Background There are limited data regarding the long term outcomes of patients with giant cell arteritis (GCA) in the modern therapeutic era.
Objectives To evaluate relapse, treatment discontinuation and complication rates in GCA patients during long term follow-up.
Methods A retrospective systematic chart review of GCA patients who were followed in an Academic Rheumatology Unit between 2002 to 2016 was performed. Demographic, clinical, laboratory and treatment data were collected and analyzed.
Results 53 GCA patients were included in the study. 62% (n=33) were women with a mean age at diagnosis of 73±8.8 years and median duration of symptoms of 1.3 months. 41 patients (77%) had biopsy proven GCA while in 5 patients (9%) there was evidence of large vessel involvement. At presentation, the most common symptoms were headache (60%), fever (51%), scalp tenderness (47%), jaw claudication (39%), visual disturbances (23%), polymyalgia rheumatica symptoms (9%) and vision loss (6%). Regarding laboratory data at baseline, the median ESR and CRP were 101 mm/h and 50 mg/dl respectively while the mean hemoglobin (Hb) and platelet (PLT) count was 11.3±1.2 g/dl and 381.000±134.000, respectively. All patients were initially treated with tapering doses of pos steroids (mean start prednisolone dose: 42±12 mg/day) while 2 patients (4%) were given IV steroid pulses. During follow-up (3.1±2.7 years), for patients with did not adequately respond or could not tolerate steroids, non-biologic (n=12, 23%) or biologic DMARDs (n=4, 7%) were added. Relapses requiring change in immunosuppressive therapy occurred in more than half of patients (n=28, 53%); among these 67% were laboratory and 56% clinical relapses. Osteoporosis (17%), cataracts (7%), fractures (4%) and avascular necrosis (2%) developed during chronic steroid treatment. At the last follow-up visit, 39% (n=21) of patients had discontinued steroids and 31% (n=17) all treatments. Comparing the group of patients who had discontinued treatment (D/C group) to those who were unable to stop therapy (continued therapy group), there were no statistically significant differences (age, duration of symptoms at diagnosis, initial steroid dose, baseline and follow-up ESR, CRP, Hb and platelet values, relapses, co-administration of DMARDs, comorbidities), except from gender (females: D/C group=41%, continued therapy group=72%, p=0.03). Kaplan-Meier analysis also showed that the median time to discontinuation of treatment was longer in females compared to males (log rank p=0.018).
Conclusions In this long-term follow-up study, relapses occurred in more than half of GCA patients while only one out of three patients were able to discontinue all therapies. Among different variables, only male sex was associated with earlier treatment discontinuation.
Acknowledgements Supported by research grants from the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece.
Disclosure of Interest None declared
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