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 follow-up, 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 non-relapsing patients. GC-dependent patients less likely had 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 [Hazards Ratio (HR) = 1.49 (95% IC 1.002—2.12), p=0.04] and GC dependence [Odds Ratio (OR) = 2.19 (95% IC 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 determine if patients with LVV require a different treatment approach.