Background Giant cell arteritis (GCA) is a vasculitis that involves large and medium sized arteries in patients older than 50 years. Relapses and recurrences of the disease have been reported in 40.8–48% of patients, leading to longer duration of glucocorticoids (GCs) therapy and to increased risk of GCs side effects.
Objectives The aim of our study was to determine the frequency and the predictors of disease relapses in a large monocentric cohort of consecutive patients with biopsy- proven GCA.
Methods All patients with a diagnosis of biopsy-proven GCA made at our centre between 1986 and 2007 were identified. Only patients with a follow-up period longer than 6 months were included in the study. A pathologist with expertise in vasculitis reviewed all temporal artery biopsies (TABs). Demographic, clinical and laboratory data at presentation and at each follow-up visit were retrospectively collected. Relapse was defined as recurrences of symptoms with rise in inflammatory markers during tapering of GCs or after GCs discontinuation.
Results 181 patients had a diagnosis of biopsy-proven GCA in the study period. 22 patients had a follow-up shorter then 6 months, and were excluded from further analyses. Median (Q1,Q3) follow-up period for the 159 patients included was 80 (49,125) months. 57/159 (35.8%) patients relapsed during the follow-up period, with a median of 1 (range: 1–7) relapses. Most common clinical manifestation at first relapse was polymyalgia rheumatica (44%), followed by headache (37%). Only 1 patient developed visual loss secondary to disease relapse. Mean (DS) prednisone dose at the time of first relapse was 6.3 (10.1) mg/day. At univariate analysis predictors of relapses were the levels of hemoglobin (Hb) (HR 0.793, p=0.037), fever (HR 1.938, p=0.029), presence of giant cells (HR 2.560, p=0.031), acute thrombosis (HR 2.805, p=0.003), and a more severe inflammation on a semiquantitative scale (HR 3.973, p=0.011 for moderate inflammation; HR 3.051, p=0.039 for severe inflammation) at TAB. Furthermore total duration of corticosteroid therapy [mean (SD) 64 (46) vs 31 (32) months, p=0.0001] and cumulative dose of prednisone [mean (SD) 16.7 (12.3) vs 9.7 (9.2) grms, p=0.0001) were significantly higher in patients whit disease relapses than in those without. Multivariate analysis confirmed as independent predictors of relapses the levels of Hb, [HR (CI 95%) 0.738 (0.575–0.947), p=0.017], the presence of moderate and severe inflammation at TAB [HR (CI 95%) 4.648 (1.328–16.363), p=0.016; and 3.653 (1.085–12.302), p=0.037 respectively for moderate and severe inflammation] and the presence of acute thrombosis at TAB [HR (CI 95%) 2.29 (0.974–5.383), p=0.05].
Conclusions The results of the present study confirm that relapses are frequent in patients with biopsy-proven GCA. The levels of hemoglobin at diagnosis, the severity of inflammation and the presence of acute thrombosis at TAB are independent predictors of disease relapses.
Disclosure of Interest None declared
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