67±58 weeks vs 31±21, p<0.001), <5mg/day (159±106 vs 89±42, p<0.001) and to completely discontinue GC treatment (237±124 vs 157±59 p=0.005). In addition, cumulative prednisone dose at one year was significantly different between both groups (6.2±1.7 gr vs 5.4±0.7, p=0.01).

Conclusion: More than 60% of patients with GCA experience at least one relapse and 36% have multiple relapses. Relapses usually consist of PMR. Those with multiple relapses have stronger systemic inflammatory response at presentation. A relapsing course is associated with higher and prolonged GC requirements underlining the need for more effective treatments for GCA.

Supported by SAF 08/04328, SAF 11/30073, CONACYT and AGAUR

.


Disclosure:

M. A. Alba,
None;

A. García-Martínez,
None;

I. Tavera-Bahillo,
None;

S. Prieto-González,
None;

M. Butjosa,
None;

G. Espígol,
None;

M. Corbera,
None;

E. Planas,
None;

J. Hernandez-Rodriguez,
None;

M. C. Cid,
None.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relapses-in-patients-with-giant-cell-arteritis-prevalence-characteristics-and-associated-clinical-findings-in-a-prospectively-followed-cohort-of-106-patients/

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