title: Relapses in patients with giant cell arteritis: prevalence, characteristics, and associated clinical findings in a longitudinally followed cohort of 106 patients.
abstract: Giant cell arteritis (GCA) is a relapsing disease. However, the nature, chronology, therapeutic impact, and clinical consequences of relapses have been scarcely addressed. We conducted the present study to investigate the prevalence, timing, and characteristics of relapses in patients with GCA and to analyze whether a relapsing course is associated with disease-related complications, increased glucocorticoid (GC) doses, and GC-related adverse effects. The study cohort included 106 patients, longitudinally followed by the authors for 7.8 ± 3.3 years. Relapses were defined as reappearance of disease-related symptoms requiring treatment adjustment. Relapses were classified into 4 categories: polymyalgia rheumatica (PMR), cranial symptoms (including ischemic complications), systemic disease, or symptomatic large vessel involvement. Cumulated GC dose during the first year of treatment, time required to achieve a maintenance prednisone dose <10 mg/d (T10), <5 mg/d (T5), or complete prednisone discontinuation (T0), and GC-related side effects were recorded. Sixty-eight patients (64%) experienced at least 1 relapse, and 38 (36%) experienced 2 or more. First relapse consisted of PMR in 51%, cranial symptoms in 31%, and systemic complaints in 18%. Relapses appeared predominantly, but not exclusively, within the first 2 years of treatment, and only 1 patient developed visual loss. T10, T5, and T0 were significantly longer in patients with relapses than in patients without relapse (median, 40 vs 27 wk, p  < 0.0001; 163 vs 89.5 wk, p = 0.004; and 340 vs 190 wk, p = 0.001, respectively). Cumulated prednisone dose during the first year was significantly higher in relapsing patients (6.2 ± 1.7 g vs 5.4 ± 0.78 g, p = 0.015). Osteoporosis was more common in patients with relapses compared to those without (65% vs 32%, p = 0.001). In conclusion, the results of the present study provide evidence that a relapsing course is associated with higher and prolonged GC requirements and a higher frequency of osteoporosis in GCA.
authors.affiliation: Vasculitis Research Unit (MAA, AG-M, SP-G, IT-B, MC-B, EP-R, GE-F, MB, JH-R, MCC), Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Alba
authors.forename: Ana
authors.initials: A
authors.lastname: García-Martínez
authors.forename: Sergio
authors.initials: S
authors.lastname: Prieto-González
authors.forename: Itziar
authors.initials: I
authors.lastname: Tavera-Bahillo
authors.forename: Marc
authors.initials: M
authors.lastname: Corbera-Bellalta
authors.forename: Ester
authors.initials: E
authors.lastname: Planas-Rigol
authors.forename: Georgina
authors.initials: G
authors.lastname: Espígol-Frigolé
authors.forename: Montserrat
authors.initials: M
authors.lastname: Butjosa
authors.forename: José
authors.initials: J
authors.lastname: Hernández-Rodríguez
authors.forename: Maria C
authors.initials: MC
authors.lastname: Cid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology; D062072:Patient Acuity; D011111:Polymyalgia Rheumatica / Q000453:epidemiology / Q000209:etiology; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D015995:Prevalence; D012008:Recurrence; D013030:Spain / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids; D011241:Prednisone