Background Glucocorticoids remain the gold standard treatment for giant cell arteritis (GCA). However, the relapses and recurrences in GCA are frequently reported.
Objectives To determine the effectiveness of standard GCA treatment at the single secondary/tertiary rheumatology center.
Methods We prospectively followed patients diagnosed with GCA between 01.09.2011 and 31.08.2014 at our center. Follow up visits with predetermined clinical and laboratory tests were performed 12, 24, 48 and 96-weeks after diagnosis. All patients who completed at least the first follow up visit were included in the analysis. All patients were treated in line with the EULAR recommendations (Ann Rheum Dis 2009;68:318-23). In short, patients with uncomplicated GCA were treated with initial oral methylprednisolone (MP) 32–48 mg qd, while the patients with ischemic complications or involvement of large vessels first received MP 250 mg on 3 consecutive days intravenously. MP tapering was started 2–4 weeks after treatment initiation slowly to 4 mg qd which was continued for at least 1.5 years. In patients who relapsed during the MP tapering unscheduled visits were arranged and treatment was adjusted. A patient was said to have a relapse if symptoms or signs characteristic of GCA reoccurred or an increase of markers of inflammation that could not be explained by another disease was noted.
Results During the observation period 71 (72% female) new GCA cases were identified, with a median (IQR) age 73.1 (67.0–77.1) years and symptom duration 30 (14–84) days. One patient died of cancer during the initial diagnostic work-up, 1 refused the treatment and 1 was lost to follow up. The remaining 68 (95.8%) patients were followed for a median (IQR) 63 (49–111) weeks. During the follow up 29/68 patients relapsed based on clinical (5/29), laboratory (14/29), both clinical and laboratory (10/29) findings. None of the patients suffered visual loss at relapse. Median (IQR) time to relapse was 26.6 (13.4–26.6) weeks. Median (IQR) MP dose at relapse was 6.5 (4.0–12.5) mg. Patients who relapsed had a significantly higher systemic inflammatory activity at baseline (Table 1). Treatment adjustments in patients who relapsed included a temporary increase of MP dose (29/29), and add-on therapy with leflunomide 20 mg qd (15/29) or weekly methotrexate (2/29).
Conclusions Even in the short term the glucocorticoids in monotherapy might be inadequate for a sustained remission in GCA.
Disclosure of Interest None declared