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.
Glucocorticoid Therapy in Giant Cell Arteritis: Duration and Predictors for Long-Lasting Remission.
Estrada, Paula, Narvaez, Javier, Lopez Vives, Laura, Gomez Vaquero, Carmen, Miquel Nolla, Joan
To analyze the clinical course and duration of glucocorticoid (GC) therapy in a series of patients with giant cell arteritis (GCA), identifying those predictors for the achievement of a long-lasting remission.
Retrospective follow-up study of an unselected population of 140 patients with GCA diagnosed in 1 center between 1986 and 2008. The end-point of patient follow-up was the date of the last clinic visit or the date of death. Long-lasting remission was recorded as the date of permanent discontinuation of treatment without recurrence of symptoms for at least 1 year.
Possible correlations between the duration of therapy and demographic, clinical, laboratory and treatment variables were explored. Multivariate regression analysis were used to identify variables associated with the achievement of long-lasting remission.
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. The median follow-up duration after diagnosis was 36.6 months (range, 12.5 to 180).
All patients were treated with GCs and responded rapidly (mean initial dosage of prednisone: 50.1 ± 13.7 mg/day). The dosage was later reduced according to the treating physicians' judgment. The median duration required to achieve a maintenance dose of less than 10 mg prednisone/day was 8.5 months. Relapses or recurrences occurred in 82 (52.6%) patients, with a mean of 2.7 ± 1.7 relapses per patient.
In 60 (42.8%) patients, GCs were discontinued and permanent remission achieved after a median of 26.7 months of treatment, with a range of 13 to 90 months. The median cumulative dose of prednisone taken by these patients was 8.51 gm. Only in 33.3% (20/60) of these patients GCs could be withdrawn within the first 2 years of treatment. This percentage increased to 73% (33/60) at 3 years, 81.6% (49/69) at 4 years, and 88.3% (53/60) at 5 years, with only 11.6% (7/60) of the patients requiring therapy for more than 5 years.
At the time of last follow-up, 80 (57.2%) of the 140 patients were still taking GCs with a median treatment duration of 36 months; in 50% of these patients the duration of treatment was longer than 3 years.
A significant correlation was found between the duration of therapy and (1) diagnostic delay (r=0.240; p=0.004), (2) age at disease onset (r =-0.237; p = 0.004), (3) the value of pre-treatment erythrocyte sedimentation rate (r=0.154; p=0.047), and (4) total dose of prednisone (r=0.824; p=<0.0001). In the multivariate analysis, the only variables associated with the achievement of long-lasting remission were the age at disease onset (OR=0.93, 95% CI: 0.87, 1.00) and the cumulative dose of prednisone (OR=0.85, 95% CI: 0.77, 0.95)
Results of the currtent study show that it is rare to stop steroid therapy before at least 2 years of treatment (only achieved in 14% of the patients). In the majority of cases the disease follows a protracted course requiring long-term treatment with GCs, with a subset of patients who need low dose prednisone indefinitely. Some baseline parameters can help to identify those patients at high risk for prolonged steroid use.
To cite this abstract, please use the following information:
Estrada, Paula, Narvaez, Javier, Lopez Vives, Laura, Gomez Vaquero, Carmen, Miquel Nolla, Joan; Glucocorticoid Therapy in Giant Cell Arteritis: Duration and Predictors for Long-Lasting Remission. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1299