Relapses and Recurrences in Giant Cell Arteritis

Abstract

We conducted the present study to determine the incidence of disease flares (relapses and recurrences) in a series of patients with biopsy-proven giant cell arteritis (GCA). We assessed a series of 174 patients who were diagnosed with biopsy-proven GCA, uniformly treated, and followed at the rheumatology division of Hospital Xeral-Calde (Lugo, Spain), the single rheumatology division for a well-defined population. All of them were followed for at least 1 year after the disease diagnosis. Seventy-one (40.8%) experienced relapses or recurrences of the disease. Patients who had relapses or recurrences did not show clinical differences when compared with the remaining biopsy-proven GCA patients. However, the total duration of corticosteroid therapy was significantly longer in those patients who had relapses or recurrences of the disease. The median dose of prednisone and the median duration of corticosteroid treatment at the time of the first relapse were 5 mg/d and 16 months, respectively. Headache (52%) was the most common feature at the time of the first relapse. Polymyalgia rheumatica manifestations occurred in 30% of the patients at that time. However, none of them developed visual loss. Thirty-two patients experienced recurrences of the disease when prednisone dose had been discontinued. The median time from the disease diagnosis to the time of the recurrence was 23 months. The presence of anemia (hemoglobin <12 g/dL) at the time of disease diagnosis was the best predictor of relapses or recurrences of GCA (odds ratio, 2.17; 95% confidence interval, 1.02-4.62; p = 0.04). The results from the present study confirm that relapses and recurrences are frequent in homogenously treated patients with biopsy-proven GCA. A chronic inflammatory response manifested by anemia at the time of disease diagnosis may predict the development of disease flares.

Disease Relapses among Patients with Giant Cell Arteritis: A Prospective, Longitudinal Cohort Study

“…In retrospective studies, at least 1 disease relapse was reported in 28% to 62% of patients 2,3,5,7,8 . Of the 3 prospective observational studies to date evaluating relapses in GCA, relapses were reported in 36% (21 of 58), 60% (15 of 25), and 68% (68 of 106) of patients 4,6,9 .…”

“…While symptoms respond to therapy, relapses are common 2,3,4,5,6,7,8,9 . Further, in a single autopsy series, nearly all patients with GCA were noted to have changes of active arteritis even though the disease was thought to be clinically quiescent 10 .…”

Is vascular endothelial growth factor a useful biomarker in giant cell arteritis?

“…Despite early treatment with high-dose glucocorticoids, 34-79% relapse. [31][32][33][34] We cannot predict which patients are likely to relapse; identification of relapse is complicated by presentation with non-specific symptoms coupled with normal laboratory tests in up to 20%. 32 It is possible that VEGF may be a useful marker for the identification of relapsing patients, and this should be tested in future studies.…”

The Birmingham Vasculitis Activity Score as a Measure of Disease Activity in Patients with Giant Cell Arteritis

“…Previous clinical trials have used terms such as “relapses”, “recurrences”, “flares”, or “remission” to define disease activity and often take into consideration markers of inflammation (11–19). GCA is a chronic granulomatous vasculitis with observational cohorts reporting at least one disease relapse in 28–64% patients in (2–5, 7, 9, 10). While markers of inflammation such as sedimentation rate and C-reactive protein are neither sensitive nor specific in the assessment of disease activity (8, 26, 27), they are frequently used to assess disease activity in patients with GCA and may influence treatment decisions.…”