Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Adverse Outcomes of Glucocorticoid Therapy among Patients with Giant Cell Arteritis.

Lopez Vives,  Laura, Narvaez,  Javier, Estrada,  Paula, Gomez Vaquero,  Carmen, Miquel Nolla,  Joan

Background:

Glucocorticoids (GC) are currently the only agents in giant cell arteritis (GCA) with proven efficacy. Two studies have demonstrated that GC therapy carries an important long-term morbidity, with an incidence of GC adverse events ranging from 58% to 86% of the patients1,2.

Purpose. To evaluate the incidence and risks of adverse events associated with GC therapy in a series of patients with GCA diagnosed in an area of north-eastern Spain over a 23-year period.

Methods:

Retrospective follow-up study of an unselected population of 140 patients with GCA diagnosed in 1 center between 1986 and 2008. Medical records of these patients were reviewed, and clinical variables, GC doses, and GC adverse events on each patient were recorded. Multivariate regression analysis were were used to identify variables associated with the development of adverse events.

Results:

The series included 94 women and 46 men with a mean age at time of diagnosis of 75 ± 7 years (range, 56 to 92). TAB was positive in 112 (80 %) patients. For the total sample the mean duration of therapy after diagnosis was 41.6 months (range, 12.5 to 180) and the total median dose of prednisone was 10.2 gm.

Adverse events associated with GCs were recorded in 89 (63.6%) patients and 2 or more events occurred in 51 patients (36.4%). The main adverse events and their frequency are presented in the following table:

Major adverse events that occurred in 89 of 140 patients with GCA

Type of adverse eventPatients with the event, number (%)
Diabetes mellitus22 (15.7%)
Hypertension41 (29.2%)
Hypelipemia49 (35%)
Total osteoporotic fractures27 (19.3%)
  Symptomatic vertebral fracture15 (10.7%)
  Hip fracture7 (5%)
  Colies' fracture3 (2.1%)
  Insufficiency fracture of the pelvis2 (1.4%)
Osteonecrosis2 (1.4%)
Posterior suboapsular cataract30 (21.4%)
Glucocorticoid-induced myopathy3 (2.1%)
Gastrointestinal bleeding2 (1.4%)
Severe or opportunistic infections25 (17.9%)

Among those patients experiencing and adverse event, the median duration of therapy was 48.7 months (range, 2 to 180), the total median dose of prednisone was 11.6 gm, and the average daily dose was 9.5 gm. The median time from initiation of therapy to the first adverse event was 8.5 months. In the multivariate analysis, only higher cumulative dose of prednisone (odds ratio = 1.17, 95% confidence interval: 1.05, 1.30) was associated with the development of adverse GC side effects

Conclusion:

The incidence of GC adverse events in patients with GCA is high, occurring at least in 63.6% of cases; being this percentage close to that observed in other populations. Adverse events may occur even in low-dose therapy and appear to be dose and duration dependent. Osteoporotic bone fractures and infections were as frequent as cardiovascular adverse events.

References:

1.Proven, Aet al. Arthritis Rheum 2003;49:703–8.

2.Nesher, Get al. J Rheumatol 1994;21:1283–6.

To cite this abstract, please use the following information:
Lopez Vives, Laura, Narvaez, Javier, Estrada, Paula, Gomez Vaquero, Carmen, Miquel Nolla, Joan; Adverse Outcomes of Glucocorticoid Therapy among Patients with Giant Cell Arteritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1277
DOI: 10.1002/art.29043

Abstract Supplement

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