It may be possible to predict the relapse of giant cell arteritis after tapering glucocorticoids via the presence of higher levels of markers of systemic inflammation at the time of diagnosis, according to recently presented data.
Researchers studied 70 patients with newly diagnosed giant cell arteritis (GCA) between Sept. 1, 2011 and Sept. 30, 2014. Patients were a median age of 73.3 years with a symptom duration of 30 days and 71.6% of the patients were women. Patients were followed for a median of 102 weeks with laboratory tests collected at 12, 24, 48, 96 and up to 144 weeks after diagnosis. All patients included completed follow-up visits at 6 months.
Patients with uncomplicated GCA were treated with 32 mg to 48 mg of daily, oral methylprednisolone while patients with ischemic complications or large vessel disease received an initial treatment of 250 mg IV methylprednisolone for three consecutive days. Tapering began 2 weeks to 4 weeks after initiation to 4 mg methylprednisolone daily for at least 1.5 years. Patients who relapsed during treatment had dosage adjustments as needed and/or the addition of 20 mg daily leflunomide or weekly methotrexate.
During the observation period, 32 patients relapsed and one patient experienced two relapse episodes.
Patients who experienced relapse had higher baseline erythrocyte sedimentation rates and C-reactive protein, serum amyloid A, haptoglobin and fibrinogen levels compared to patients with GCA who did not relapse after tapering methylprednisolone. Disease duration prior to treatment, large vessel disease, dosing regimen and anemia were not predictive of relapse. – by Shirley Pulawski
Hocevar A, et al. Paper #1969. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.