Clinical rheumatology · 2025
Characteristics of patients with major relapse in giant cell arteritis: a multicenter case-control study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Rubinsztajn Alice, Parreau Simon, Sailler Laurent, de Boysson Hubert, Espitia Olivier, Sève Pascal, Hot Arnaud, Perard Laurent, Lega Jean-Christophe, Mainbourg Sabine, and the French Large Vessel Arteritis Study Group (GEFA)
Аннотация
OBJECTIVES: The objective was to identify predictive factors for major relapses (MR) in patients with giant cell arteritis (GCA) and to compare clinical characteristics between MR phenotypes.
METHOD: This multicenter retrospective case-control study included patients fulfilling GiaCTA criteria for GCA. Cases were patients experiencing MR according to 2018 EULAR definitions. Controls were GCA patients without MR with a 1:3 ratio. Data were collected and analyzed using univariate and multivariate logistic regression to determine factors independently associated with MR. MR was subclassified into cranial-MR and large-vessel-MR which were compared using appropriate statistical tests.
RESULTS: 258 patients were included, 70 cases and 188 controls (48.4% minor relapse, and 24.4% without relapse). The mean age at diagnosis was 72.5 ± 8.6 years, 70,9% were females. Younger age at diagnosis was associated with an increased risk of MR (OR = 0.93 per 10 years, 95% CI [0.87; 0.999], p = 0.043). No other clinically significant risk factors were identified. Among the 70 cases, 48.6% had a cranial-MR and 51.4% a large-vessel-MR. Patients with a cranial-MR were older (74.3 ± 6.3 years vs. 67.3 ± 7.0 years, p < 0.001) and were more likely to have cranial symptoms at diagnosis of GCA (91.2% vs. 69.4%, p = 0.023) compared to those with a large-vessel-MR. Compared with cranial-MR, large-vessel MR was more frequent in women (80.5% vs. 52.9%, p < 0.01) and tended to be associated with aortitis at diagnosis (70.0% vs. 43.5%, p = 0.052).
CONCLUSIONS: Younger age at diagnosis was the only independent predictor of MR. Relapse patterns mirrored initial disease phenotype, supporting the existence of cranial and large-vessel GCA subtypes. Key Points •Younger age at diagnosis is associated with a higher risk of major relapse in giant cell arteritis. •Cranial and large-vessel major relapses display distinct clinical patterns, often mirroring the initial disease phenotype. •No strong laboratory or imaging predictor of major relapse was identified in this multicentre case-control study.
METHOD: This multicenter retrospective case-control study included patients fulfilling GiaCTA criteria for GCA. Cases were patients experiencing MR according to 2018 EULAR definitions. Controls were GCA patients without MR with a 1:3 ratio. Data were collected and analyzed using univariate and multivariate logistic regression to determine factors independently associated with MR. MR was subclassified into cranial-MR and large-vessel-MR which were compared using appropriate statistical tests.
RESULTS: 258 patients were included, 70 cases and 188 controls (48.4% minor relapse, and 24.4% without relapse). The mean age at diagnosis was 72.5 ± 8.6 years, 70,9% were females. Younger age at diagnosis was associated with an increased risk of MR (OR = 0.93 per 10 years, 95% CI [0.87; 0.999], p = 0.043). No other clinically significant risk factors were identified. Among the 70 cases, 48.6% had a cranial-MR and 51.4% a large-vessel-MR. Patients with a cranial-MR were older (74.3 ± 6.3 years vs. 67.3 ± 7.0 years, p < 0.001) and were more likely to have cranial symptoms at diagnosis of GCA (91.2% vs. 69.4%, p = 0.023) compared to those with a large-vessel-MR. Compared with cranial-MR, large-vessel MR was more frequent in women (80.5% vs. 52.9%, p < 0.01) and tended to be associated with aortitis at diagnosis (70.0% vs. 43.5%, p = 0.052).
CONCLUSIONS: Younger age at diagnosis was the only independent predictor of MR. Relapse patterns mirrored initial disease phenotype, supporting the existence of cranial and large-vessel GCA subtypes. Key Points •Younger age at diagnosis is associated with a higher risk of major relapse in giant cell arteritis. •Cranial and large-vessel major relapses display distinct clinical patterns, often mirroring the initial disease phenotype. •No strong laboratory or imaging predictor of major relapse was identified in this multicentre case-control study.