Disease relapses among patients with giant cell arteritis: A prospective, longitudinal cohort study

Tanaz A. Kermani, Kenneth J Warrington, David Cuthbertson, Simon Carette, Gary S. Hoffman, Nader A. Khalidi, Curry L. Koening, Carol A. Langford, Kathleen Maksimowicz-McKinnon, Carol A. McAlear, Paul A. Monach, Philip Seo, Peter A. Merkel, Steven R Ytterberg

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1213-1217
Number of pages5
JournalJournal of Rheumatology
Volume42
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Giant Cell Arteritis
Longitudinal Studies
Cohort Studies
Recurrence
Blood Sedimentation
C-Reactive Protein
Glucocorticoids
Polymyalgia Rheumatica
Prednisone
Jaw
Tongue
Multicenter Studies
Headache
Therapeutics
Extremities
Biomarkers

Keywords

  • Cohort study
  • Disease activity
  • Giant cell arteritis
  • Relapses

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

Disease relapses among patients with giant cell arteritis : A prospective, longitudinal cohort study. / Kermani, Tanaz A.; Warrington, Kenneth J; Cuthbertson, David; Carette, Simon; Hoffman, Gary S.; Khalidi, Nader A.; Koening, Curry L.; Langford, Carol A.; Maksimowicz-McKinnon, Kathleen; McAlear, Carol A.; Monach, Paul A.; Seo, Philip; Merkel, Peter A.; Ytterberg, Steven R.

In: Journal of Rheumatology, Vol. 42, No. 7, 01.07.2015, p. 1213-1217.

Research output: Contribution to journalArticle

Kermani, TA, Warrington, KJ, Cuthbertson, D, Carette, S, Hoffman, GS, Khalidi, NA, Koening, CL, Langford, CA, Maksimowicz-McKinnon, K, McAlear, CA, Monach, PA, Seo, P, Merkel, PA & Ytterberg, SR 2015, 'Disease relapses among patients with giant cell arteritis: A prospective, longitudinal cohort study', Journal of Rheumatology, vol. 42, no. 7, pp. 1213-1217. https://doi.org/10.3899/jrheum.141347
Kermani, Tanaz A. ; Warrington, Kenneth J ; Cuthbertson, David ; Carette, Simon ; Hoffman, Gary S. ; Khalidi, Nader A. ; Koening, Curry L. ; Langford, Carol A. ; Maksimowicz-McKinnon, Kathleen ; McAlear, Carol A. ; Monach, Paul A. ; Seo, Philip ; Merkel, Peter A. ; Ytterberg, Steven R. / Disease relapses among patients with giant cell arteritis : A prospective, longitudinal cohort study. In: Journal of Rheumatology. 2015 ; Vol. 42, No. 7. pp. 1213-1217.
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abstract = "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.",
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AU - Cuthbertson, David

AU - Carette, Simon

AU - Hoffman, Gary S.

AU - Khalidi, Nader A.

AU - Koening, Curry L.

AU - Langford, Carol A.

AU - Maksimowicz-McKinnon, Kathleen

AU - McAlear, Carol A.

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N2 - 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.

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