Francesco Muratore1, Luigi Boiardi1, Giovanna Restuccia1, Alberto Cavazza2, Mariagrazia Catanoso1, Pierluigi Macchioni1, Lucia Spaggiari3, Luca Cimino4, Raffaella Aldigeri5, Nicolò Pipitone1, Antonio Fontana6, Massimiliano Casali7, Stefania Croci8, Carlo Salvarani9. 1. Rheumatology Unit, Department of Specialistic Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 2. Operative Unit of Pathologic Anatomy, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 3. Department of Radiology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 4. Ophthalmology Unit, Department of Specialistic and General Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 5. Department of Medicine and Surgery, University of Parma, Parma, Italy. 6. Unit of Vascular Surgery, Department of Specialistic and General Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 7. Division of Nuclear Medicine, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 8. Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 9. Rheumatology Unit, Department of Specialistic Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy. Electronic address: salvarani.carlo@ausl.re.it.
Abstract
OBJECTIVE: To evaluate characteristics and predictors of relapses and long-term remission in an Italian cohort of patients with large-vessel (LV) giant cell arteritis (GCA). METHODS: We evaluated 87 consecutive patients with LV-GCA followed up at the Rheumatology Unit of Reggio Emilia Hospital (Italy) for at least 2 years. Patients with relapses and long-term remission were compared to those without. A group of 34 patients with biopsy proven GCA without LV vasculitis (LVV) at diagnosis was considered for comparison. PATIENTS: 37 patients (42.5%) experienced one or more relapses. Nineteen (37.2%) of the 51 relapses were experienced during the first year after diagnosis. The majority of relapses occurred with doses of prednisone (PDN) ≤ 10 mg/day (74.5%). Polymyalgia rheumatica (PMR) (41.2%) and worsening at imaging of LVV (39.2%) were the most frequently observed relapsing manifestations. The total cumulative prednisone dose was significantly higher (p < 0.0001) and the total duration of PDN treatment longer (p < 0.0001) in relapsing patients compared to those without relapses. Relapsing patients had at diagnosis more frequently fever ≥ 38°C (p = 0.03) and visual manifestations (p = 0.03), and less frequently long-term remission (p = 0.002). In the multivariate model fever ≥ 38°C (HR 2.30, 95%CI:1.11-4.78) and total cumulative PDN dose (HR 1.18, 95%CI: 1.08-1.30) were significantly associated with an increased risk of relapses, while aortic arch involvement at imaging at diagnosis (HR 0.26, 95%CI: 0.11-0.59) and long-term remission (HR 0.27, 95%CI: 0.11-0.65) with a reduced risk. 35/84 patients (41.6%) experienced long-term remission. PMR and disease relapses were less frequently observed (p = 0.04 and p = 0.002, respectively), and the total cumulative prednisone dose was lower (p < 0.001) in patients with long-term remission compared to those without. In the multivariate model the presence of relapses (HR 0.21, 95%CI: 0.07-0.62) and the total cumulative PDN dose (HR 0.85, 95%CI: 0.77-0.95) were significantly negatively associated with long-term remission. CONCLUSION: In our cohort of patients with LV GCA we identified predictors of a relapsing course and long-term remission, which were observed in around half of the patients.
OBJECTIVE: To evaluate characteristics and predictors of relapses and long-term remission in an Italian cohort of patients with large-vessel (LV) giant cell arteritis (GCA). METHODS: We evaluated 87 consecutive patients with LV-GCA followed up at the Rheumatology Unit of Reggio Emilia Hospital (Italy) for at least 2 years. Patients with relapses and long-term remission were compared to those without. A group of 34 patients with biopsy proven GCA without LV vasculitis (LVV) at diagnosis was considered for comparison. PATIENTS: 37 patients (42.5%) experienced one or more relapses. Nineteen (37.2%) of the 51 relapses were experienced during the first year after diagnosis. The majority of relapses occurred with doses of prednisone (PDN) ≤ 10 mg/day (74.5%). Polymyalgia rheumatica (PMR) (41.2%) and worsening at imaging of LVV (39.2%) were the most frequently observed relapsing manifestations. The total cumulative prednisone dose was significantly higher (p < 0.0001) and the total duration of PDN treatment longer (p < 0.0001) in relapsing patients compared to those without relapses. Relapsing patients had at diagnosis more frequently fever ≥ 38°C (p = 0.03) and visual manifestations (p = 0.03), and less frequently long-term remission (p = 0.002). In the multivariate model fever ≥ 38°C (HR 2.30, 95%CI:1.11-4.78) and total cumulative PDN dose (HR 1.18, 95%CI: 1.08-1.30) were significantly associated with an increased risk of relapses, while aortic arch involvement at imaging at diagnosis (HR 0.26, 95%CI: 0.11-0.59) and long-term remission (HR 0.27, 95%CI: 0.11-0.65) with a reduced risk. 35/84 patients (41.6%) experienced long-term remission. PMR and disease relapses were less frequently observed (p = 0.04 and p = 0.002, respectively), and the total cumulative prednisone dose was lower (p < 0.001) in patients with long-term remission compared to those without. In the multivariate model the presence of relapses (HR 0.21, 95%CI: 0.07-0.62) and the total cumulative PDN dose (HR 0.85, 95%CI: 0.77-0.95) were significantly negatively associated with long-term remission. CONCLUSION: In our cohort of patients with LV GCA we identified predictors of a relapsing course and long-term remission, which were observed in around half of the patients.
Authors: John H Stone; Helen Spotswood; Sebastian H Unizony; Martin Aringer; Daniel Blockmans; Elisabeth Brouwer; Maria C Cid; Bhaskar Dasgupta; Juergen Rech; Carlo Salvarani; Robert Spiera; Min Bao Journal: Rheumatology (Oxford) Date: 2022-07-06 Impact factor: 7.046
Authors: Maria C Cid; Sebastian H Unizony; Daniel Blockmans; Elisabeth Brouwer; Lorenzo Dagna; Bhaskar Dasgupta; Bernhard Hellmich; Eamonn Molloy; Carlo Salvarani; Bruce C Trapnell; Kenneth J Warrington; Ian Wicks; Manoj Samant; Teresa Zhou; Lara Pupim; John F Paolini Journal: Ann Rheum Dis Date: 2022-03-09 Impact factor: 19.103