Predictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study

被引:119
|
作者
Labarca, Cristian [1 ]
Koster, Matthew J. [2 ]
Crowson, Cynthia S. [2 ,3 ]
Makol, Ashima [2 ]
Ytterberg, Steven R. [2 ]
Matteson, Eric L. [2 ,4 ]
Warrington, Kenneth J. [2 ]
机构
[1] Univ Desarrollo, Clin Alemana Santiago, Dept Internal Med, Santiago, Chile
[2] Mayo Clin, Dept Med, Div Rheumatol, 200 First St SW, Rochester, MN 55905 USA
[3] Mayo Clin, Dept Hlth Sci Res, Div Biostat, Rochester, MN 55905 USA
[4] Mayo Clin, Dept Hlth Sci Res, Div Epidemiol, Rochester, MN 55905 USA
关键词
giant cell arteritis; cohort; retrospective; relapse; glucocorticoids; adverse events; diabetes; hypertension; SYSTEMIC INFLAMMATORY RESPONSE; LARGE-VESSEL VASCULITIS; TEMPORAL ARTERITIS; POLYMYALGIA-RHEUMATICA; RISK-FACTORS; CORTICOSTEROID TREATMENT; PROGNOSTIC-FACTORS; CONTROLLED-TRIAL; DOUBLE-BLIND; DISEASE;
D O I
10.1093/rheumatology/kev348
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. To evaluate characteristics of relapse, relapse rates, treatment and outcomes among patients with biopsy-proven GCA in a large, single-institution cohort. Methods. We conducted a retrospective review of all patients with biopsy-proven GCA from 1998 to 2013. Demographic, clinical, laboratory and treatment data at presentation and during follow-up were collected. Comparisons by relapse rate were performed using chi-square tests. Prednisone discontinuation by initial oral dose <= 40 and>40 mg/day was compared using Cox models. Results. The cohort included 286 patients [74% female, mean age at diagnosis 75.0 years (S.D. 7.6), median follow-up 5.1 years). During follow-up, 73 patients did not relapse, 80 patients had one relapse and 133 had two or more relapses. The first relapse occurred during the first year in 50% of patients, by 2 years in 68% and by 5 years in 79%. More patients with established hypertension (P = 0.007) and diabetes (P = 0.039) at GCA diagnosis were in the high relapse rate group (>= 0.5 relapses/year) and more females were in the low or high relapse groups than in the no relapse group (P = 0.034). Patients receiving an initial oral prednisone dose> 40 mg/day were able to reach a dose of< 5 mg/day [hazard ratio (HR) 1.46 (95% CI 1.09, 1.96)] and discontinue prednisone [HR 1.56 (95% CI 1.09, 2.23)] sooner than patients receiving <= 40 mg/day without an increase in observed glucocorticoid-associated adverse events. Conclusion. Females and patients with hypertension or diabetes at GCA diagnosis have more relapses during follow-up. Patients treated with an initial oral prednisone dose >40 mg/day achieved earlier prednisone discontinuation.
引用
收藏
页码:347 / 356
页数:10
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