Objectives: To describe the impact of cumulative glucocorticoid (GC) doses on related adverse events (AEs) in giant cell arteritis (GCA) in a real-life setting. Methods: The medical charts of the last 139 consecutive GCA patients followed in a tertiary centre were retrospectively analysed. The cumulative GC doses were calculated, and the main GC-related AEs were collected during the follow-up. Results: After a median follow-up duration of 35.6 (2–111) months, the median cumulative GC dose in the 139 patients was 9184 (1770–24,640) mg, and 131 patients (94%) presented at least one GC-related AE. Infections (63%) were the most frequently reported GC-related AE, followed by metabolic events (63%), including weight gain in 51% of them. Cardiovascular and neuropsychiatric events occurred in 51% and 47% of patients, respectively. Osteoporotic fractures, muscular involvement, digestive events, geriatric deterioration, skin fragility, ophthalmologic complications and hypokalaemia were reported in <35% of patients. Cardiovascular events (p = 0.01), osteoporotic fractures (p = 0.004), cataract occurrence (p = 0.03), weight gain (p = 0.04) and infections (p = 0.01) were significantly associated with GC cumulative doses > 9 g. Longer GC durations were associated with cataract occurrence (p = 0.01), weight gain (p = 0.03) and all-grade infections (p = 0.048), especially herpes zoster occurrence (p = 0.003). Neuropsychiatric and metabolic events appeared within the first months after GC introduction, whereas herpes zoster recurred, and most cardiovascular AEs emerged after 1 year. Geriatric events, especially osteoporotic fractures, occurred 2 years after GC introduction. Conclusion: This study highlights how frequent GC-related AEs are and the impact of prolonged GC and cumulative doses.
Objectives To describe, in a real-life setting, the direct causes of death in a cohort of consecutive patients with giant cell arteritis (GCA). Methods We retrospectively analyzed the deaths that occurred in a cohort of 470 consecutive GCA patients from a center of expertise between January 2000 and December 2019. Among the 120 patients who died, we retrieved data from the medical files of 101 patients. Results Cardiovascular events were the dominant cause of death (n = 41; 41%) followed by infections (n = 22, 22%), geriatric situations (i.e. falls or senile deterioration; n = 17, 17%) and cancers (n = 15, 15%). Patients in each of these four groups were compared with the other deceased patients pooled together. Patients who died from cardiovascular events were more frequently male (46% vs 27%, p= 0.04) with a past history of coronary artery disease (29% vs 8%, p= 0.006). Patients who died from infections mostly had ongoing glucocorticoid treatment (82% vs 53%, p= 0.02) with higher cumulative doses (13994 mg vs 9150 mg, p= 0.03). Patients who died from geriatric causes more frequently had osteoporosis (56% vs 17%, p= 0.0009) and had mostly discontinued glucocorticoid treatment (76% vs 33%, p= 0.001). The predictive factors of death in multivariate analysis were a history of coronary disease (HR: 2.39; 95% CI: 1.27–4.21; p= 0.008), strokes at GCA diagnosis (HR: 2.54; 95% CI: 1.05–5.24; p= 0.04), any infection during follow-up (HR: 1.93; 95% CI: 1.24–2.98; p= 0.004) and fever at GCA diagnosis (HR: 1.99; 95% CI: 1.16–3.28; p= 0.01). Conclusion Our study provides real-life insight on the cause-specific mortality in GCA patients.
Objective To assess patients’ self-reported glucocorticoid (GC)-related adverse events (AEs) in a giant cell arteritis (GCA) population. Methods A questionnaire was sent to the 100 patients most recently diagnosed with GCA in a tertiary center. This autoquestionnaire included open- and close-ended questions on the disease and GC effects. Eight primary AE areas were analyzed: cardiovascular, metabolic, muscle, cognitive and psychologic, bone, cutaneous and hairiness, infective and visual complications. Including derivative subitems from preceding areas, a total of 18 GC-related AEs were analyzed separately and according to GC duration. Results Ninety patients were analyzed, and 89 (99%) reported at least one GC-related AE (median 6 [1—11]). Cognitive and psychological changes, primarily insomnia (72%), affected 90% of patients. Cutaneous changes and muscle loss affected 70% of patients, with frequent impairment of physical autonomy (p= 0.007) associated with this event. Metabolic issues, especially weight gain (40%) and diabetes mellitus (20%), affected 49% of patients. Conversely, vision troubles and bone fractures were mentioned by 42% and 9% of patients, respectively, and more frequently in patients who received GCs for >18 months (p= 0.01 and p= 0.007, respectively). Cardiovascular changes and infections affected 30% and 26% of patients, respectively. Conclusion This real-life study of GC tolerance assessed using a self-evaluation provides pragmatic and updated data reminding us that GC tolerance remains more noteworthy than ever. This study suggests carefully monitoring GC-related AEs during follow-up and encourages GC-sparing strategies in some patients.
Little is known about the impact of giant cell arteritis (GCA) and its treatment on patient-reported physical, mental, and psychic quality of life (QoL). In this monocentric study, a questionnaire was sent to the 100 last patients diagnosed with GCA and followed-up in a single tertiary center. Their physical, mental and psychic status were self-assessed via close-ended questions, the 12-item short form survey (SF-12) and the 15-item geriatric depression scale (GDS). We aimed to identify parameters that were significantly associated with moderate-to-severe disability in both physical and mental domains. Ninety patients were analyzable. Moderate to severe physical disability was found in 41 (46%) patients. In multivariate analysis, walking difficulties (OR, 95% CI 8.42 [2.98–26.82], p <0.0001), muscle mass and strength reduction (OR, 95% CI 4.38 [1.37–16.31], p = 0.01) and age >80 (OR, 95% CI 4.21 [1.44–13.61], p = 0.008) were independent findings associated with moderate to severe physical disability. Moderate to severe mental disability was found in 30 (33%) patients. In multivariate analysis, depressive mood (OR, 95% CI 11.05 [3.78–37.11], p < 0.0001), felt adverse events attributable to glucocorticoids (OR, 95% CI 10.54 [1.65–213.1], p = 0.01) and use of immune-suppressants (OR, 95% CI 3.50 [1.14–11.87], p = 0.03) were independent findings associated with moderate to severe mental disability. There was a statistically significant negative correlation between GDS and the physical and/or mental disability scores (GDS and PCS-12: r = −0.33, p = 0.0013; GDS and MCS-12: r = −0.36, p = 0.0005). In conclusion, this study identified via a self-assessment of patients with GCA some medical and modifiable findings that significantly affect their physical and mental quality of life. A better knowledge of these factors may help improve the care of GCA patients.
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