RT Journal Article
SR Electronic
T1 Disease Relapses among Patients with Giant Cell Arteritis: A Prospective, Longitudinal Cohort Study
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.141347
DO 10.3899/jrheum.141347
A1 Tanaz A.  Kermani
A1 Kenneth J.  Warrington
A1 David Cuthbertson
A1 Simon Carette
A1 Gary S.  Hoffman
A1 Nader A.  Khalidi
A1 Curry L.  Koening
A1 Carol A.  Langford
A1 Kathleen Maksimowicz-McKinnon
A1 Carol A.  McAlear
A1 Paul A.  Monach
A1 Philip Seo
A1 Peter A.  Merkel
A1 Steven R.  Ytterberg
YR 2015
UL http://www.jrheum.org/content/early/2015/04/09/jrheum.141347.abstract
AB Objective To evaluate the frequency, timing, and clinical features of relapses in giant cell arteritis (GCA). Methods Patients with GCA enrolled in a prospective, multicenter, longitudinal study were included in the analysis. Relapse was defined as either new disease activity after a period of remission or worsening disease activity. Results The study included 128 subjects: 102 women (80%) and 26 men (20%). Mean ± SD age at diagnosis of GCA was 69.9 ± 8.6 years. Mean followup for the cohort was 21.4 ± 13.9 months. Median (interquartile range) duration of disease at study enrollment was 4.6 months (1.2, 16.8). During followup, 59 relapses were observed in 44 patients (34%). Ten patients (8%) experienced 2 or more relapses. The most common symptoms at relapse were headache (42%) and polymyalgia rheumatica (51%), but ischemic (some transient) manifestations (visual symptoms, tongue or jaw claudication, and/or limb claudication) occurred in 29% of relapses (12% cohort). Forty-three relapses (73%) occurred while patients were taking glucocorticoid therapy at a median (range) prednisone dose of 7.5 (0–35) mg. In 21% of relapses, both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal. Among 69 patients enrolled in the cohort with newly diagnosed disease, 24% experienced a first relapse within 12 months after diagnosis. Conclusion Among patients with GCA, relapses are common, often occurring during treatment. ESR and CRP are frequently normal at times of clinical relapse, highlighting the need for better biomarkers to assess disease activity in GCA. There remains a need for effective therapeutic alternatives to glucocorticoids in GCA.