Relapses in patients with giant cell arteritis: prevalence, characteristics, and associated clinical findings in a longitudinally followed cohort of 106 patients.
Relapses in patients with giant cell arteritis: prevalence, characteristics, and associated clinical findings in a longitudinally followed cohort of 106 patients.
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DOI：
10.1097/md.0000000000000033
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发表时间：
2014-07
期刊：
影响因子：
1.6
通讯作者：
Cid MC
中科院分区：
文献类型：
--
作者：
Alba MA;García-Martínez A;Prieto-González S;Tavera-Bahillo I;Corbera-Bellalta M;Planas-Rigol E;Espígol-Frigolé G;Butjosa M;Hernández-Rodríguez J;Cid MC
巨细胞动脉炎（GCA）是一种复发性疾病。然而，复发的性质，时间顺序，治疗效果和临床后果几乎没有得到解决。本研究旨在调查GCA患者复发的患病率、时间和特征，并分析复发过程是否与疾病相关并发症、糖皮质激素（GC）剂量增加和GC相关不良反应相关。研究队列包括106例患者，作者纵向随访7.8 ± 3.3年。 复发定义为需要调整治疗的疾病相关症状复发。复发分为4类：风湿性多肌痛（PMR）、颅骨症状（包括缺血性并发症）、全身性疾病或症状性大血管受累。记录治疗第一年的累积GC剂量，达到维持泼尼松剂量<10 mg/d（T10），<5 mg/d（T5）或完全停用泼尼松（T0）所需的时间，以及GC相关的副作用。 68例患者（64%）至少复发1次，38例（36%）复发2次或以上。第一次复发包括PMR在51%，颅症状在31%，全身投诉在18%。复发主要出现在治疗的前2年内，但不限于此，只有1例患者出现视力丧失。复发患者的T10、T5和T0显著长于未复发患者（中位数分别为40 vs 27 wk，p <0.0001; 163 vs 89.5 wk，p = 0.004; 340 vs 190 wk，p = 0.001）。 复发患者第一年的累积泼尼松剂量显著较高（6.2 ± 1.7 g vs 5.4 ± 0.78 g，p = 0.015）。 骨质疏松症在复发患者中比未复发患者更常见（65% vs 32%，p = 0.001）。 总之，本研究的结果提供的证据表明，复发过程与更高和更长的GC需求和更高的频率骨质疏松症的GCA。
Giant cell arteritis (GCA) is a relapsing disease. However, the nature, chronology, therapeutic impact, and clinical consequences of relapses have been scarcely addressed. We conducted the present study to investigate the prevalence, timing, and characteristics of relapses in patients with GCA and to analyze whether a relapsing course is associated with disease-related complications, increased glucocorticoid (GC) doses, and GC-related adverse effects. The study cohort included 106 patients, longitudinally followed by the authors for 7.8 ± 3.3 years. Relapses were defined as reappearance of disease-related symptoms requiring treatment adjustment. Relapses were classified into 4 categories: polymyalgia rheumatica (PMR), cranial symptoms (including ischemic complications), systemic disease, or symptomatic large vessel involvement. Cumulated GC dose during the first year of treatment, time required to achieve a maintenance prednisone dose <10 mg/d (T10), <5 mg/d (T5), or complete prednisone discontinuation (T0), and GC-related side effects were recorded. Sixty-eight patients (64%) experienced at least 1 relapse, and 38 (36%) experienced 2 or more. First relapse consisted of PMR in 51%, cranial symptoms in 31%, and systemic complaints in 18%. Relapses appeared predominantly, but not exclusively, within the first 2 years of treatment, and only 1 patient developed visual loss. T10, T5, and T0 were significantly longer in patients with relapses than in patients without relapse (median, 40 vs 27 wk, p < 0.0001; 163 vs 89.5 wk, p = 0.004; and 340 vs 190 wk, p = 0.001, respectively). Cumulated prednisone dose during the first year was significantly higher in relapsing patients (6.2 ± 1.7 g vs 5.4 ± 0.78 g, p = 0.015). Osteoporosis was more common in patients with relapses compared to those without (65% vs 32%, p = 0.001). In conclusion, the results of the present study provide evidence that a relapsing course is associated with higher and prolonged GC requirements and a higher frequency of osteoporosis in GCA.