Anael Dumont1,2, Jean-Jacques Parienti1,2, Claire Delmas1,2, Jonathan Boutemy1,2, Gwénola Maigné1,2, Nicolas Martin Silva1,2, Audrey Sultan1,2, Gaétane Planchard1,2, Achille Aouba1,2, Hubert de Boysson3,4. 1. From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France. 2. A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital. 3. From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France. deboysson-h@chu-caen.fr. 4. A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital. deboysson-h@chu-caen.fr.
Abstract
OBJECTIVE: To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant cell arteritis (GCA). METHODS: We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses. RESULTS: The 326 patients (73% women) were followed up for 62 (12-262) months. During followup, 171 (52%) patients relapsed, including 113 (35%) who developed GC dependence. Relapsing patients had less history of stroke (p = 0.01) and presented large-vessel vasculitis (LVV) more frequently on imaging (p = 0.01) than patients without relapse. During the first months, therapeutic strategy did not differ among relapsing and nonrelapsing patients. GC-dependent patients were less likely to have a history of stroke (p = 0.004) and presented LVV on imaging more frequently (p = 0.005) than patients without GC-dependent disease. In multivariable analyses, LVV was an independent predictive factor of relapse (HR 1.49, 95% CI 1.002-2.12; p = 0.04) and GC dependence (OR 2.19, 95% CI 1.19-4.05; p = 0.01). Conversely, stroke was a protective factor against relapse (HR 0.21, 95% CI 0.03-0.68; p = 0.005) and GC-dependent disease (OR 0.10, 95% CI 0.001-0.31; p = 0.0005). Patients with a GC-dependent disease who received a GC-sparing agent had a shorter GC treatment duration than those without (p = 0.008). CONCLUSION: In this study, LVV was an independent predictor of relapse and GC dependence. Further prospective studies are needed to confirm these findings and to determine whether patients with LVV require a different treatment approach.
OBJECTIVE: To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant cell arteritis (GCA). METHODS: We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses. RESULTS: The 326 patients (73% women) were followed up for 62 (12-262) months. During followup, 171 (52%) patients relapsed, including 113 (35%) who developed GC dependence. Relapsing patients had less history of stroke (p = 0.01) and presented large-vessel vasculitis (LVV) more frequently on imaging (p = 0.01) than patients without relapse. During the first months, therapeutic strategy did not differ among relapsing and nonrelapsing patients. GC-dependent patients were less likely to have a history of stroke (p = 0.004) and presented LVV on imaging more frequently (p = 0.005) than patients without GC-dependent disease. In multivariable analyses, LVV was an independent predictive factor of relapse (HR 1.49, 95% CI 1.002-2.12; p = 0.04) and GC dependence (OR 2.19, 95% CI 1.19-4.05; p = 0.01). Conversely, stroke was a protective factor against relapse (HR 0.21, 95% CI 0.03-0.68; p = 0.005) and GC-dependent disease (OR 0.10, 95% CI 0.001-0.31; p = 0.0005). Patients with a GC-dependent disease who received a GC-sparing agent had a shorter GC treatment duration than those without (p = 0.008). CONCLUSION: In this study, LVV was an independent predictor of relapse and GC dependence. Further prospective studies are needed to confirm these findings and to determine whether patients with LVV require a different treatment approach.
Authors: Fugang Chen; Yang Li; Hongyan Zhou; Chuang Sun; Sun Li; Lu Wang; Xin Li; Xiaoqiang Liu Journal: Biomed Res Int Date: 2021-04-09 Impact factor: 3.411
Authors: Paul Castan; Anael Dumont; Samuel Deshayes; Jonathan Boutemy; Nicolas Martin Silva; Gwénola Maigné; Alexandre Nguyen; Sophie Gallou; Audrey Sultan; Achille Aouba; Hubert de Boysson Journal: J Clin Med Date: 2022-02-16 Impact factor: 4.241