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2014 ; 93
(5
): 194-201
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Relapses in patients with giant cell arteritis: prevalence, characteristics, and
associated clinical findings in a longitudinally followed cohort of 106 patients
#MMPMID25181312
Alba MA
; García-Martínez A
; Prieto-González S
; Tavera-Bahillo I
; Corbera-Bellalta M
; Planas-Rigol E
; Espígol-Frigolé G
; Butjosa M
; Hernández-Rodríguez J
; Cid MC
Medicine (Baltimore)
2014[Jul]; 93
(5
): 194-201
PMID25181312
show ga
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.