Subclinical giant cell arteritis increases the risk of relapse in polymyalgia rheumatica
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVE: The aim of the present study was to determine the clinical significance of subclinical giant cell arteritis (GCA) in polymyalgia rheumatica (PMR) and ascertain its optimal treatment approach.
METHODS: Patients with PMR who fulfilled the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology Provisional Classification Criteria for PMR, did not have GCA symptoms and were routinely followed up for 2 years and were stratified into two groups, according to their ultrasound results: isolated PMR and PMR with subclinical GCA. The outcomes (relapses, glucocorticoid use and disease-modifying antirheumatic drug treatments) between groups were compared.
RESULTS: We included 150 patients with PMR (50 with subclinical GCA) with a median (IQR) follow-up of 22 (20-24) months. Overall, 47 patients (31.3 %) had a relapse, 31 (62%) in the subclinical GCA group and 16 (16%) in the isolated PMR group (p<0.001). Among patients with subclinical GCA, no differences were found in the mean (SD) prednisone starting dosage between relapsed and non-relapsed patients (32.4±15.6 vs 35.5±12.1 mg, respectively, p=0.722). Patients with subclinical GCA who relapsed had a faster prednisone dose tapering in the first 3 months compared with the non-relapsed patients, with a mean dose at the third month of 10.0±5.2 versus 15.2±7.9 mg daily (p<0.001). No differences were found between relapsing and non-relapsed patients with subclinical GCA regarding age, sex, C reactive protein and erythrocyte sedimentation rate.
CONCLUSIONS: Patients with PMR and subclinical GCA had a significantly higher number of relapses during a 2-year follow-up than patients with isolated PMR. Lower starting doses and rapid glucocorticoid tapering in the first 3 months emerged as risk factors for relapse.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:83 |
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| Enthalten in: |
Annals of the rheumatic diseases - 83(2024), 3 vom: 15. Feb., Seite 335-341 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
De Miguel, Eugenio [VerfasserIn] |
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| Links: |
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| Themen: |
Giant Cell Arteritis |
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| Anmerkungen: |
Date Completed 19.02.2024 Date Revised 19.02.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/ard-2023-224768 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM364238178 |
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| 245 | 1 | 0 | |a Subclinical giant cell arteritis increases the risk of relapse in polymyalgia rheumatica |
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| 500 | |a Date Revised 19.02.2024 | ||
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVE: The aim of the present study was to determine the clinical significance of subclinical giant cell arteritis (GCA) in polymyalgia rheumatica (PMR) and ascertain its optimal treatment approach | ||
| 520 | |a METHODS: Patients with PMR who fulfilled the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology Provisional Classification Criteria for PMR, did not have GCA symptoms and were routinely followed up for 2 years and were stratified into two groups, according to their ultrasound results: isolated PMR and PMR with subclinical GCA. The outcomes (relapses, glucocorticoid use and disease-modifying antirheumatic drug treatments) between groups were compared | ||
| 520 | |a RESULTS: We included 150 patients with PMR (50 with subclinical GCA) with a median (IQR) follow-up of 22 (20-24) months. Overall, 47 patients (31.3 %) had a relapse, 31 (62%) in the subclinical GCA group and 16 (16%) in the isolated PMR group (p<0.001). Among patients with subclinical GCA, no differences were found in the mean (SD) prednisone starting dosage between relapsed and non-relapsed patients (32.4±15.6 vs 35.5±12.1 mg, respectively, p=0.722). Patients with subclinical GCA who relapsed had a faster prednisone dose tapering in the first 3 months compared with the non-relapsed patients, with a mean dose at the third month of 10.0±5.2 versus 15.2±7.9 mg daily (p<0.001). No differences were found between relapsing and non-relapsed patients with subclinical GCA regarding age, sex, C reactive protein and erythrocyte sedimentation rate | ||
| 520 | |a CONCLUSIONS: Patients with PMR and subclinical GCA had a significantly higher number of relapses during a 2-year follow-up than patients with isolated PMR. Lower starting doses and rapid glucocorticoid tapering in the first 3 months emerged as risk factors for relapse | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Giant Cell Arteritis | |
| 650 | 4 | |a Outcome Assessment, Health Care | |
| 650 | 4 | |a Polymyalgia Rheumatica | |
| 650 | 4 | |a Therapeutics | |
| 650 | 4 | |a Ultrasonography | |
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| 650 | 7 | |a Glucocorticoids |2 NLM | |
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| 700 | 1 | |a Macchioni, Pierluigi |e verfasserin |4 aut | |
| 700 | 1 | |a Ponte, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a Conticini, Edoardo |e verfasserin |4 aut | |
| 700 | 1 | |a Cowley, Sharon |e verfasserin |4 aut | |
| 700 | 1 | |a Tomelleri, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Monti, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Monjo, Irene |e verfasserin |4 aut | |
| 700 | 1 | |a Batalov, Zguro |e verfasserin |4 aut | |
| 700 | 1 | |a Klinowski, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Falsetti, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Kane, David J |e verfasserin |4 aut | |
| 700 | 1 | |a Campochiaro, Corrado |e verfasserin |4 aut | |
| 700 | 1 | |a Hočevar, Alojzija |e verfasserin |4 aut | |
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